Question 1

Which Babies are Eligible?

Accepted Answer

Circumcision, yes or no. It is an emotive issue. Overall, the pros (in favour of) and cons (reasons not to do it) are about equal.My view is that it is not wrong to perform a newborn male circumcision, nor is it wrong not to perform a circumcision. There are however times when circumcision cannot be performed (when it is contraindicated).If you have decided to proceed, then please note the following:●     Male newborn circumcisions only.●     Only for newborns who are four weeks of age or younger.
        That is, up to 4 weeks of age MAXIMUM (see below if premature).●     Please don't ring the surgery enquiring about the procedure for older babies, children, teenagers, or adults.●     The earlier the procedure is done the less pain and the fewer the complications.●     If baby was premature (born before 37 weeks) then up to 4 weeks, corrected.To calculated the corrected age for a premature baby, take how many weeks of prematurity from the baby's current age. For example; Your baby was born at 34 weeks, it was 6 weeks premature (40w - 34w). If your baby is now 8 weeks old, then its corrected age is 2 weeks (8w - 6w).

Question 2

When cant it be performed?

Accepted Answer

The procedure should not be performed if:●     Premature infant (until the baby is the equivalent of 37 weeks)●     Baby weights less than 2500gms●     During a significant Neonatal illness●     In the presence of bleeding disorders or a significant family history of bleeding disorder.●     If there is a Hypospadias; The hole at the end of the penis (Urethra) is abnormally placed.●     If baby has a Myelomeningocoele (spina bifida)●     In the first 24 hrs of life.If you are unsure, please ask your paediatrician or GP.If you wish to proceed with your son's circumcision, it is your responsibility to read and understand the consent information and after care instructions before you proceed

Question 3

Advantages (Pros)?

Accepted Answer

Some of the arguments FOR Circumcision are....●     Decreases the incidence of urinary tract infections (UTI). In un-circumcised infants there is a 10-12 times increase in the risk of UTI. If a child has a UTI in the first year of life there is a higher risk of kidney failure, meningitis, bone marrow infection, and even death.
●     Decreased incidence of phimosis (inability to retract a tight foreskin), balanitis (inflammation of penis), and paraphimosis (constriction of the penis by a tight foreskin). Up to 18% of boys may develop one of these problems by 8 years of age. The chance of these problems occurring in circumcised boys is virtually nil.
●     In Africa the risk of catching HIV is less, but this may or may not be true in Australia.
●     Decrease incidence of problems with erections at puberty
●     Decrease in urological problems and infections in older men
●     Elimination of the risk of penile cancer in later life if circumcision is performed in the newborn period. However, penile cancer is extremely rare in uncircumcised males in the Western world (about 1 in 100,000).
●     Possibly a decreased incidence of Sexually Transmitted diseases (Gonorrhoea, Syphilis, Genital Herpes or warts).
It should be noted that the risk of operative complications increases  if the procedure is performed in later life rather than the newborn period.
A percentage of males who are uncircumcised undergo circumcision in later life.

Question 4

Disadvantages (Cons) and Risks?

Accepted Answer

All procedures carry some risk, and that also applies to circumcision.Complications include:●     Pain during the procedure and shortly after is to be expected, despite all care and the use of local anaesthetic.●     Haemorrhage (Bleeding). This can happen up to 10% of the time. Most of the time it is managed with a dressing that is removed after two days.Sometimes Dr Bell may have to suture the edges.There is a small chance you may need to attend a public hospital and your baby may require surgical control of bleeding under anaesthesia (i.e. be taken to theatre and operated on by a paediatric surgeon). The risk of serious bleeding is less than 1%.●     Infection. That can be local (a wound infection) which is generally not a significant problem, or rarely infection can spread through the blood stream with serious consequences (eg. meningitis).●     Retained plastibell (the bell would need to be cut off. Anaesthetic not required).●     There may be parental dissatisfaction:○     Asymmetric removal of foreskin (that is, the cosmetic appearance is not to the liking of the parents)○     The length of the skin underneath the penis may be significantly shorter than along the top; this is most commonly because of the original difference in skin lengths but can be highlighted when the foreskin is removed.○     The length of residual foreskin may be greater than you anticipated (especially compared to children who have had a surgical removal of foreskin later in life under general anaesthetic).As for any wound or cut, other much less common complications may occur, namely:●     Meatal stenosis (tightening of the urethral tube)●     Avascular necrosis (death of tissue because of poor blood supply)●     Concealed penis (penis buried in the body because of adhesions/short penis/obesity)●     Cosmetic Disfigurement●     Difficulty repairing surgical Hypospadias (abnormally placed urethral opening) and/or penile chordee (abnormal curvature of the penis- which may not become apparrent until after the circumcision and/or until the child is older)●     Fibrous adhesions●     Urethro-cutaneous Fistula (urine comes out at an abnormal location)●     Cysts of the glans penis (the glans is the head of the penis)●     Fibrotic phimosis (ie. the residual foreskin tightens up and restricts the penis).●     Lymphoedema or elephantiasis (very rare fluid build up in the skin)●     Laceration of the penis or scrotum

Question 5

Other Sources Of Information?

Accepted Answer

The Royal Australian College of Paediatrics has a position statement that you may access via their website (http://www.racp.edu.au/hpu/paed/circumcision/index.htm). Some feel that the position statement is too negative (see Professor Brian Morris at www.circinfo.net).

Dr Peter Christopher Bell Obstetrician & Gynaecologist

Newborn Circumcision

circumcision

Who is eligible, pros, cons, cost, after care, more reading

Consent points

Booking form

eMail

print

Circumcision FAQ's

Which Babies are Eligible?

When cant it be performed?

Advantages (Pros)?

Disadvantages (Cons) and Risks?

Other Sources Of Information?

Newborn Circumcision

circumcision

Who is eligible, pros, cons, cost, after care, more reading

Consent points

Booking form

​eMail

print

Circumcision FAQ's

Which Babies are Eligible?

When cant it be performed?

Advantages (Pros)?

Disadvantages (Cons) and Risks?

Other Sources Of Information?

eMail