The Circumcision Procedure: What To Expect When Baby Gets Circumcised
If your baby is a boy, you'll need to determine if he'll have a circumcision procedure. Knowing the latest health information can help you make an informed choice.
A little less than two-thirds of baby boys are circumcised in America, according to the Centers for Disease Control and Prevention (CDC). The procedure involves surgically removing the foreskin of the penis to expose the tip. Circumcision has many proven benefits, including a decreased risk of urinary tract infections, penile cancer, and HIV/AIDS transmission, says Vanessa Elliott, M.D., a urologist at UCP Urology of Central PA, Inc. But it also comes with potential side effects—the most common of which are bleeding and infection.
In a 2012 task force report, the American Academy of Pediatrics (AAP) determined that the medical benefits of circumcision outweigh the risks. However, the AAP doesn’t routinely recommend it, and instead says that parents should make the decision based on religious, cultural, and ethical concerns. Here’s everything you need to know about the circumcision procedure, from necessary preparations to the recovery process.
Preparing for Newborn Circumcision
Ideally, you should decide about circumcision before your child is born, so you'll have time to find a practitioner you trust and consider whether you want to be in the room when it takes place. You should also inquire about pain relief options.
“Many hospitals have adopted policies that support the use of analgesia during circumcision," says Carole M. Lannon, M.D., co-director of the Center for Children's Healthcare Improvement. If your physician does not use pain relief for circumcision (usually in the form of a topical cream or lidocaine injection), the AAP strongly recommends that parents request it to spare their sons from unnecessary discomfort.
When a circumcision is part of the Jewish ritual called a bris, it’s is usually performed at home when the baby is eight days old. Jewish parents should seek out a mohel who is also a medical doctor. In the hospital, male circumcision is most commonly done on newborns about 24 hours old—usually by the physician on call, your Ob-Gyn, a pediatrician, or family doctor of your choice. The entire procedure only takes 10 or 15 minutes.
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The Circumcision Procedure: What to Expect
The infant is placed on a firm surface, and Velcro straps are wrapped around the boy's arms and legs to keep him very still. A nurse may also hold him during the circumcision.
The performing doctor will clean the penis and probably administer some type of analgesia, which is typically a lidocaine injection or topical ointment. Next, a sterile circumcision clamp or device is placed over the head of the penis, and the foreskin is removed with a scalpel or scissors. Although your baby may cry, Dr. Elliot said he’ll experience little distress during the procedure.
There are three main types of circumcision instruments: the Gomco clamp, the Mogen clamp, and the Plastibell device. Your doctor can determine the right circumcision surgery method for your newborn.
Gomco Clamp: Circumcision with the Gomco clamp is the most common type in America. First, doctors separate the foreskin from penis head with a probe. A bell-shaped device is inserted underneath the foreskin, covering the head of the penis. Doctors then pull the foreskin over the bell and tighten the clamp, which crushes the foreskin to stop blood flow. Doctors cut the foreskin with a scalpel, and they leave the clamp on the penis for five minutes so blood can clot.
Mogen Clamp: After the foreskin is separated with a probe, it's stretched over the tip of the penis head. Doctors then put the foreskin into a metal clamp and cut it with a scalpel.
The Plastibell Technique: To start, doctors separate the foreskin from the penis head. Then they insert a plastic ring under the foreskin and tie a piece of sterile string around it. This halts blood supply to the foreskin. Doctors leave the plastic ring on the penis, and it comes off naturally (along with excess foreskin) within 7-10 days.
Caring for a Circumcised Penis
The doctor or mohel will give you instructions on how to clean and care for the wound. A little yellow discharge or coating around the head of the penis is normal but should not last more than a week.
If there is gauze on the wound, change it with each diapering to lower the risk of infection. You should clean the penis with warm water daily and after every poop. Dr. Elliot also says to apply Vaseline or an antibiotic ointment for two weeks to keep the wound from sticking to his diaper. If your baby is circumcised with the plastibell technique, he will have a protective plastic ring on the penis; don't pull it—the ring will fall off on its own after about ten days.
The tip of the penis may appear very red immediately after the procedure, and some yellow discharge or crust is normal. Phone your doctor if there is swelling, more than a few drops of blood, a black or blue bruise, or if your baby is running a fever. Also, keep an eye on your child's diaper, and call your M.D. if he doesn't urinate within eight hours or so.
The tip of a circumcised penis usually heals in about seven days. Complications occur in one to three percent of cases; mild bleeding and local infection are the two most common. A botched job can result in injury to the penis, sepsis (when an infection gets into the bloodstream), or even death, but severe complications like these are extremely rare.
How Much Does Circumcision Cost?
According to a 2011 article from The New York Times, newborn circumcisions generally cost between $200 and $400, depending on the region, hospital, and insurance policy. However, parents should note that fewer insurance companies are covering circumcision nowadays, says Ronald Gray, M.D., a professor of epidemiology at Johns Hopkins University in Baltimore. Check with your healthcare provider for more information.