To Circumcise or Not. Here's What You Need to Know

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Circumcision is a relatively common procedure for infant boys with over 55% of newborns in the US circumcised annually. If you are planning on having your baby boy circumcised, planning can begin before you even deliver!

While circumcision is believed to be - and does provide some added benefits to male hygiene, it is mainly done for cultural or religious reasons, less for medical needs.

To help you understand the process Oasis International Hospital has created a patient FAQ below, as well as options for treatment of phimosis (unable to retract foreskin) in older boys, both available here at OASIS International Hospital.

Circumcision Method@OASIS

At OASIS, the Gomco clamp technique is used for circumcision. This method of circumcision has the advantage of a steel bell that protects the glans of the penis during the procedure and the absence of a foreign body remaining at the site post-surgery as with other circumcision techniques.

Gomco Clamp Technique

Benefits & Complications to Consider:

Circumcision for some is not much of a decision, it’s a part of their religious beliefs. For others, it can be a decision based on the pros and cons and whether other family members have undergone this procedure.

Circumcision is a very safe procedure, but no procedure goes without the possibility for complications.

Possible complications for such a procedure involve:

• bleeding, particularly if the infant has a bleeding disorder

• infection, if the area is not well-taken care of in recovery

• injury to the head of the penis

• poor cosmetic outcome (too much or too little skin removed)

Acclaimed benefits of circumcision include:

• Reduced chance of urinary tract infection and penile inflammation

• Reduced chance of penile cancer

• Better hygiene, a circumcised penis is easier to clean than an uncircumcised one.

HomecarePost-Circumcision

The wound will take about 5-7 days to heal. During this time parents should expect to see some redness, swelling, and minute bleeding post-surgery for the first one or two days. A bandage dressing will be kept on for the first 24hrs, the penile tip will be lubricated with Vaseline so as not to adhere to the dressing.

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Diapers & Bathing

• Diapers can be worn as usual, however, do lubricate the front of the diaper with Vaseline so the glans of the penis do not adhere to the diaper.

• When changing soiled diapers (pee or poo), gently wash the penis with normal saline solution or distilled water, then gently dry with gauze.

• Erythromycin ointment should be applied after each diaper change at the site of the incision. Use cotton swabs to spread the ointment around and up to the glans of the penis (head).

• If parts of the remaining foreskin adhere to the glans of the penis, gently retract the skin downwards to free the tip.

• Avoid full immersion in a bath until the area has dried and healed.

1

Who should I contact when enquiring about options for circumcision for my son?

If you are deciding whether to get your newborn circumcised, you may contact Dr. Wennie Balawis, Pediatrician. Dr. Wennie along with our General Surgeon, Dr. Han, perform circumcisions for infants here at OASIS.

About: Dr. Wennie, has more than 15 years experience as a pediatrician. She has worked as a pediatric emergency room consultant  at the  Philippine Children’s Medical Center and the Medical City Ortigas. She has been a senior pediatric hospitalist at the PICU and NICU of the Asian Hospital and Medical Center where she attended to premature babies, critically ill and post-cardiac surgery children. Before joining Oasis Hospital, she is the pediatric specialist of the Dalian Vitup Clinic, an international clinic in Dalian City, Liaoning Province.

Specialized Areas: Dr Wennie is experienced in attending to various emergency room cases. She is an American Heart Association certified provider of pediatric advance life support (PALS) and basic life support (BLS). She is a certified provider of Neonatal Advance Life Support. She can handle various critical cases in the ER and ICU and she can perform several skills to include advanced airway management, central line access and minor surgeries. As a general pediatrician she also works in the out-patient clinic to provide health supervision for children and at the same time she can manage various pediatric out-patient sick cases.

2

When is the most appropriate time to get my son circumcised? Is there a cut-off age?

There is no cut-off age for circumcision, but rather when could be considered the best time for circumcision:

• During the newborn period - from birth to one month, the foreskin is still very thin and soft making the incision easier with less chance of bleeding and a faster healing process.

• Newborn circumcision can be done under local anesthetic whereas beyond this age, general anesthesia is recommended for circumcision.

• Parental decision is a major contributing factor too. Some may want to have it done early on or wait for their child to grow.

• Circumcision can be done anytime if there is a strong medical indication to do so, like in the case of persistent phimosis with recurrent penile and urinary tract infections.

Oasis can perform circumcisions for newborns from birth up to 1 month of age with our Pediatrician, Dr. Wennie Balawis. Beyond this age, a Pediatric Surgeon can be arranged for circumcisions over 1mth to 2yrs. OASIS General Surgeon can perform surgeries for ages 2yrs and up.

It is advised to make a decision and consult with your pediatrician before delivery so you have ample time to be clear on your reasoning for wanting this surgery when to have it done and have any questions answered.

3

Is this an outpatient procedure? How long does it take?

Newborn circumcision is an outpatient procedure, the baby may go home following the procedure. The surgery takes approximately 40mins to 1 hour with a local anesthetic used on the area. Mom should avoid feeding the baby an hour ahead of the procedure. One hour of observation is needed post-surgery, Mom may hold and nurse the baby during this time. After 1hr, the wound will be inspected for any abnormal bleeding or other issues. With no other problems, the baby may go home with mom and dad after post-surgical aftercare has been demonstrated.

4

Is there a follow-up appointment after the procedure?

Yes, the baby should be brought back after 5days for a follow-up visit.

5

What to expect afterwards? How long until full recovery?

Your newborn may be in some discomfort after the procedure, but swaddling can comfort the baby. Within the first 24hrs, infant Tylenol drops can be given to the baby for pain relief. After 24hrs we would not advise continuing with infant Tylenol unless the baby is extremely fussy and in pain.

The wound should take 5-7 days to heal post-surgery. Parents can expect to see some redness, swelling, and minute bleeding post-surgery for the first day or two.

6

Is there anything to be aware of when changing diapers?

Be sure to gently rinse the area at each diaper change with saline solution or distilled water and dry with gauze. Apply the medicated ointment to the incision and the glans with cotton swabs. The diaper should be lubricated with Vaseline where the penis will touch to avoid the glans adhering to the diaper. Repeat until the wound has dried and healed.

7

When to seek medical attention?

• If the baby is inconsolable even with pain medication, bring him back for further evaluation.

• If there is a foul-smelling discharge, the area may be infected and needs further medical attention (However, antibiotic ointment may sometimes crust and be mistaken for ulcers or discharge, remove any accumulation by soaking with warm water).

• If there is active bleeding, try to wrap the area with gauze and apply pressure for 3-5mins. If the bleeding persists, bring baby back to the hospital.

• Swelling and redness beyond the expected time.

Images: Oasis International Hospital, Pexels

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