Circumcision in Children: What Parents Need to Know

Circumcision is a surgical procedure to remove the foreskin. 

• Circumcision may be performed on boys of any age who have indicated conditions such as balanoposthitis or phimosis. 
• Balanoposthitis is a foreskin infection which can occur often, tightening the foreskin and making it difficult to retract or open the foreskin (phimosis). 
• New-born boys aged between 1–2 days born into families with certain religious or cultural beliefs regarding circumcision can have the procedure performed during the neonatal stage. However, these infants must be in good health and not have been born prematurely to ensure the procedure can be carried out safely. 

The foreskin naturally exfoliates, leaving behind a substance known as smegma, which can easily result in bacterial build-up and inflammation. Circumcision can therefore have the following benefits: 

•  Makes cleaning the penis a lot simpler. 
•  Reduces the risk of infection and urinary tract infection. 
•  Reduces the likelihood of contracting a sexually transmitted disease. 
•  Can reduce the chance of penile cancer. 
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Nevertheless, these issues can also be prevented without circumcision with careful care and cleaning of the foreskin. 

• There is a risk of reduced sensitivity as there is no longer any skin to cover the glans, meaning frequent contact with clothing or underwear could lead to reduced sensitivity. 
• The esthetic results following surgery may not be as anticipated. 
• Issues associated with removing too little or too much of the foreskin are as follows: 
  • Removing too much foreskin could lead to pain when the penis is erect. 
  • Removing too little foreskin could result in similar issues experienced by those with a foreskin, thus making further surgery necessary. 
• Friction between the opening of the urethra and clothing could lead to inflammation or narrowing of the opening. 

• Circumcision under local anesthesia  
  • Infants do not require general anesthetic; a localized anesthetic is used which means it is not necessary for them to fast from liquids and solids. 
  • Infants are given oral paracetamol medication around 30 minutes to one hour prior to the procedure, so they are in a calm enough state to have their bodies covered with a surgical cloth during the operation. 
  • Surgeons inject the base of the penis with anesthetic medication to numb the area and ensure no pain is felt during the procedure. They then surgically remove the foreskin, stop any bleeding, stitch the wound, and cover the area with a special gauze. 
  • The new-born is then monitored for a day after the operation to ensure the wound is healing properly and that there is no bleeding. Medical staff will offer advice to parents regarding aftercare once the child is allowed home. 
• Circumcision under general anesthesia  
  • Infants aged 2 months and above must receive pain relief drugs and a general anesthetic to have a circumcision, and they must also fast from liquids and solids for 6–8 hours prior to the procedure. 
  • The anesthesiologist will converse with the child at the start of the procedure as they gradually administer the anesthetic. 
  • The circumcision procedure will begin once the child has lost consciousness due to the anesthetic. Once bleeding stops, the wound is closed using absorbable stitches. 
  • Medical staff will monitor the child in a recovery room for around 2 hours following the procedure. 
  • Once the child’s health has been confirmed, they will be allowed to return home to continue their recovery, or they may require a night in hospital for closer observation. 

• Parents will receive advice from a doctor regarding the procedure, its benefits, its risks, and other forms of treatment available to their child. 
• Children requiring a general anesthetic procedure must fast from liquids and solids for 6–8 hours prior to surgery. 
• Parents should bathe their child and clean their body prior to the procedure, but they must not apply any talcum powder or creams to their genitalia. 

• Gauze is wrapped around the penis for a day, after which the wound should be soaked in warm water for 5–10 minutes. The child can sit down and let the affected region soak in a tub or bath as they would normally bathe and then gently remove the bandage. . The wound should be gently dabbed with a soaking gauze when they get out of the water before it is dabbed again using a disinfectant (parents can use saline solution instead of normal water if they wish). 
• There is usually some build-up of serum crusts on the wound for 1–2 days following surgery. However, this gradually goes away within 1–2 weeks, so it should not be scratched, pulled off, or scrubbed too vigorously as doing so could cause bleeding to occur. 
• The wound should be cleaned with saline or tap water each time the child urinates to avoid dirt or bacteria build-up. 
• Children experiencing pain may take paracetamol medication. 
• Do not apply any powders or creams to the genitals until the wound has fully healed. 
• The stitches will dissolve after 10-14 days. 
• The wound should be carefully monitored for around 14 days following surgery to reduce the likelihood of bleeding, swelling, and inflammation. All forms of sport including swimming should be stopped temporarily. The patient should also be taken to all follow up appointments as advised by his doctor. 
• Children who experience bleeding, swelling and redness, the formation of pustules, fever or severe pain should be taken to see a pediatric surgeon at a hospital, who will screen them and prescribe treatment as necessary. 

The chances of complications arising from a circumcision are minimal, although the following symptoms are possible: 

• Bleeding 
• Wound infection 
• Anesthetic allergy 
• Injury to the glans 
• The resulting esthetic of the penis may involve a lump or other unwanted blemishes 

Where there is a foreskin that can be pulled back normally: 

• Clean the penis with clean water every day when bathing. 
• Pull the foreskin back fully and wash the penis with clean water before pulling the foreskin back to its original position. 
• The foreskin should be pulled back slightly when urinating to ensure the urine does not come into contact with the foreskin, checking that all urine has been expelled before pulling the foreskin back to its original position. 
• Avoid applying powders or creams to the genitalia as this can lead to irritation. 

Where the patient has been circumcised 

• The genitalia should be cleaned as outlined above, although the process should be simpler without the presence of the foreskin. 
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Samitivej Children’s Hospital, Bangkok, Thailand features the latest technology and equipment for pediatric surgery, and our team of highly skilled surgeons is experienced in all major procedures. 

The Newborn and Pediatric Surgery Center at Samitivej Children’s Hospital provides general children’s surgery, as well as surgery for childhood diseases that require specialized procedures, ranging from congenital, to those that occur after birth. All our pediatric surgeons have received certified international education and have undertaken extensive pediatric surgery training. Our pediatric surgeons are able to accurately diagnose, treat and care for patients, ranging from newborns to adolescents. Through our collaboration with Doernbecher Children’s Hospital in the United States, pediatric surgery at Samitivej is more successful than ever before, giving children the safe treatment they need. For more information on our partnership with Doernbecher, click here. 

Our pediatric surgeons: 

• Lantom Tonvichien, M.D. 
• Professor Akkrapol Mungnirandr, M.D. 
• Chollasak Thirapattaraphan, M.D. 
• Kulsiri Tiansri, M.D. 
• Assist. Prof. Niramol Tantemsapya, M.D. 
• Piangpen Thepsuwan, M.D. 
• Wannisa Poocharoen, M.D.