Circumcision

Circumcision

Circumcision Wamuran

Wamuran Doctors perform infant male circumcision.


Dr Easton
has been performing circumcisions on babies up to the age of 10 weeks for over 35 years.  Dr Easton uses the Gomco Clamp method for performing circumcisions.

What are the potential benefits?

Circumcision may reduce the risk of the following conditions:

  • Urinary tract infections. These affect up to four percent of boys, especially in infancy, but may be 10 times less frequent in circumcised boys.
  • Penile cancer. This cancer is rare (one in 250,000 Australian men develops it) but there is an increased risk of cancer of the penis in uncircumcised men
  •  Cervical cancer. Uncircumcised men may be more likely to acquire and transmit the human papilloma virus (HPV) that is responsible for most cervical cancers. However, cervical cancer rates are declining in Australia due to effective screening and vaccination programs
  • Penile inflammation and dermatoses (skin disorders). Penile inflammatory disorders are less common in circumcised men but can develop whether or not circumcision has been performed. Uncircumcised males who retract the foreskin while bathing are less likely to experience problems with inflammation. Acute and recurrent problems of the foreskin can sometimes be managed medically but surgical intervention may be required
  • Sexually transmitted infections (eg syphilis, gonorrhoea, herpes, HPV, HIV). Although circumcision may slightly reduce the risk of transmission, particularly in high-risk groups, it does not provide protection against sexually transmitted infections and should not replace safe sex practices.

What are the risks?

Circumcision has a complication rate of one to four percent that includes local infection, bleeding and damage to the penis.

When performed on healthy newborn male infants as an elective procedure, the incidence of serious complications from circumcision is extremely low. Serious complications such as uncontrolled bleeding, meningitis and septicaemia are rare but may result in death.

Why is circumcision controversial?

Circumcision has been around for religious and cultural reasons for thousands of years, and is still an important ritual in some religious groups. Circumcision for medical reasons became popular in the UK and United States in the late 19th century, while in Australia and New Zealand the practice of circumcision was adopted later. In the 1950s around 85 percent of Australian boys were circumcised.  It has since become uncommon in Europe and is declining in Australia and New Zealand but is still practised widely in the US.

Circumcision does have some possible medical benefits, as mentioned above. It does not prevent diseases, however, and good hygiene and safe sex practices are still just as necessary. Circumcision also carries some risks and there is debate over whether these outweigh the potential benefits. Some people argue against circumcision saying that the foreskin does have a functional purpose – primarily to protect the glans, which is highly sensory tissue.

Circumcision of male infants is a deeply personal matter, and includes medical, ethical, cultural and social considerations. Parents may need to consider how the child might respond, opinions of family and friends, pressure to conform with dad, medical risks and benefits, and whether they should be making such a decision without the consent of the child.

Ultimately, parents have the right and obligation to make the decision of whether or not to circumcise their sons. The decision, like all medical procedures, should be based on the principle of weighing up the risks and benefits for the long-term wellbeing of the child. It’s important to have access to accurate information so you can make an informed decision. Talking to informed people you trust, such as our GP’s, can also help with the decision-making process.

How to care for an uncircumcised foreskin

It is normal for the inner surface of the foreskin to be fused to the glans in newborn males. Separation of the foreskin from the glans usually occurs spontaneously during childhood. By five years of age most boys are able to retract their foreskin. A small percentage of boys are unable to retract their foreskin fully until puberty.

The foreskin requires no special care during infancy and should be left alone. Attempts to retract it forcibly are painful, often injure the foreskin, and can lead to scarring and phimosis (difficulty in retracting the foreskin).

Later in childhood, the boy may be able to retract his foreskin gently to the point where resistance is met and the end of the penis and the urethral opening become visible. Only the boy should attempt to retract his foreskin – no one else. He can be shown how to clean the glans and the inner-surface of the foreskin once separation has occurred and the foreskin is fully retractable.

At puberty, all uncircumcised boys should be able to retract their foreskin and clean underneath it with water in the bath or shower. It is important that they always return the foreskin to its original position after they have finished. If the foreskin is left retracted behind the glans, it may swell up and become painful (paraphimosis).

As the foreskin separates from the glans, dead skin cells will collect between the two layers. These dead cells appear as white crumbly or cheesy material and have been termed smegma. Smegma may produce a noticeable (and often asymmetrical) swelling beneath the foreskin. This material rarely causes problems and usually discharges spontaneously. Accumulation of smegma assists the normal process of separation of the inner surface of the foreskin to the glans of the penis in the young boy.

Circumcision

Up until the mid 20 th century, most baby boys were circumcised. However, over the last 50 years, the trend has reversed and now, fewer than ten percent of all baby boys in Australia are routinely circumcised. There are several reasons both for, and against, circumcision. Ultimately, it is the decision of the parents whether or not to have their child circumcised.

Most circumcisions are performed within a day or two after birth. The child’s arms and legs are restrained, and an anaesthetic cream or injection is used to numb the area around the foreskin. A doctor places a special clamp around the penis and removes the foreskin. The procedure takes about 15 minutes from start to finish.

After circumcision, your baby might be a bit fussy. He might cry when he pees in his nappy because the urine may irritate his penis. Make sure to keep the penis clean and dry. Try dabbing on a little petroleum jelly after each nappy change to keep urine from stinging the area and to keep the penis from sticking to the nappy.

A bit of bleeding and a yellowish crust around the penis is normal. The circumcision site should heal completely within a week to ten days. You should avoid giving pain relievers to infants. If your child becomes irritated by the circumcision, pick him up and comfort him, being sure to avoid putting pressure on his penis. He’ll soon feel much better.

