What is circumcision?
Circumcision is the surgical removal of the sleeve of skin and
mucosal tissue that normally covers the glans (head) of the penis.
This double layer, sometimes called the prepuce, is more commonly
known as the foreskin.
What are the functions of the foreskin?
The foreskin serves three functions: protective, sensory, and
sexual. In most cases, the foreskin is still fused to the glans at
birth and will separate over a variable period of time over the
first few years. During the diaper period, the foreskin protects
against abrasion from diapers and faeces. Throughout life, the
foreskin keeps the glans soft and moist and protects it from
trauma and injury. Parts of the foreskin, such as the mucosa
(inner foreskin) and frenulum, are particularly sensitive and
contribute to sexual pleasure. Specialised nerve endings enhance
sexual pleasure and control. The inner foreskin (mucosa) is the
skin directly against the glans. The foreskin provides ample loose
skin for the penis to occupy when erect. It is a movable skin
sheath for the penis during intercourse, reducing chafing and the
need for artificial lubricants, and allowing the glans and
foreskin to naturally stimulate each other.
What are some reasons that circumcision is performed?
Phimosis is the inability to retract the foreskin fully. In babies
and young boys this is normal. As the baby grows older, the
foreskin separates from the underlying glans penis. In some
individuals, this separation does not happen fully or due to
repeated infection in that area the skin becomes scarred. It might
also happen later in life. When the foreskin does not retract, it
predisposes to repeated infection in that area. Also, sexual
intercourse may become painful and result in bleeding. The only
treatment at that stage is a minor operation called circumcision,
in which the foreskin is surgically removed.
Is circumcision painful?
When done without pain medicine, circumcision is painful. There
are pain medicines available that are safe and effective. It is
recommended that they be used to reduce pain from circumcision.
Local anaesthetics can be injected into the penis to lower pain
and stress in infants. There are also topical creams that can
help. Problems with using pain medicine are rare and usually not
serious.
What to expect after the procedure?
After the circumcision, the tip of the penis may seem raw or
yellowish. If there is a bandage, it should be changed with each
diapering to reduce the risk of the penis becoming infected. The
plastic ring that is left on the tip of the penis usually drops
off within five to eight days. For both newborns and older
children, circumcision is considered a very safe procedure with
complete healing expected.
What are the health benefits?
Possible benefits of circumcision include:
* Circumcision prevents infection and inflammation of the
foreskin. And it may decrease the risk of penile cancer.
* It might play a role in reducing the risk of sexually
transmitted diseases. Practicing safe sex, however, is a far more
important factor in preventing these diseases than whether a man
is circumcised.
* Infants who are not circumcised may be more likely to develop
urinary tract infections. These infections early in life may lead
to kidney problems later in life. Infants who have kidney or
bladder abnormalities are at higher risk of urinary tract
infections, so circumcision may be advised for these babies.
* In rare circumstances problems can occur with the uncircumcised
penis that may require circumcision at an older age. These
problems include inflammation of the foreskin or adherence of the
foreskin to the tip of the penis. Circumcision during infancy
eliminates the possible need for the procedure at an older age.
* Circumcision makes it easy to keep the end of the penis clean.
However, the shedding skin cells that naturally accumulate on the
glans of an uncircumcised boy are not harmful. Do not try to force
the foreskin back to clean the penis of an infant or young boy.
Washing externally with mild soap and water is all that is
necessary.
Possible risks:
Like any minor surgery, circumcision poses some risk to the
newborn:
* Circumcision may cause excessive bleeding or infection, but this
is rare.
* Circumcision does cause pain. Local anaesthesia is frequently
used. If you decide to have your son circumcised, you should to
talk to your doctor about whether local anaesthesia will be used.
* Circumcision is a preventive measure but is by no means a
guarantee that medical issues will not develop later in life at
the tip of the penis.
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