circumcision-in-children

Childhood Circumcision (Childhood Foreskin Removal)

What is the foreskin?

The foreskin is the skin that covers the glans of the penis. All normal newborn males have their glans covered by the foreskin, which does not necessarily mean the foreskin is too long. On the contrary, if the glans is exposed at birth, it could be a sign of hypospadias. After the age of 5, the front part of the glans will start to become exposed when the penis is erect, but it's not until around 14-16 years of age, during puberty, that the adhesions between the glans and the foreskin will completely separate. During puberty, male hormones peak, causing rapid growth of the penis and frequent erections, which naturally lead to the separation of adhesions. Therefore, before puberty, the foreskin will no longer completely cover the glans.

The foreskin can develop abnormalities, such as a tight foreskin. When the foreskin is pulled back, it may get stuck at the narrow point, only allowing a small part of the glans to be exposed. This condition is known as "phimosis." If a male still has this condition at the age of 14, it can be considered phimosis, which, if not treated promptly, may affect daily life.

Common Foreskin Problems

Tight Foreskin
In cases of a tight foreskin, pulling back the foreskin can cause pain around the base of the penis. Additionally, discomfort or pain during erections can affect future sexual activity.

Urinary Tract Infections
Some congenital conditions like vesicoureteral reflux, posterior urethral valves, and ureteropelvic junction obstruction can increase the risk of urinary tract infections. For male infants, the space between the foreskin and the glans can harbor bacteria, potentially leading to retrograde urethral infections.

Balanitis Xerotica Obliterans (BXO)
BXO occurs on the glans and foreskin, characterized by progressive hardening and shrinking of the tissue, sometimes resembling lichen sclerosus et atrophicus. It commonly appears around 9-10 years of age. Patients mostly exhibit no symptoms, but those with significantly narrowed urethral openings may experience difficulty urinating.

Recurrent Balanoposthitis
The primary cause of recurrent balanoposthitis is excessive foreskin or phimosis, coupled with improper daily hygiene leading to smegma accumulation, which can breed bacteria and cause infections.

Culture, Tradition, and Religion
Some religions such as Judaism and Islam require male infants to undergo circumcision.

Benefits of Circumcision

The benefits of circumcision include reducing the risk of urinary tract infections and inflammation in children, lowering the risk of developing phimosis, reducing the risk of penile cancer, preventing urinary issues due to a narrow foreskin opening, easier observation of genital abnormalities, and avoiding potential impact on future sexual activity.

Reducing the Risk of Urinary Tract Infections and Inflammation in Children
After circumcision, genital hygiene becomes easier, reducing the chances of inflammation between the foreskin and glans and preventing bacterial buildup that can lead to retrograde urinary tract infections.

Lowering the Risk of Phimosis
Phimosis can cause narrowing of the urethral opening due to the development of phimotic balanitis, affecting urination. Circumcision can lower the risk of developing phimosis.

Lowering the Risk of Penile Cancer
Circumcision can reduce the risk of penile cancer, which is often associated with repeated inflammation from bacterial irritation under the foreskin. Symptoms of penile cancer include bleeding, pain, discharge with a foul odor, or ulcers. However, since the penis is covered by the foreskin, early signs of the disease can be easily overlooked, and these symptoms can be similar to those of some sexually transmitted infections, requiring a biopsy for confirmation.

Preventing Urinary Issues Due to a Narrow Foreskin Opening
An overly long foreskin can narrow the opening, obstructing urination and potentially leading to inflammation in the urethra, bladder, or even the kidneys. Removing the foreskin can prevent this problem.

Easier Observation of Genital Abnormalities
Removing the foreskin makes it easier to observe any abnormalities in the genital area. Risks associated with circumcision include the risks of anesthesia (local anesthesia for adults, general anesthesia for infants), wound infections, persistent postoperative bleeding, penile adhesions, and excessive removal of the foreskin leading to painful intercourse.

Avoiding Impact on Future Sexual Activity
The foreskin contains numerous nerve endings that are important for a child's future sexual life. Removing excess foreskin can prevent any impact on a child's future sexual activity. Generally, during circumcision, some portion of the foreskin should be retained, making post-circumcision care crucial. Children should be instructed to pull back the foreskin daily to expose the glans, as the circumcision wound, like any other wound, tends to contract. If the wound contracts in front of the glans, it could potentially lead to a recurrence of phimosis.

Comparison of Circumcision Surgical Treatments

Circumcision surgical treatments may include conventional circumcision and laser circumcision. Here are details about these two procedures:

Circumcision Surgical Treatment	Details
Conventional Circumcision	Conventional circumcision involves surgically removing excess foreskin.
Laser Circumcision	Laser circumcision involves using heat energy to remove excess foreskin.

Frequently Asked Questions

Last updated: July 2021
Please note that all medical health articles featured on our website have been reviewed by Chiron Medical doctors. The articles are for general information only and are not medical opinions nor should the contents be used to replace the need for personal consultation with a qualified health professional on the reader’s medical condition.