Circumcision in Boys

When we talk about male circumcision, this means the surgical removal of the foreskin. Circumcision rates in Australia have fallen in recent years, but about a third of males under the age of 30 have been circumcised. Many circumcisions are carried out at birth because of religious or cultural reasons, and is most common in Islamic, Jewish, and African communities, or it can just be parental preference. However, there are sometimes reasons why a circumcision needs to be carried out for medical reasons, and this can be when the child is a little older.

Why is circumcision carried out?

There are a few medical reasons why circumcision might be carried out. The most common are:

  • Tight foreskin – also known as phimosis, circumcision can help when other treatments have failed
  • Balanitis – recurrent infections of the foreskin could mean circumcision is the best option. There’s also a condition called balanitis xerotica obliterans where the foreskin gradually becomes thickened and white with narrowing of the opening
  • Paraphimosis – when the foreskin is pulled back, it’ll usually easily return to the original position. Paraphimosis means the foreskin doesn’t go back, creating pain and swelling in the head of the penis. Your child needs to see a doctor immediately in these cases
  • UTIs – boys can suffer from urinary tract infections, usually associated with renal tract abnormalities that would need medical investigation, and if infections keep occurring, circumcision might be recommended

When boys have problems with their foreskin, most doctors will try a variety of treatments before they suggest circumcision, and it’s normally only carried out as a last resort. You may want to visit a circumcision clinic in Perth to discuss your child’s case with the experts, and decide whether it’s the best choice for him.

Foreskin development

Don’t worry if your child can’t pull back his foreskin for the first few years of life. It’s not until after the age of two that the foreskin begins to separate from the glans, or ‘head’, of the penis. However, full separation might not happen until they’re seven. If it hasn’t separated by that point, you might want to see a doctor for peace of mind, but usually it doesn’t mean there’s a problem, it’s just taking longer than usual.

During the separation, the foreskin can look like it’s ballooning out when your child goes to the toilet. While there are occasions when this leads to balanitis, the ballooning of the foreskin will usually stop as they get older. It’s important not to force your child’s foreskin back, as this can cause damage and be very painful for him. If you have any concerns, it’s best to see a doctor who can check that his development is on track.

Other treatments

Before suggesting circumcision, doctors will want to try some alternatives first. Some mild cases of phimosis, a tight foreskin, can be treated with a steroid cream. Softening the foreskin, this allows it to retract over time. When it comes to balanitis, there are antibiotic and antifungal creams that can be successful in treating the infection, and if it does reoccur, then circumcision might be necessary. Balanitis Xerotica Obliterans can be cured with early circumcision.

Paraphimosis is rare in boys under five, and stops the foreskin going back into its natural position. In these cases, a doctor will usually numb the head of the penis, then put pressure on the glans, sliding the foreskin forward. If it’s too severe, then a slit might need to be made to relieve pressure, and options such as circumcision should be looked at. If you are considering circumcision in Perth for your son, then your doctor will need to know their medical history, such as which infections they’ve had and how often they’ve reoccurred, so they can make the best recommendation.

How are circumcisions carried out?

Circumcisions are optimally done after 6 months of age under general anaesthesia as a day surgery patient, so your child doesn’t have to stay in hospital. They can’t eat or drink before the surgery, and your doctor will confirm the practicalities such as when they should arrive. You’ll get a chance to speak to their surgeon before the procedure when they are examined, and this is a good opportunity to talk through any concerns before you sign the consent form.

When general anaesthetic is given for circumcisions, means your child won’t be aware of what’s going on, or able to feel pain during the surgery. Once under, the surgeon removes the foreskin behind the head of the penis, and then cauterises the area using heat to stop any bleeding. Dissolvable stitches and glue are then used to stitch together the edges of the skin.

How long is recovery?

Full healing from a circumcision takes around two to four weeks. Your doctor will be able to advise on the best pain relief, and whether ointments will be needed while healing.

Most boys have a week off school, and they should relax and wear loose trousers for the first few days. He should avoid riding a bike or any ride-on toys until the swelling is reduced. There are rare occasions where swelling isn’t going down, or there is bleeding, in which case you should see a doctor.

Are there risks?

As with any surgery, there are risks, which is why it’s important to use a surgeon who’s experienced and qualified. There’s a risk of bleeding after the operation, and there are risks involved with any procedure where general anaesthetic is used. There’s also a small risk of infection. It’s important to speak with your doctor about the procedure, so you can make an informed decision.

If you are considering having your child circumcised, then speak to Dr Jill Orford, a paediatric surgeon in Perth. Simply call 1300 37 5455 to book your appointment and find out more.