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Circumcision may be done for cultural, family or religious reasons. It is rarely needed for medical reasons.1
In issuing a statement in 2010, that routine circumcision was not warranted in Australia, The Paediatrics & Child Health Division of The Royal
Australasian College of Physicians stated that the circumcision rate had fallen in recent years to an estimated 10-20% of newborn male infants.
Why circumcision is carried out in boys
Circumcision in boys may be carried out for:
- medical reasons – for example, as a treatment of last resort for conditions such as a tight foreskin (phimosis) and recurrent infection of the foreskin and head of the penis (balanitis)
- religious or cultural reasons – it's a common practice in Jewish and Islamic communities, and it's also practised by many African communities; most cultural circumcisions are carried out in young boys
How the foreskin develops
Male circumcision is the surgical removal of the foreskin. The foreskin is the retractable fold of skin that covers the end of the penis. It's a continuation of the skin that covers the whole penis.
It's normal for a baby boy's foreskin not to pull back (retract) for the first few years of life.
Around the age of two – or later, in some cases – the foreskin should start to separate naturally from the head of the penis (glans). Full separation occurs in most boys by the age of five years.
For some boys, the foreskin can take longer to separate, but this doesn't mean there's a problem, it will usually just detach at a later stage.
As the foreskin starts to separate from the head of the penis, you may see the foreskin "ballooning out" when your son passes urine. This can occasionally lead to infection (balanitis), but this ballooning usually settles down with time.
Never try to force your son's foreskin back, as it may be painful and damage the foreskin.
Medical reasons for a boy to have a circumcision
It's rare for circumcision to be recommended for medical reasons in boys. This is because other less invasive and less risky treatments are usually available.
The following conditions affect the penis and, in rare cases, may require a circumcision:
- tight foreskin (phimosis) – where the foreskin is too tight to be pulled back over the head of the penis; this can sometimes cause pain when the penis is erect and, in rare cases, passing urine may be difficult
- recurrent infection (balanitis) – where the foreskin and head of the penis become inflamed and infected
- paraphimosis – where the foreskin can't be returned to its original position after being pulled back, causing the head of the penis to become swollen and painful; immediate treatment is needed to avoid serious complications, such as restricted blood flow to the penis
- balanitis xerotica obliterans – a condition that causes phimosis and, in some cases, also affects the head of the penis, which can become scarred and inflamed
- repeated urinary tract infections (UTIs) – in very rare cases, circumcision may be recommended as a treatment of last resort if a boy has repeated UTIs
These conditions can often be treated successfully with non-surgical treatments, which will often be tried first before circumcision is considered.
Mild cases of phimosis can be treated with topical steroids to help soften the skin and make it easier for the foreskin to retract.
However, circumcision may be necessary if the foreskin is damaged and won't slide back over the head of the penis. This is very rare before the age of five.
In paraphimosis, a healthcare professional may rub a local anaesthetic gel on to the head of the penis (glans) to help reduce pain and inflammation. They may then apply pressure to the glans while pushing the foreskin forward.
In severe cases of paraphimosis, local anaesthetic gel can be applied and a small slit made in the foreskin to help relieve the pressure.
Balanitis and balanitis xerotica obliterans can sometimes be successfully treated using corticosteroid ointment, gel or cream, antibiotic creams or antifungal creams.
Most UTIs are mild and can be treated with antibiotics. However, repeated UTIs can occasionally cause kidney damage.
For example, if a boy has a birth defect that causes urine to leak back up into the kidney, bacteria can spread from the foreskin, through the urine, and infect the kidney. Circumcision may be recommended in these cases.
Circumcision is usually carried out on a day patient basis. This means your child will be admitted to hospital on the same day he has surgery and won't need to stay overnight.
He won't be able to eat or drink before having surgery – you'll receive detailed information in a letter.
After being admitted to hospital, your child will be seen by the surgeon who will carry out the procedure. They’ll explain the operation in more detail, discuss any concerns and answer any questions you have.
They'll also ask you to sign a consent form, giving your permission for the operation.
The anaesthetist will also visit your child before the operation. They will usually have a general anaesthetic, so they'll be unconscious throughout the procedure and unable to feel any pain or discomfort.
Circumcision is a relatively simple procedure. The foreskin is removed just behind the head of the penis using a scalpel or surgical scissors.
Any bleeding can be stopped using heat (cauterised). The remaining edges of skin are stitched together using dissolvable stitches. It will take up to six weeks for your son's penis to fully heal.
Recovering after male circumcision
After the operation, a dressing will be put over the penis to protect the wound. It will be removed before your child goes home.
He will be allowed home after he's passed urine, which may be slightly uncomfortable at first.
The penis will be sore and inflamed for a few days after the operation. Ointment may be prescribed to use for a few days to help the area heal.
Your child will also need regular pain relief, in the form of paracetamol or ibuprofen, for at least three days.
It may be more comfortable to wear loose clothing – or no clothing at all – on his bottom half for a few days after the operation. Passing urine in the bath or shower may also be more comfortable.
Your child will be able to have a bath the day after the operation. He should avoid riding a bicycle or other toys you sit on until any swelling has gone down.
He should be able to return to school or childcare about a week after the operation. Make sure you tell the school or childcare about the operation.
In most cases, a follow-up appointment won't be necessary.
However, you should contact your GP or hospital care team if:
- the penis is bleeding
- the penis is still swollen two weeks after the operation
- passing urine is still painful a few days after the operation
Risks of male circumcision
The risks associated with circumcisions when carried out by qualified and experienced doctors are small.
The main risk is bleeding, both during and after the operation. The surgeon will seal off any bleeding during the procedure, and the dressing applied afterwards will absorb any further bleeding.
However, seek medical advice if your child's penis continues to bleed after they return home.
There are also risks associated with general anaesthetic, such as having a serious allergic reaction (anaphylaxis). However, these risks are small.
The anaesthetist will explain the risks to you before the operation. You can also read more about the complications and risks of general anaesthetic.
You can also have a headache or feel sick or dizzy after having a general anaesthetic. However, these side effects should pass quickly.
There's also a small risk of infection after having a circumcision.
Female circumcision (female genital mutilation)
Female circumcision – also known as female genital mutilation (FGM) – is a procedure where the female genitals are deliberately cut, injured or changed, but where there's no medical reason for this.
It's usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts. It is illegal in Australia.2 This includes performing it on a child that lives in Australia while they are overseas. Each state and territory has its own version of these laws.
It's very painful and can seriously harm the health of women and girls.
1 Contains public sector information licensed under the Open Government Licence v3.0.
2 The National Education Toolkit for Genital Mutilation/Cutting Awareness (http://www.netfa.com.au)