Circumcision, Phimosis and Paraphimosis

The prepuce, or foreskin, is a normal part of the external genitalia, forming a natural covering over the tip of the penis (glans). At birth, the foreskin typically is unretractable, or does not easily glide back and forth over the glans. This is a normal condition, and the foreskin will become fully retractable as the child grows. It should be noted that at birth up to 95% of boys have unretractable foreskins, compared with the fourth year of life, when only 10% of boys have unretractable foreskins. Medical intervention is usually unnecessary. Medical or surgical intervention is necessary when a child has urinating difficulties (such that the urine pools in the foreskin) or problems with infections.

Circumcision

Circumcision involves the removal of the foreskin from the tip of the glans to the ridge of the glans. Circumcision is often a hotly debated issue in terms of when it should be done and whether it should be done. The latest recommendations put out by the AAP (American Academy of Pediatrics) state that there are no medical indications for routine newborn circumcisions. In The United States, it is frequently done within 1–2 days after birth, for varying reasons including, religious and/or cultural beliefs. Circumcision should never be done if there is a question as to whether the possibility of hypospadias exists.

Phimosis

This is a condition in which the foreskin is tight and narrow, making it impossible or painful to retract. This may cause extreme pain when your child experiences stronger erections. In addition, it may cause problems with infections, as stated in the first paragraph. Although this is a normal condition in infancy, if it persists beyond the average age (typically 4–5 years old), medical or surgical intervention may be indicated. At this point, your child should be evaluated by a pediatric urologist, who can make the decision as to whether the need circumcision is warranted.

Paraphimosis

This condition is somewhat opposite phimosis in that the foreskin is fully retracted behind the ridge of the glans and is unable to be pulled back over the glans. Because the foreskin remains behind the ridge of the glans, it may cause irritation and swelling, making it impossible for the foreskin to be pulled back over the glans. This condition requires urgent medical attention.

Medical Treatment

Some families prefer to try other options before immediately having their child circumcised. If the pediatric urologist believes the child will not be at risk for further problems, it may be appropriate to try a low-potency steroid cream. The parents or child (if old enough) will be instructed to apply the cream 2–3 times a day, with a Q-tip, to the tip of the penis to help the foreskin naturally and easily retract. This is typically tried for 1 full month, and then the child is re-evaluated.

Surgical Treatment

As stated earlier, circumcision is the removal of the foreskin. If this is not done within the first few days of life, the earliest it will be done is at 6 months of age. This delay is because general anesthesia is required. By 6 months of age, infants are healthy and strong, and able to tolerate general anesthesia (in fact, they tolerate it better than an adult). By this time, they have also had some time to bond with their parents and have not reached the separation/anxiety stage of development.

The procedure itself will take approximately 30 minutes and will be done as an outpatient procedure. This means your child will go home as soon as he is stable and tolerating fluids, which can be as early as 2 hours after the circumcision.

Postoperative Care

Postoperative care is minimal in that you will apply a combination antibiotic/pain ointment called Spectrocin to the penis to help the healing process and to prevent the penis from sticking to the diaper. You may bathe your child within 24 hours.