What is Circumcision?
Circumcision is a surgical procedure that involves the removal of the foreskin (the skin covering the head of the penis). In Australia, about 1 in 5 boys undergo circumcision for various medical or personal reasons. The procedure is typically performed under general anaesthetic as a day surgery, meaning your child can go home the same day.
Should I Have My Newborn Boy Circumcised?
Routine circumcision of newborn boys is not recommended without a specific medical reason. This is the consensus from several leading medical organisations, including the Royal Australasian College of Physicians, the American Academy of Pediatrics, and the Canadian Pediatric Society.
While circumcision can be considered for medical or cultural reasons, it’s important to discuss the options with your paediatric surgeon. We are happy to answer any questions and help you make an informed decision.
Here are some statements from various associations:
Urological Society of Australia and New Zealand: https://usanz.org.au/info-resources/position-statements-guidelines/racp-circumcision-of-infant-males
Royal Australasian College of Physicians: https://www.racp.edu.au/docs/default-source/advocacy-library/racp-circumcision-of-infant-males-position-statement.pdf
Circumcision for Medical Reasons
Circumcision is sometimes recommended for children for specific medical reasons. There are a range of conditions where circumcision may be a treatment option discussed with your Paediatric Surgeon to prevent complications and improve a child’s quality of life. Below are some of the most common medical reasons for circumcision in children.
Phimosis
Phimosis is a condition where the foreskin cannot retract (pull back) over the glans (head) of the penis. In younger boys, this is often normal (physiological phimosis), and the foreskin usually becomes retractable as they grow older. However, in some cases, pathological phimosis occurs when scarring or tightness prevents retraction. This can cause discomfort, pain, and difficulty urinating.
If phimosis is caused by scarring or a condition called BXO (Balanitis Xerotica Obliterans), circumcision is often the most effective treatment. BXO causes the foreskin to thicken and harden, making it difficult or impossible to retract. Circumcision can remove the affected tissue and resolve the issue.
Recurrent Balanitis
Balanitis is an infection of the foreskin and glans, causing swelling, redness, and pain. In some cases, this infection can spread, leading to balanoposthitis (infection of the entire shaft of the penis). Balanitis is often treated with topical ointments and warm baths, but if the infection becomes recurrent, circumcision may be recommended to prevent further infections.
In boys who experience frequent episodes of balanitis, circumcision can be a long-term solution. By removing the foreskin, the risk of infection is significantly reduced, as the area is less likely to trap bacteria and become irritated.
Urinary Tract Infections (UTIs) Related to Foreskin Issues
Boys with certain foreskin abnormalities, such as phimosis, may have a higher risk of developing urinary tract infections (UTIs). Additionally, conditions of the renal system, such as vesico-ureteric reflux (a condition where urine flows backward into the kidneys), can increase this risk.
In cases where foreskin-related issues, such as phimosis, are contributing to repeated UTIs, circumcision may help lower the risk of infection. By removing the foreskin, it becomes easier to keep the area clean and free of bacteria, reducing the likelihood of future infections.
Paraphimosis
Paraphimosis occurs when the foreskin is retracted and becomes stuck behind the glans, causing swelling and pain. This is a medical emergency that requires prompt treatment to avoid complications like restricted blood flow to the glans.
If there are recurrent episodes, circumcision may be recommended to prevent the condition from recurring.
Balanitis Xerotica Obliterans (BXO)
BXO is a chronic inflammatory condition that leads to scarring and thickening of the foreskin, causing it to become tight and difficult to retract. It is one of the more serious forms of phimosis and can also affect the opening of the urethra (meatus), leading to difficulty urinating.
Circumcision is often the only effective treatment for BXO. By removing the affected foreskin, the inflammation and scarring are eliminated, preventing further progression of the condition.
Meatal Stenosis (Narrowing of the Urethral Opening)
Meatal stenosis is a condition where the opening of the urethra (meatus) becomes narrowed, which can occur as a result of inflammation, injury, or infection. This can cause difficulty urinating, pain, and urinary retention.
In some cases, circumcision can help prevent meatal stenosis by improving hygiene and reducing irritation around the meatus, especially in boys who are prone to foreskin infections or scarring.
Foreskin Ballooning and Urine Retention
Ballooning occurs when the foreskin fills with urine during urination. While this is often a normal part of development, persistent ballooning can cause discomfort and may lead to issues with urine retention and flow.
If ballooning is causing problems with urine trapping, irritation of the skin and chemical dermatitis, then circumcision may be an option to resolve the problem and improve the condition.