Circumcision: Guide for parents

In Australia today circumcision of baby boys is rare, and the uncut penis is the normal thing among young people, but many parents are still anxious about the subject. Because Australia has a past history of widespread circumcision, they may be unfamiliar with the normal penis and worried that they will not know how to look after it. They may also have been alarmed by reports in the media about the risks to health supposedly caused by the foreskin, or they may have heard stories from relatives or friends that the normal penis is somehow difficult to look after or prone to problems.

This page aims to answer questions commonly asked by parents who are considering whether to circumcise their baby boy and to reassure them that all these fears are groundless. Boys are exactly right the way nature made them.

Circumcision: Frequently asked questions

Introduction

Parents want to make the best decision for the health of their children, but not all Australian state health departments and medical bodies are equally forthcoming with information for parents on the risks of circumcision and care of the normal (intact) penis.

What is male circumcision?

The word circumcision means “to cut around”. In male infants, circumcision is a surgical operation which involves tearing the foreskin* away from the glans (head) of the penis, clamping it and cutting it off. There are several techniques in use, but they all involve cutting, blood and removal of sensitive tissue. The skin of the penis is a complex movable sheath with no clear indication of where it should be cut during a circumcision. This means that the amount of foreskin removed from one operation to the next can be very different, and no two circumcisions are the same.

Why do you Circumcise?

Parents may choose to circumcise their son for religious, cultural, traditional reasons but possibly to look like other male members of their family. There have been increasing claims over recent years for the health benefits of male circumcision.

Existing scientific evidence demonstrates a circumcised penis is far easier to clean for the remainder of a males life.  Males who have undergone a circumcision are ten times less likely to contract a urinary tract infection (UTI) along with the reduction of contracting Sexually Transmitted Diseases (STD’s) such as  HIV, herpes, syphilis and Chlamydia.

Medical condition or infection (phemosis) is another reason to do it for older children and adults

What are Contraindications to routine neonatal circumcision?

  • Hypospadias and other congenital anomalies of the penis. (Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urethral meatus (opening).
  • Family history of a bleeding disorder or an actual bleeding disorder.
  • Severely jaundiced (yellow) neonates.
  • Chordee (ventral angulation of the penis).
  • Sick and unwell neonates.

What are the risks of Circumcision?

  • Risk of bleeding
  • Risk of infection
  • Surgical mishap

The Procedure (Circumcision)

Circumcisions are performed by Dr David Easton , who has extensive experience in newborn circumcisions.

EMLA cream is applied approximately 30mins prior to the procedure, this has proven to be successful in decreasing pain during the procedure and for several hours post procedure.  All procedures are done under a local aneasthetic.  Dr Easton encourages parents to administer paracetamol post procedure should the baby require it.

How much will the procedure cost?

Please call one of our team on 1300 364 480 for pricing and to check your eligibility for medicare rebate

What do parents need to do post Circumcision to care for their baby?

The wound will be covered with a dressing which acts as a barrier between the wound and potential contamination by stools and urine. Leave the dressing around the shaft of the penis in place for 48 hours. Rarely one or two doses of infant paracetamol may be required. If there any problems or further questions please phone the surgery on the number in Contact Us. Healing time for the wound usually takes about 1 week.

Circumcision Video (3d)

Want to know more about circumcision click here for more info. See more at: http://www.wammed.com.au/Circumcision.aspx#sthash.WNeusQu1.dpuf

Does any medical organisation recommend circumcision of boys?

No medical organisation anywhere in the world recommends routine circumcision of boys. Many organisations state that there is no medical indication for routine circumcision, including the Royal Australasian College of Physicians, the British Medical Association, and the American Academy of Paediatrics.

Isn’t circumcision just a “tiny snip” with no risks?

The risks of circumcision include bleeding, infection, damage to the glans and frenulum**, excessive skin removal, scarring, loss of penis, and even death. Infant circumcision carries more risks than adult circumcision, as a baby’s penis is very small and difficult to operate on, and more penile skin is removed than in adults. Excessive tissue removal is a common problem, and this can cause painful erections and even restrict the growth of the penis at puberty.

Is circumcision necessary to prevent UTIs in infants?

Some research suggests that circumcised infants may have a lower incidence of urinary tract infections (UTIs). Approximately 0.188 per cent of circumcised infants and 0.702 per cent of intact infants develop a UTI. This difference is too slight to matter, and female infants have a far higher incidence of UTIs than circumcised or intact boys (5 per cent). Mothers will be happy to know that immediate breastfeeding protects male and female infants from such infections. If a UTI does occur, the most conservative treatment is with antibiotics and more rigorous follow-up in rare cases of recurrent infections. Chronic UTIs are often the result of abnormalities in the urethra or bladder which will usually require internal surgery.

Should a boy’s foreskin be retracted everyday for cleaning with soap and water?

The foreskin* of most newborn boys is stuck to the glans and cannot be retracted. Forcible retraction can result in tearing, scarring and infection, with the result that circumcision may become medically necessary because of the consequent damage. A boy will retract his foreskin when he is ready to do so, and it is normal for this to happen any time between the ages of 3 and mid-teens. After the foreskin has become retractable boys either know instinctively or can be shown how to gently retract and wash underneath it with water. Diluted soap can help with cleaning, but it must be thoroughly rinsed away so as to avoid irritation of the foreskin’s sensitive inner surface. Too much soap can cause skin problems, such as eczema, that used to be blamed on the foreskin.

Attachment Size
Infant male circumcision An evidence based policy statement.pdf 1.14 MB
circumcision a guide for parents.pdf 965.57 KB
have you heard about the benefits of circumcision.pdf 893.79 KB
sex and male circumcision what every woman wants to know.pdf 1.49 MB

We can help you, so don’t wait.