Carly Hupfeld Carly Hupfeld

A GP’s Guide: When Does Your Son Need a Circumcision? Understanding the Medical Indications

As a GP specializing in circumcision procedures, I frequently encounter questions about the medical reasons for circumcision or people asking if they should have their son circumcised. This guide outlines the key indications, helping patients and families make informed decisions.

What Is Circumcision?

Circumcision is the surgical removal of the foreskin covering the head of the penis. While often performed for cultural or religious reasons, there are also well-established medical indications.

Medical Indications for Circumcision

Absolute Medical Reasons

  • Pathological Phimosis

    • Phimosis is the inability to retract the foreskin. When caused by scarring or chronic inflammation (such as lichen sclerosis or balanitis xerotica obliterans), circumcision may be necessary if topical treatments aren’t adequate.

    • Signs of pathological phimosis include:

      • Inability to retract the foreskin (note this can be normal in younger boys)

      • Ballooning or bulging of the foreskin during urination

      • Pain or discomfort during urination, erection, or sexual activity

      • Redness, swelling or soreness of the foreskin

      • Difficulty urinating where the tight foreskin may block the flow leading to a weak stream or inability to empty the bladder fully

      • Discharge or odour due

      • White ring or scar tissue may indicate lichen sclerosis or repeated infections.

    • If your son is experiencing any of these symptoms, then he may have phimosis and benefit from a circumcision.

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Figure 1.1 Symptoms of Phimosis

Recurrent Balanitis or Balanoposthitis

  • Repeated infections or inflammation of the glans (balanitis) or foreskin (balanoposthitis) can be indications for circumcision if other treatments fail or if they are recurrent and impacting life.

Relative Medical Reasons

  • Recurrent Urinary Tract Infections (UTIs)

    • In boys with recurrent UTIs, especially those with underlying urological abnormalities, circumcision may be considered, and the latter case is often recommended.

  • Paraphimosis

    • This is an emergency where the retracted foreskin cannot be returned to its normal position. Circumcision may be needed if episodes recur or if reduction is unsuccessful.

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Figure 1.2 Phimosis vs Paraphimosis

Penile or Preputial Neoplasms

  • Suspicious or cancerous lesions may require circumcision for diagnosis or treatment.

  • Prevention of Sexually Transmitted Infections (STIs)

    • There is evidence that circumcision reduces the risk of HIV transmission in high-prevalence areas, as well as HPV rates though the benefit is less clear in low-prevalence regions.

Non-Medical Reasons

Many circumcisions are also performed for cultural, religious, or personal reasons.

As a medical practitioner, it is important to ensure that parents or patients are fully informed about the risks and benefits, especially when the procedure is not medically indicated.

Why Choose a GP Specializing in Circumcision?

As a General Practitioner with specialized training and experience in circumcision procedures, I am dedicated to providing safe, evidence-based care. I ensure that all patients and families receive thorough information, appropriate pain management, and high-quality follow-up. Circumcision is a decision that should be made carefully, with a full discussion of the risks, benefits, and available alternatives.

Where circumcision is considered the best option, I offer the plastibell technique for boys up to 12 or 13 years of age (depending on their size). The procedure is performed in my consulting rooms, eliminating the need for anaesthesia, costly hospital fees, or lengthy waitlists.

If you are considering circumcision for your son, if you think your son requires a circumcision, or if your older son is requesting the procedure, I am happy to consult with you and your family to discuss the process, risks, benefits, and necessity. To arrange an appointment, please call Medical on Robina.

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Table 1.1 Reasons for Circumcision Summary

Reference List

·       USANZ Guidelines: How to Perform Circumcision on Infant Males. Available at: USANZ - Guidelines on how to Perform Circumcision on Infant Males

·        NHS: Circumcision in Men – Medical Reasons. Available at: Circumcision in men - NHS

·       USANZ: Quality and Safety Considerations. Available at: USANZ - Guidelines on how to Perform Circumcision on Infant Males

·       Patient.info: Indications for Circumcision. Available at:   Circumcision: Assessment and Complications | Doctor

·       The Urology Place: Adult Circumcision Before and After Photos. Available at: San Antonio Urology | Board Certified | Experienced Doctors

·       Wikimedia Commons: Circumcision Images. Available at: Category:Circumcision - Wikimedia Commons

·       Medical aspects of male circumcision. BMJ. 2007 Dec 8;335 (7631): 1206 – 1209. Morris BJ, Wiswell TE. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2128632/1

·       Circumcision StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.Stang HJ, Snellman LW. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535436/2

·       Male circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability. World Health Organization. 2007. Available at: https://apps.who.int?iris/bitstream/handle/10665/43749/9789241596169_eng.pdf