While many foreskin conditions resolve on their own over time, certain medical issues, such as recurrent infections or difficulty urinating, may require intervention. Circumcision can be an effective treatment for these issues, helping to alleviate discomfort, prevent complications and improve your child’s overall well-being. In general it should take under 20 seconds to void completely.
For more information on foreskin abnormalities, visit our Foreskin Abnormalities page.
The Circumcision Procedure for Children
Circumcision is a relatively quick procedure that typically takes about 15-20 minutes under general anaesthetic. This means your child will be completely asleep and will not have any awareness during surgery.
The foreskin is carefully marked and surgically removed. Dissolvable sutures are used to close the wound, and a simple dressing is placed around the shaft of the penis. Your child will also receive local anaesthetic, which numbs the area and lasts for a few hours.
You will be away from your child for approximately an hour, including the anaesthetic and recovery period. Once your child wakes up in the recovery room, you will be notified, and we will go over the procedure and aftercare instructions with you.
Are There Alternatives to Circumcision?
Depending on the reason for considering circumcision, there may be other treatment options to explore:
- Steroid Cream: In some cases, applying a steroid cream can be effective for treating some conditions like phimosis (where the foreskin cannot retract).
- Partial Circumcision / Preputioplasty: If preserving the foreskin is a priority, your surgeon may discuss partial circumcision or preputioplasty, which leaves part of the foreskin intact.
- Time: In some situations, the best course of action is to wait, as pubertal development and growth can resolve certain foreskin issues over time.
What Are the Risks of Circumcision?
Circumcision performed in Australia is a straightforward procedure when performed by a qualified and experienced medical practitioner. However, as with any surgery, there are potential risks. These risks occur in 2-10% of cases:
- Bruising and Swelling: This can feel scary to see after the surgery, but is a normal part of the healing process and usually resolves within the first week.
- Infection: While uncommon, proper hygiene and aftercare help reduce the risk of infection.
- Bleeding: Rarely, there may be some bleeding that doesn’t stop with gentle pressure. If this happens, you may need to visit the emergency department.
- Meatal Stenosis: This is a longer-term risk where the urinary opening (meatus) becomes narrowed, making urination difficult.
- Anaesthetic Risks: The anaesthetist will discuss any potential risks related to anaesthesia before the procedure.
What to Expect After Circumcision Surgery
After surgery, your child will wake up in the recovery room, and you can join them shortly after. You can offer them a feed once they are fully awake and comfortable. Most children are able to go home within 1-2 hours after surgery, once the nursing team ensures that your child is safe, comfortable, and able to pass urine without difficulty.
Caring for the Wound and Dressings After Circumcision
The area around the penis will become swollen and bruised in the first few days, which is a normal part of the healing process. Your child will have a waterproof silicone dressing around the shaft, which may fall off after 1-2 days. Older boys may have a firmer white wrap dressing, which also comes off after a day or two.
You will be given liquid paraffin and white paraffin to apply to the area, as it may become itchy for the first week as it heals.
- Apply 2-3 drops of liquid paraffin on the skin every few hours for a few days.
- After this, white paraffin can be applied for the following week.
Please see the video above to help clarify your understanding.
Pain Relief After Circumcision
Your child will receive local anaesthetic during the surgery that will make the penis numb for the first few hours. After the surgery, your child will need paracetamol and possibly ibuprofen (e.g., Nurofen) for a few days. Be sure to inform your surgeon and anaesthetist if your child has any allergies or intolerances to medications.
It’s also a good idea to distract your child with quiet activities like reading, drawing, or playing board games and other engaging activities – this can help keep their mind off the area while it heals and reduce the amount of pain relief medication that is needed.
Normal Activity After Surgery
Your child can return to normal activities fairly quickly, but with some restrictions:
Bath or Shower: The day after surgery.
Swimming: After 1 week.
Daycare or School: Within 5-7 days.
Sports or Physical Activity: After 2-3 weeks.
Troubleshooting After Circumcision: Common Concerns
Bleeding
It’s common to notice a little oozing from the surgical area due to swelling.
Sometimes due to itchiness as the wound is healing, your boy may inadvertently try to scratch the area and that may cause it to bleed.
If there is enough bleeding that there is visible dripping of blood, apply gentle pressure with a clean towel for 5 minutes.
If bleeding persists, keep it wrapped under gentle pressure and take your child to the nearest emergency department. Do not give anything to eat or drink if you are going to the emergency department. He can have pain relief prior to attending.
Is there an infection?
