Is a circumcision in children medically necessary?
Written by:Circumcision is the removal of the foreskin of the penis and may be carried out for different reasons in children. Highly experienced consultant urologist Ms Johanna Thomas tells us why a child may need to be circumcised, how circumcision is performed and alternatives.
All male children are born with a non-retractile foreskin (physiological phimosis). The foreskin will gradually retract as the child gets older. The age at which this happens can vary, however, in general, the age at which the foreskin is expected to go back over the head of this penis is:
- Birth - 4%
- 6 months - 20%
- 1 year - 50%
- 3 -11 years - 90%
- 12-13 years - 95%
- 14+ years - 99%
Parents are often concerned that the foreskin can balloon when the child wees. However, this is normal and very commonly seen when the foreskin is still not retractile.
Circumcision for medical reasons under the age of 5 is very rarely indicated.
What would be the indication for a circumcision in children?
A circumcision operation may be performed for the following medical reasons:
- Scarring of the foreskin – also known as balanitis xerotica obliterans (BXO). Here the foreskin is scarred and is unable to stretch over the head of the penis (glans). Sometimes the skin can split and the child can often complain of pain or difficulty peeing.
- Balanitis and balanoposthitis – recurrent infections of the foreskin and or glans.
- Recurrent problems with paraphimosis – the foreskin getting stuck over the glans of the penis.
- In boys age 14 or older where the foreskin is still not coming back.
What are the alternatives to circumcision?
Using a mild steroid ointment on the foreskin can be useful for:
- Where the foreskin is still stuck down on the head of the penis – a 4 to 6 week course of using the cream can help to separate the points where the skin is stuck.
- Scarring of the foreskin – occasionally with mild scarring. A trial of steroid ointment can help resolve this.
- Surgically dividing the band where the foreskin attaches to the gland on the underside of the penis (frenuloplasty) or dividing the tight band on the foreskin itself (prepucioplasty) can be surgical alternatives to removing the foreskin completely which is done in a circumcision.
How is a circumcision performed?
The circumcision operation is a fairly simple procedure. The foreskin is removed from behind the head of the penis using a scalpel or scissors so that the excess foreskin is clipped off. The remaining edges of skin will be stitched together with dissolvable stitches. In children, it is performed under a general anaesthetic, as a day case procedure.
What are the risks of a circumcision operation?
As with any surgical procedure, there is a risk, although with circumcision the risk is low. Problems that can occur include pain, the risk of bleeding, irritation, increased risk of meatitis (inflammation of the opening of the penis) and risk of injury to the penis.
Recovery after a circumcision procedure
Sports and swimming should be avoided for 3 to 4 weeks following the procedure.
If you are concerned that your child may need a circumcision and would like to book an appointment with Ms Thomas, do not hesitate to do so by visiting her Top Doctors profile today.