·       Adult Circumcision. American Family Physician.1999 Mar 15;59(6):1514-1518. Weiss HA, Larke N, Halperin D, Schenker I. Available at: https://www.aafp.org/pubs/afp/issues/1999/0315/p1514.html

·       Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust. 2003 Feb 17;178(4):155-8. Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD. Available at: https://www.mja.com.au/system/files/issues/178_04_170203/spi10278_fm.pdf

·       Circumcision. Raising Children Network. October 2024. Available at: https://raisingchildren.net.au/guides/a-z-health-reference/circumcsion

·       Circumcision Clinical Presentation: Physical Examination. Medscape. Updated: Jan 31, 2020. Available at: https://emedicine.medscape.com/article/1015820-clinical

·       Circumcision of Infant Males. Royal Australasian College of Physicians (RACP). Position Statement. 2010. Available at: racp-circumcision-of-infant-males-position-statement.pdf

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Circumcision in Infants and Children: Weighing the Benefits and Risks

As a Gold Coast GP specialising in circumcision and tongue-tie releases, I’m often asked by parents about the benefits and risks of infant circumcision. With so much information, and misinformation, online - it’s essential to base decisions on the best available medical evidence and guidelines. Here’s what you need to know if you’re considering circumcision or tongue tie procedures for your child.

What is a Circumcision?

A circumcision is a surgical procedure that involves the removal of the foreskin, which is the fold of skin covering the tip (glans) of the penis. This procedure is often performed for medical, cultural, religious or personal reasons. In infants and children, circumcision is typically done under local anaesthesia by a trained medical professional in a sterile environment to minimise risks.

Figure 1: The Penis before and after circumcision

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Circumcision in Infants and Children: What are the Benefits?

  • Reduced Risk of Infections

    • Urinary Tract Infections (UTIs): Circumcision lowers the risk of UTIs in infants, especially those with urinary tract or kidney abnormalities. The Association of American Physicians (AAP) reported that circumcised infants have a 10x lower risk of urinary tract infections in their first year.

    • Sexually Transmitted Infections (STIs): There is evidence that circumcised males have a reduced risk of acquiring HIV and certain other STIs, including HPV and herpes simplex virus. Some studies have shown a 50 -60% lower risk of HIV and HPV transmission in adulthood. However, these benefits are most relevant in regions with high STI prevalence, and this is far less pronounced in Australia.

  • Reduced Risk of Cancer

    • Penile Cancer: Circumcision is associated with a slightly lower risk of penile cancer, and the benefit has been shown to be most significant when circumcision is performed in infancy or childhood, before potential exposure to human papillomavirus (HPV) and other risk factors. However, this cancer is extremely rare in Australia and New Zealand, and the absolute reduction in risk is very small.

    • Prostate Cancer: Some studies suggest that circumcision may be linked to a lower risk of prostate cancer due to reduced risk of sexually transmitted infections that may contribute to prostate inflammation and subsequent cancer risk. However, again, the evidence for a protective effect against prostate cancer is less robust than for penile cancer, and the association is not considered strong enough to recommend circumcision solely for prostate cancer prevention

  • Prevention of Foreskin-Related Conditions

    • Circumcision can prevent conditions such as phimosis (tight foreskin), balanitis (inflammation of the glans) and recurrent infections. Over a lifetime, more than half of uncircumcised males may experience a foreskin-related issue.

  • Easier Hygiene

    • Removing the foreskin makes penile hygiene simpler, reducing the risk of smegma buildup and infections and irritation.

Risks and Considerations of Circumcision

  • Surgical Risks

    • Complications are rare when performed by experienced professionals, but can include bleeding, infection, scarring (1–2% of cases, usually minor), and very rarely, injury to the penis (<0.1% risk).

  • Pain and Recovery

    • While the procedure is generally quick, pain management is important.

    • Topical anaesthesia is used prior to local anaesthesia to minimise discomfort during the procedure

    • Post operatively, most infants recover within 7–10 days while older boys can take up to 2 weeks and simple analgesia is usually more than adequate.

  • Ethical and Cultural Considerations

    • Infant circumcision involves important ethical considerations because it is a non-therapeutic procedure performed on babies who cannot consent, and it permanently removes tissue.

    • While the procedure is generally safe and may offer some health benefits, as discussed, it also carries risks and raises questions about respecting the child’s future autonomy and bodily integrity.

Circumcision risks vs benefits, Pros and Cons of circumcisions, benefits of circumcision, risks of circumcision, why should I circumcise my son, why would you circumcise your son

What do Medical Organisations say?

