Circumcision
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Circumcision is the surgical removal of the foreskin, the tissue covering the head (glans) of the penis.
It is one of the most common surgical procedures worldwide, with global rates reaching up to about 40%. However, in Australia, the rates are significantly lower, ranging from approximately 15% to 20%.
The procedure can be performed at any age. However, during the first 12 months of life, infants generally experience fewer risks, less discomfort, and a faster recovery compared to older children or adults.
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Religious or cultural practices
Hygiene considerations: Circumcision simplifies long term proper cleaning, minimising the accumulation of smegma thus reducing the likelihood of irritation, odour, and infections.
Cosmetic reasons
Potential health benefits:
Reduced risk of urinary tract infections (UTIs)
Lower risk of penile infections and phimosis, a condition where the foreskin can't be retracted.
Decreased risk of some sexually transmitted infections (STIs)
Reduced rates of penile cancer
Lower rates of cervical cancer in female partners - likely due to the reduced transmission of HPV
It is important to note that while benefits for circumcision exist, good hygiene practices in both circumcised and uncircumcised males can prevent many of the issues outlined.
The American Academy of Pediatrics states that the health benefits of newborn male circumcision outweigh the risks, but that the benefits are not significant enough to recommend universal newborn circumcision.
The Royal Australian College of Physicians (RACP) outline that in Australia, Aotearoa New Zealand, Canada, the United Kingdom and Europe, analogous organisations have not found the benefits outweigh the risks and therefore, leaves the decision to parents.
Parents should consider medical, cultural, and personal factors when making this choice. It's crucial to discuss the procedure, its benefits, and risks with a healthcare provider before deciding.
For more detail on the RACP position statement, see the following links:
https://ranzcog.edu.au/wp-content/uploads/RACP-Circumcision-Infant-Males.pdf
For more information about normal penile conditions and when it is necessary to treat, see the following link from the Royal Children’s Hospital:
https://www.rch.org.au/clinicalguide/guideline_index/the_penis_and_foreskin/
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There are a number of techniques to perform a circumcision. The technique used by Dr Carly Hupfeld is known as the Plastibell technique and has been used for over 75 years in the medical industry.
The procedure itself takes approximately 10 -15 minutes. After using a topical or local anaesthetic to numb the area, a plastic ring - the plastibell - is placed between the foreskin and the head of the penis, protecting the head of penis while a surgical string is used to secure the plastibell device in the correct position. The string acts as a torniquet, cutting off the blood supply to the foreskin, gradually working its way through the layers of the foreskin, healing it as it goes. Once the string has completely cut through the layers of the foreskin, the plastibell ring and the string spontaneously separate from the penis taking the residual tissue with it.
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Studies report very low complication rates when the Plastibell technique is performed by an experienced practitioner.
Some potential risks of the procedure include:
Discomfort
Pain
Bleeding
Infection
Scarring
Rare complications such as injury to the penis
The most common risks are minor complications such as delayed ring separation or slight bleeding.
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The Plastibell typically falls off within 3-10 days. This process is generally painless, but you may notice swelling, redness and a slight odour around the ring during healing.
Your child may experience some discomfort, typically within the first 24 hours or as the bell lifts off. In most cases, simple paracetamol will suffice for pain relief. However, in rare instances, additional pain medication may be necessary and if needed, will be prescribed in consultation with your doctor.
While the Plastibell is in place:
Petroleum Jelly will be applied morning and night, (or as needed) to act as a barrier and help with wound healing
Once Daily saline (salt water) rinses will be started on Day 2, in addition to their regular bathing routine.
It is important to note - a newly circumcised penis will look different from an adult's, with three distinct colour areas: deep pink/purple head, shiny pink skin cuff, and skin-coloured shaft.
Once the plastibell falls off, the skin on the penis head will need to be gently pushed back towards the body to ensure you can see all three areas clearly when cleaning.
You should contact your doctor if you have any concerns during the healing process.