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Circumcision is the procedure for the removal of the foreskin of the penis. The surgery is carried out on newborns, children, or adults for religious or personal reasons. Some conditions may also require the removal of the foreskin, such as balanitis, phimosis, and more. In healthy newborns, it is done for cultural reasons. For instance, the religious laws of Judaism, Islam, and some ethnicities of Africa require that newborn boys be circumcised.
Circumcision Causes
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Personal preference
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Aesthetics
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Lowered risk of infections
In Judaism, the ritual circumcision is known as brit milah. It is performed either at home, in a synagogue, or at the hospital. At the synagogue, it is performed by a mohel, who has been surgically trained to perform the ritual circumcision. The procedure is carried out when the child is about eight days old.
The ritual circumcision in Islamic culture is called khitana. It is performed as a religious ceremony or at the hospital. In most Islamic countries, the khitana is performed in infancy, but it may be accomplished when a boy enters puberty.
However, the risks of not being circumcised are rare and can be prevented with proper care. Circumcision is avoided in people with bleeding disorders, premature babies, and babies born with abnormalities of the penis. Circumcision neither affects fertility nor does it enhances sexual pleasure.
When Circumcision surgery is needed?
Circumcision is done for medical and religious reasons. In Jewish and Islamic culture and some African and Australian communities, circumcision is done for religious purposes. For them, it is a matter of maintaining personal hygiene, following family tradition, or simply for preventive reasons. Sometimes, circumcision can be done for medical reasons, for example:
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Tight foreskin (it won't pull back or retract)
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Recurrent inflammation of the head of the penis
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Paraphimosis
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Swelling of the foreskin
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Phimosis, scarring, and inflammation of the head of the penis
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Penile cancer
Circumcision is known to have varied health benefits such as:
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Better hygiene: It is easier to clean and wash the penis after circumcision. However, males with uncircumcised penises need to learn to wash frequently beneath the foreskin.
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Decreased risk of urinary tract infections: The absence of foreskin can lower the chances of contracting urinary tract infections. At an early age, contracting severe infections can lead to renal disorders later in life.
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Reduced risk of sexually transmitted infections: Circumcised men might be at a lower risk of contracting sexually transmitted diseases, such as HIV and gonorrhoea. Still, practising safe sex is essential.
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Decreased risk of penile cancer
Who are the best candidates for Circumcision surgery?
Circumcision may be carried out for several reasons that include medical and non-medical purposes.
Medical reasons
Circumcision is most commonly indicated in the following conditions:
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Tight foreskin (it won't pull back or retract): A condition known as phimosis
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Recurrent balanitis: A condition in which the foreskin and head of the penis become inflamed and infected
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Paraphimosis: when the foreskin fails to return to its original position after being pulled back. This may lead to swelling and pain in the head of the penis. Prompt treatment is required to prevent any serious complications, such as reduced blood flow to the penis.
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Balanitis xerotica obliterans: causes phimosis and may scar and inflame the head of the penis
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Penile cancer
Non-Medical Reasons
Circumcision is a common practice in Jewish, African, and Islamic communities.
Who Should Not Consider Circumcision Surgery?
People with certain conditions cannot undergo the circumcision procedure. These include:
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A pre-existing medical condition that requires monitoring
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Known bleeding diathesis (e.g., haemophilia, thrombocytopenia)
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Certain disorders of the skin or connective tissue may lead to impairment of normal healing
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Informed parental consent has not been obtained.
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Premature babies
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Babies aged 12 to 24 hours
How to Prepare for Circumcision Surgery?
Circumcision is performed while newborns are still in the hospital. The procedure can be performed by paediatricians or obstetricians. Signing the consent form before getting the circumcision is essential.
For children or older adults, circumcision is an outpatient procedure. Even for them, signing a consent is mandatory. Doctors explain the associated risks and benefits of the procedure before beginning. Painkillers are prescribed to deal with the pain after the procedure.
Circumcision Diagnosis
Routine medical tests such as complete blood count, haemoglobin levels, platelet count, and urine analysis may be advised. These tests help rule out any infection. If circumcision is being carried out for cancer, then a biopsy may be taken to confirm the diagnosis. Doctors usually assess the symptoms and decide if circumcision is the right choice of treatment for medical-related circumcisions.
Circumcision Treatment
Circumcision in newborns is performed in the hospital within ten days of their birth. The procedure usually takes about 10 minutes after the anaesthesia takes effect. It can be done with the stapler technique as well. Cosmetically it's superior to the conventional method.
Newborns are made to lie on their back with their arms and legs restrained. First, the penis and the adjacent area are cleaned with an antiseptic. Then, anaesthesia is injected into the base of the penis. Next, a clamp or plastic ring is attached to the penis to remove the foreskin.
The penis is then coated with an ointment and wrapped loosely with gauze. The procedure is similar for older boys and adults.
Possible Complications of Circumcision Surgery
Circumcision most commonly leads to bleeding and infection. Some side-effects of anaesthesia may be evident. Circumcision might be associated with foreskin problems such as:
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The foreskin might become too short or long
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The foreskin might not heal entirely
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Rarely the remaining portion of the foreskin might reattach to the end of the penis, requiring minor surgical repair
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Pain
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Irritation on the tip of the penis
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Meatitis (inflamed opening of the penis)
Care after Circumcision Surgery
The penis takes about seven to twelve days to heal completely. People experience swelling, redness, and soreness around the penis. Sometimes a yellow fluid may be present on the tip of the penis.
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As the anaesthesia wears off, babies may feel pain and can get cranky. Avoid applying any pressure on their penis.
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Wash the penis gently after it heals and keeps the area hygienic. Change bandage with every change in the diaper for newborns.
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Keep the diaper loose.
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The application of petroleum jelly to the tip of the penis can prevent it from sticking to the diaper.
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If a plastic ring has been placed instead of a bandage, it will drop off within a week.
In case any of the following symptoms arise, contact the doctor immediately:
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Difficulty in urinating even after 12 hours of the circumcision
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Persistent bleeding
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Foul-smelling fluid drain from the tip of the penis
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The plastic ring does not fall off on its own even after two weeks of circumcision
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Increased pain
Last Update
Reviewed by Dr. Waheed Zaman, Director - Urology & Renal Transplantation, Urology, Kidney Transplant on 20-May-2022
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