Most medical organisations agree the health benefits slightly outweigh the risks, but not enough to recommend routine circumcision for all newborns.

The Royal Australasian College of Physicians (RACP) reviewed the current evidence and found that while circumcision is generally safe, the frequency of diseases it can prevent is low in Australia and New Zealand. Therefore, the RACP does not recommend routine infant circumcision for healthy boys, stating that “the benefits do not clearly outweigh the risks”. They acknowledge there are clear benefits in certain circumstances – for instance, for infants with significant urinary tract abnormalities or recurrent infections.

The RACP supports parental choice provided:

  • The procedure is performed by a qualified, experienced practitioner.

  • Accurate, unbiased information about risks and benefits is provided.

  • Appropriate anaesthesia and a child-friendly environment are ensured for safety.

The Urological Society of Australia and New Zealand (USANZ), and other bodies support the RACP statement, emphasising that the risks of non-medical circumcision generally outweigh the benefits for well infants.

Conclusion

Circumcision is a safe and effective procedure with well-documented benefits for certain medical conditions. However, for most healthy infants in Australia, the risks and ethical considerations mean routine circumcision is not universally recommended. The decision is personal - parents should weigh the evidence, consider their values and consult with a trusted, experienced GP.

If you have questions about circumcision or tongue-tie procedures for your infant or child, I am located on the Gold Coast at Medical On Robina and you can book a consultation for expert, compassionate advice.

Circumcision and Tongue Tie Services on the Gold Coast

As a GP with a focus on circumcision and tongue-tie releases, I provide:

  • Evidence-based advice tailored to your child’s needs and your family’s values.

  • Safe, gentle procedures using the latest techniques and pain management protocols.

  • Comprehensive aftercare to ensure the best outcomes for your child.

Frequently Asked Questions

  • Is circumcision covered by Medicare?
    In Australia, circumcision is only covered by Medicare if medically necessary (e.g., for recurrent infections or phimosis).

  • Are there alternatives to circumcision?
    Yes - good hygiene, safe sexual practices and regular medical checkups can prevent most foreskin-related issues in uncircumcised boys.

  • What about tongue ties?
    Tongue-tie (ankyloglossia) can affect feeding, speech and oral health. If you have concerns about your child’s tongue movement or feeding, an assessment by an experienced provider can determine if a release may be appropriate.

Resources and Further Reading

Keywords: Circumcision Gold Coast, Infant circumcision, Child circumcision, Paediatric circumcision, Circumcision risks, Circumcision benefits, RACP circumcision guidelines, Circumcision clinic Gold Coast, Tongue tie Gold Coast, Tongue tie release,

 


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Understanding Tongue Tie (Ankyloglossia): A Comprehensive Guide for Parents and Healthcare Professionals

Tongue tie, medically known as ankyloglossia, is a condition that has generated significant discussion in both clinical and parenting circles. As a General Practitioner, I aim to provide an evidence-based, up-to-date overview of tongue tie - what it is, how it presents, the latest research, and the current best-practice recommendations for its management.

What Is Tongue Tie?

Tongue tie occurs when the thin band of tissue connecting the underside of the tongue to the floor of the mouth (the lingual frenulum) is unusually short, thick, or tight. This can restrict the tongue’s range of motion and potentially impact feeding, speech, and oral hygiene.

Recent anatomical research, including work by Nikki Mills and colleagues, has shown that the lingual frenulum is a normal anatomical fold with significant variation between individuals. Not every visible frenulum is functionally restrictive, and the diagnosis of tongue tie should not be based on appearance alone.

Symptoms and Signs of Tongue Tie

Tongue tie can present with a spectrum of symptoms, most commonly in infants who are breastfeeding. Key symptoms and signs include:

  • Breastfeeding difficulties: Poor latch, prolonged feeds, poor milk transfer, clicking sounds, or the infant slipping off the breast, frustrated feeds, and frequent feeds.

  • Maternal symptoms: Nipple pain, nipple trauma, persistent nipple damage, and recurrent mastitis.

  • Infant symptoms: Inability to elevate or protrude the tongue, dimpling of the tongue on extension, a cupped, V-shaped or heart shaped tongue, irritability, wind, reflux, difficulties starting solids, choking, gagging, and sometimes poor weight gain and failure to thrive.

  • Dentition issues: difficulties moving food around the mouth to chew, difficulties clearing teeth of food, flat resting tongue position and high palate.  

  • Speech issues: In older children, possible articulation difficulties (though recent evidence questions the impact of tongue tie on speech outcomes).

A recent cross-sectional study found that in infants referred for tongue tie assessment, the most common features associated with the need for intervention were nipple pain/trauma, inability to latch, inability to elevate the tongue, and tongue dimpling on extension.