Infections are uncommon but can develop 2-4 days after the surgery.
It is normal for a dry crust to form is normal and is not a sign of infection. Signs of infection include increasing redness, tenderness, or discharge.
If you suspect an infection, contact your family doctor or surgeon for advice.
It is very swollen
Some swelling is normal after circumcision and may last for a few days. The penis tip can sometimes double in size, which can look alarming but is usually harmless.
If you’re concerned, call your surgeon so that your child can be assessed.
Itchiness
Itchiness is common as the wound heals after circumcision.
Itchiness can also be due to the glans (head of the penis) now being exposed to the outside, and not contained in the foreskin – the newly exposed skin can become dry and feel itchy. You will be provided with paraffin to help reduce discomfort. Use liquid paraffin (2-3 drops every few hours) for the first few days until it is less painful to apply the white paraffin directly. The white paraffin can be applied for a week or so.
When to Seek Medical Attention After Circumcision
You know your child best and can observe signs or changes in behaviour – if you have any concerns, you should contact your family doctor or surgeon. If your child experiences any of the following symptoms after surgery, then it is important to seek medical attention:
- Increasing pain that doesn’t improve with medication.
- Fever over 38.2°C.
- Increased swelling or a bulge at the surgery site.
- Vomiting or refusal to feed/feed intolerance.
- Discharge or bleeding from the wound that doesn’t stop with gentle pressure.
FAQs Circumsion
Why is circumcision performed in children?
Although circumcision may be considered for various reasons, leading Medical Organisations do not recommend routine circumcision in newborn boys without a specific medical reason. Common medical reasons include conditions like phimosis (tight foreskin that cannot retract), recurrent infections, and urinary tract infections (UTIs). Circumcision may also be recommended for children who experience conditions like paraphimosis or balanitis.
Is circumcision safe for children?
Yes, circumcision is a safe procedure when performed by a qualified and experienced surgeon. As with any surgery, there are some risks, including bruising, swelling, and infection, but these are generally mild and resolve with proper aftercare.
How long does the circumcision procedure take?
The procedure itself typically takes about 15-20 minutes. Including anaesthetic administration and recovery, you can expect to be away from your child for about an hour. Your child will be able to go home the same day.
How should I care for my child after circumcision?
After circumcision, your child’s wound will be covered with a dressing, which usually falls off within 1-2 days. You will be provided with liquid paraffin and white paraffin to apply to the area to reduce itchiness and promote healing. Your child may need paracetamol or ibuprofen for pain relief.
When can my child return to normal activities?
Most children can resume normal activities like bathing or showering the day after surgery. Swimming can usually be resumed after 1 week, and your child can return to daycare or school within 5-7 days. Physical activities like sports should be avoided for 2-3 weeks.
What are the risks of circumcision?
Circumcision is a straightforward procedure, but there are some risks, including:
- Bruising and swelling, which is normal and typically resolves within a week.
- Infection, which is uncommon with proper aftercare.
- Bleeding, which can usually be managed with gentle pressure but may require medical attention in rare cases.
- Meatal stenosis, a longer-term risk where the urinary opening becomes narrowed, which can affect urination.
How can I tell if my child’s wound is healing properly?
Some swelling, bruising and crusting around the wound is normal. If your child experiences increased redness, tenderness, or discharge, this may be a sign of infection, and you should contact your surgeon or family doctor for advice.
In some cases, alternatives such as steroid creams or partial circumcision may be options for conditions like phimosis. Your surgeon will discuss these alternatives with you if they are suitable for your child’s condition.
Most children can resume normal activities like bathing or showering the day after surgery. Swimming can usually be resumed after 1 week, and your child can return to daycare or school within 5-7 days. Physical activities like sports should be avoided for 2-3 weeks.
Is there an alternative to circumcision?
In some cases, alternatives such as steroid creams or partial circumcision may be options for conditions like phimosis. Your surgeon will discuss these alternatives with you if they are suitable for your child’s condition.
When should I seek medical attention after circumcision?
You should contact your doctor or surgeon if your child experiences:
- Increased pain that does not improve with medication.
- Fever over 38.2°C.
- Persistent bleeding that doesn’t stop with gentle pressure.
- Vomiting or refusal to feed.
- Increased swelling or any other concerning changes at the surgery site.
How long does it take for my child to fully recover from circumcision?
Most children recover quickly from circumcision, with full healing typically occurring within 1-2 weeks. Your child can return to normal activities in stages, with some restrictions on sports and swimming for the first couple of weeks.
