Baby

Circumcision

No, it is not always useful and yes, it has some benefits. When performed on children older than two years old, circumcision (foreskin removal) may be relevant for two medical reasons. First, says Dr. Dickens Saint-Vil, paediatric surgeon and Director of the Paediatric Surgery Program at Sainte-Justine hospital, “It can be relevant for children who have a foreskin problem, such as phimosis (a narrow foreskin opening due to recurrent infections) or for those who suffer from repeated urinary tract infections.”

In infants less than eight weeks of age, circumcision is only performed for personal and religious motives, and under local anaesthesia. In children’s hospitals, children between eight weeks and two years of age are not circumcised because it would have to be under general anaesthesia and it is two risky for children under two years old, says Dr. Saint-Vil.

When parents want their child to undergo this surgery for personal motives, it usually is for religious reasons. “It happens a lot in Muslim families who believe it will make hygiene easier or simply because the father was circumcised”, explains Dr. Saint-Vil. This intervention, which is not covered by Quebec’s Health Insurance, can cost up to $1,800. When circumcision is performed for medical reasons, it costs $250.

Since the province of Quebec – and more specifically the metropolitan area – welcomes more and more families of different cultural communities, the number of circumcised babies, boys and young men rose considerably in the past few years. 

The operation and postoperative care

Performed in infants, circumcision is an operation lasting around twenty minutes. After restraining the baby and injecting an anaesthetic substance in the periphery of his penis, we place a bell-shaped plastic ring around the glans, under the foreskin, before cutting the foreskin. For boys over two years of age, the “bell” is not used; the surgeon removes the foreskin instead and stops the bleeding with stitches. This operation lasts about an hour. 

The foreskin is a mucous membrane that protects the glans, a very sensitive part of the male anatomy. Deprived of its natural protection during circumcision, the glans eventually becomes thicker and changes color to build a new form of protection.

Newborns, just as much as young children, experience pain after circumcision. Acetaminophen (Tempra and Tylenol for example) as well as EMLA cream can ease the pain but not completely, at least during the first 48 hours after surgery. The friction of the glans on the diaper or the underwear can obviously amplify the pain. You can apply Polysporin or Vaseline to ease the pain, recommends Dr. Saint-Vil.

« Do not wet the glans on the first day after surgery, he adds. It is best not to practice sports for at least two weeks to avoid possible hits“.

Risks

In Quebec, circumcision is mainly performed in paediatric hospitals or by paediatricians in regional hospitals for medical reasons.

Parents can have their newborn circumcised in private clinics where some paediatricians have a training certificate to perform the bell method. Because clinics are only allowed to perform medical treatments under local anaesthesia, they cannot perform circumcision in children over two years of age.

However, Dr. Saint-Vil warns that in clinical cases, circumcision sometimes shows the work of a specific paediatrician or doctor that adds to the risk of complications. Parents should imperatively enquire about the doctor’s skills before entrusting him with their child, says the paediatric surgeon.

When problems occur, the little patients often must be transported to the Sainte-Justine hospital.

The most common complication that doctors face is haemorrhage. “If the child is brought quickly, we can stop it. The other post-surgery risk is phimosis; too much skin is left around the glans and it ends up covering it. There is also a risk of burn and sometimes too much skin is taken off. It is then necessary to graft skin”, says Dr. Saint-Vil, mentioning that these incidents can lead to death.

These problems occur after 5% of the interventions performed in Quebec. In Sainte-Justine, at least one baby every month must receive a transfusion because of a haemorrhage caused by circumcision.

Benefits questioned

Circumcision slightly reduces the risk of penile cancer in adulthood. A circumcised man in a million is diagnosed with penile cancer every year while the proportion is three per million for men who have not undergone this operation.

Some doctors claim that circumcised men enjoy a greater protection against AIDS. “My opinion is that there are better ways to be protected against AIDS…”, replies Dr. Saint-Vil.

We often hear or even read about the link between circumcisions and enhanced sexual pleasure, it is a myth”, says the paediatrician.

In fact”, he concludes, “in the balance between advantages and disadvantages, the risks, the pain and the possible complications far outweigh the benefits of this delicate surgery”.

Parents who choose not to subject their baby to this must still clean their male organs, warns Dr. Saint-Vil. “They must also know that it is normal not to be able to pull the skin covering the glans before their boy is two years old. It is better not to try until he is nine months old. They can then progressively expand it by trying to pull down the foreskin”, he explains, noting that every parent should be able to replace the skin after the age of two and a half. And of course, you must clean the glans regularly with a washcloth.


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