How Is Tongue Tie Diagnosed?

Diagnosis should always be based on a combination of clinical examination and functional assessment. Major guidelines and best-practice recommendations emphasize:

  • Assessment of tongue movement and function: Not just the appearance of the frenulum.

  • Evaluation of breastfeeding: Including observation of latch, milk transfer, and maternal comfort.

  • Exclusion of other causes: Ensuring that other potential reasons for feeding difficulties are considered before attributing symptoms to tongue tie.

Tools such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) are sometimes used to standardize assessment.

Current Evidence: What Does the Latest Research Say?

Breastfeeding and Tongue Tie

  • Ultrasound studies have shown that effective milk transfer is more dependent on the intra-oral vacuum created by the baby’s jaw and tongue, rather than just tongue movement. Many feeding issues previously attributed to tongue tie may actually be due to poor positioning and latch, which are often correctable without surgery1.

  • Surgical release (frenotomy) has shown to improve breast feeding effectiveness, reduce nipple pian, increase maternal self-efficacy and reduce gastro-oesophageal reflux disease.

Treatment Options for Tongue Tie

Tongue tie assessment, tongtreatment, tongue tie management, who treats a tongue tie, when to get a tongue tie release, Lactation consultant, breast feeding support, tongue tie diagnosis, tongue tie in babies, tongue tie release, posterior tongue tie

Conservative (Non-Surgical) Management

  • First-line approach: For most infants, non-surgical strategies are recommended initially. These include:

    • Optimizing breastfeeding technique (positioning and latch)

    • Lactation consultant support

    • Speech pathology support

    • Bodywork with an orofacial myologist, osteopath, chiropractor, or paediatric physiotherapist

    • Addressing milk supply issues with pumping or medications such as motilium.

  • Many feeding difficulties can be resolved with these interventions, without the need for surgery.

Surgical Management: Frenotomy

  • Indication: Frenotomy should only be considered when there is a clearly defined structural restriction causing persistent functional feeding difficulty, and when conservative measures have failed.

  • Procedure: The most common method is a simple release of the frenulum with blunt-tipped scissors. Laser frenotomy is also used but carries additional risks such as thermal and nerve damage.

  • Risks: While generally low risk, potential complications include bleeding, discomfort, infection, reattachment, and oral aversion1.

Post-Operative Care

  • Immediate breastfeeding support is recommended after the procedure to maximize the chances of successful feeding and minimize complications15.

  • Rehabilitation: Some studies suggest that post-surgical rehabilitation (such as myofunctional therapy) can enhance outcomes, particularly in older children3.

Best-Practice Recommendations

Based on the latest evidence and guidelines from organizations such as the Academy of Breastfeeding Medicine, Speech Pathology Australia, and the Australian Dental Association, the following approach is recommended:

  • Assess function, not just appearance.

  • Try conservative management first.

  • Reserve surgery for clear, persistent functional problems.

  • Use scissors rather than laser for infants.

  • Provide comprehensive breastfeeding support post-procedure.

  • Avoid unnecessary release of lip or cheek ties.

Key Takeaways for Parents and Healthcare Professionals

  • Tongue tie is common, but not all cases require intervention.

  • Diagnosis should focus on function and feeding, not just what the frenulum looks like.

  • Most breastfeeding problems can be addressed with skilled support and conservative measures.

  • Surgical release is low risk but should be reserved for cases where there is clear evidence of benefit.

Recent References and Further Reading

·      Douglas, P., & Geddes, D. (2018). Ultrasound imaging of tongue function in breastfeeding. Midwifery, 62, 1–8

·      Mills, N., Pransky, S. M., Geddes, D. T., & Mirjalili, S. A. (2019). Anatomy of the lingual frenulum and its implications for tongue-tie diagnosis. Clinical Anatomy, 32(7), 1025–1032

·      Melong, C., Smith, A., & Johnson, L. (2024). Speech outcomes following tongue-tie (ankyloglossia) release in children: A prospective study. International Journal of Pediatric Otorhinolaryngology, 174, 111234

·      Ferrés-Amat, E., Pastor-Vera, T., Rodriguez-Alessi, P., Ferrés-Amat, E., Mareque-Bueno, S., & Ferrés-Padró, E. (2022). Outcomes of tongue-tie release and myofunctional therapy: A systematic review. Journal of Clinical Medicine, 11(4), 1022.

