Circumcision is a surgical procedure to remove the skin that covers the tip of the penis (the foreskin). The foreskin protects the sensitive glans (top of the penis) against urine, faeces, and other irritation and protects the urinary opening (urethra) against infection or scarring.

Circumcision may be done for medical reasons but is sometimes done for religious reasons (Jewish and Moslem faiths). Some cultures practice circumcision because they think the foreskin is unhygienic, unnecessary, or causes health problems. In certain religions and cultures, circumcision may be required for all males and the decision not to circumcise may cause social and personal problems.

Routine circumcision in babies is common in America where around 60% of males are circumcised but is not common in Europe. Globally, most men - over 80% - are not circumcised. Circumcision is not routinely performed in Ireland.

Does circumcision have any health benefits?

Medical opinion is mixed as to whether circumcision has any health benefits. Some studies show certain benefits, while other studies do not. The American Academy of Paediatrics says that the benefits of circumcision are not significant enough to recommend circumcision as a routine procedure.

Some of the health benefits claimed for circumcision include:

• Lower risk of cancer of the penis (an extremely rare cancer). However, good personal hygiene is equally protective.

• Reduced risk of some sexually transmitted diseases (STDs). Men who aren’t circumcised may be less likely to notice the symptoms of some STDs. However, infections such as penile warts and urethritis are more common in circumcised men, and yeast infections such as thrush affect circumcised and uncircumcised men equally. A man's sexual practices (e.g. if he uses condoms, if he has more than one partner, etc.) is more important in STD prevention than whether or not he is circumcised.

• Prevention of urinary tract infections during the first year of life. Most studies confirm this.

• Lower risk of HIV. Studies have produced mixed results.

• Reduced risk of cervical cancer in female sex partners. This has not been scientifically proven.

• Less penile infections. Keeping the penis clean can be just as beneficial as circumcision in preventing infections under the foreskin.

What are the medical reasons for circumcision?

Circumcision is carried out for emergency medical conditions and where other treatments haven’t been successful. Medically, the main reason for circumcision is because the foreskin is damaged or infected and won’t slide back over the head of the penis.

Phimosis

Phimosis is where the foreskin is very tight and can’t be pulled back (retracted) over the head (glans) of the penis. The foreskin can’t be retracted in boys up to about the age of five and this is normal. Parents shouldn’t try to pull it back because this can cause pain or injury. The majority of foreskins loosen naturally by the age of six.

Circumcision is not always necessary to treat phimosis; special creams are often prescribed that help loosen the skin and avoid the need for circumcision. Circumcision isn’t usually needed for phimosis under the age of six, but may be considered after this if the foreskin is damaged because of severe or repeated infections.

Paraphimosis

Paraphimosis is where a tight, retracted foreskin can't be pulled back down over the head of the penis. The foreskin forms a ring around the penis, cutting off some of the blood flow to the glans and causing it to swell and become painful.

Balanitis

Balanitis is inflammation of the foreskin or penis. Recurrent balanitis can lead to scarring and phimosis, and may eventually make circumcision necessary. Keeping the penis clean with soap and water helps reduce balanitis. Recurrent balanitis is more common in men with diabetes.

Penile cancer affecting the foreskin

Cancer of the penis (very rare) often starts on the foreskin, and circumcision may be necessary to stop it spreading.

Painful sex

Circumcision is occasionally indicated if a tight foreskin is making sex painful.

What does the operation involve?

Circumcision is usually a minor procedure and takes only about 5 to 10 minutes. Routine circumcision is usually performed on the first or second day after birth.

Babies who are circumcised are usually given a local anaesthetic in the form of cream or an injection into the penis. Older children and adults usually need a general anaesthetic and circumcision is generally a more complicated procedure.

Dissolvable stitches are normally used, and don’t need to be removed.

How long does it take to recover from circumcision?

Babies heal very quickly and usually recover in around seven to ten days. Healing is slower in older boys and men and can take up to three weeks.

• Painkillers (such as paracetamol or ibuprofen in babies) will need to be taken for at least the three days after the operation.

• In babies, nappies and urine can irritate the sensitive skin of the exposed glans causing soreness. Applying petroleum jelly will help this.

• Gently clean the area with water every day and whenever the nappy area becomes soiled.

• The penis will be red and swollen for a few days after circumcision and loose clothing is advisable.

Make sure your child does not ride a bike or use other sit-on toys until the swelling has completely settled. Children should be able to return to school about a week after being circumcised.

Consult your GP if:

• There is bleeding from your child’s penis
• Your child’s penis stays swollen after two weeks
• Your child still finds passing urine painful a few days after the operation
• There is a yellow discharge from the wound
• Your child has a fever or appears ill.

What are the risks of circumcision?

Complications after circumcision are low but like all operations, there are certain risks.

• These include:
• Bleeding
• Infection
• Pain
• Decrease in sensation (feeling) in the penis
• Damage to the urethra (urine tube in the penis) causing the urine tube to become narrow and making it hard to pass urine
• Other surgical accidents/hazards of general anaesthesia
• Scarring

Circumcision done in a non-medical setting is extremely dangerous and death from bleeding can occur.