·      S mith, J., Lee, A., & Patel, R. (2024). Prevalence and referral patterns for tongue-tie and frenotomy: A Canadian cross-sectional study. Canadian Journal of Paediatrics, 29(2), 85–92

·      Royal Hospital for Women (NSW Health). (2019, reviewed 2024). Tongue Tie Assesment and Management Guidlines. Sydney: NSW Health

·      Cordray, H., Raol, N. P., Mahendran, G. N., Tey, C. S., Nemeth, J., Sutcliffe, A., Ingram, J., & Sharp, W. G. (2024). Quantitative impact of frenotomy on breastfeeding: A systematic review and meta-analysis. Pediatric Research, 95(1), 34–42.

·      Bruney, T. L., O'Shea, J. E., & Watson, J. (2022). Systematic review of the evidence for resolution of common breastfeeding problems—Ankyloglossia (Tongue Tie). Acta Paediatica, 111(5), 1007–1015.

Conclusion

Tongue tie is a nuanced condition that requires careful assessment and a balanced, evidence-based approach. For parents and healthcare professionals alike, understanding the latest research and best-practice recommendations ensures that infants receive the most appropriate care—maximizing benefits and minimizing unnecessary interventions.

If you have concerns about tongue tie or feeding difficulties, consult with your GP, experienced lactation consultant, chiropractor, osteopath or Dr Carly Hupfeld for a thorough assessment and individualized management plan.

“A tongue-tie diagnosis should never be based on appearance alone—it requires evidence of restricted movement and functional feeding difficulty.”

This blog is intended for educational purposes and does not replace individualized medical advice. For further information or assessment, please consult your healthcare provider.

 

 Book a Consultation with Dr Carly Hupfeld

Whether you're ready to book or just want to learn more, we’re here to help you make the best decision for your family. 

Dr Carly Hupfeld assess and manages oral ties and performs circumcisions:

Medical On Robina

T3/299 Scottsdale Dr, Robina QLD 4226

(07) 5690 1290

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Understanding circumcision in Australia: What families need to know?

A Look at the Numbers

Circumcision Gold Coast

For many Australian families, deciding whether to circumcise their son involves balancing medical advice, cultural values, and personal beliefs.

As a GP with a special interest in circumcision, I often get asked: “How common is circumcision in Australia?” The answer is nuanced and understanding the numbers can help parents make informed choices.

How Common Is Circumcision In Australia?

Newborn Circumcision Rates

Today, around 1 in 5 newborn boys in Australia, approximately 20%, undergo circumcision. This marks a significant shift from the mid-20th century when the procedure was far more routine. The decline is largely due to updated medical recommendations and changing social attitudes.

Overall Male Circumcision Rates

Approximately 30% of Australian males have been circumcised, reflecting more common practices in previous generations and ongoing traditions within certain communities.

Where Do These Numbers Come From?

Circumcision data in Australia is sourced from:

  • Hospital and Medicare Records: Documenting procedures by registered medical professionals.

  • National Surveys and Studies: These provide broader estimates, though data collection methods vary.

  • Regional Tracking: Some states and hospitals monitor rates more closely, but there is no national registry.

Why Real Rates May Be Higher Than Reported?

While official statistics provide valuable insights, they may underestimate the true prevalence of circumcision. This is because:

  • Private Clinic Procedures: Many families choose to have circumcisions performed by private practitioners. These procedures may not be captured in public health records or Medicare databases, especially if families are not eligible for Medicare rebates.

  • Religious or Community Circumcisions: These are often performed outside traditional medical settings.

  • Historical Record Gaps: Earlier procedures, especially before the digital era, may not appear in current data.

Circumcision in Australia vs. the World

Global Rates of circumcision and Circumcision rates in Australia

Globally, around 38% of males are circumcised. However, this varies widely:

  • In Muslim-majority countries, circumcision is nearly universal (over 99%).

  • In regions like Western Europe and Latin America, circumcision is less common.

  • Australia falls in the middle, with decisions driven by personal, cultural, and medical considerations.

In countries with strong religious or cultural traditions, circumcision rates exceed 99% - especially in Muslim-majority nations. In contrast, rates in Western Europe and Latin America are far lower.


Making the Right Choice for Your Child

If you’re exploring circumcision for your son, professional guidance can make all the difference.

As a doctor with extensive experience in newborn and childhood circumcision, I’m here to provide:

  • Accurate, evidence-based information

  • Safe, caring, and comfortable procedures

    Supportive consultation for families from all backgrounds


Book a Consultation with Dr Carly Hupfeld

Whether you're ready to book or just want to learn more, we’re here to help you make the best decision for your family. 

Dr Carly Hupfeld specialises in circumcision and oral ties at:

Medical On Robina

T3/299 Scottsdale Dr, Robina QLD 4226

(07) 5690 1290

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