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Circumcision - Child

What is it?

The delicate bulb end (the glans) of the penis is protected by a sleeve of skin called the foreskin. Usually the front of the sleeve of skin gradually frees itself from the bulb. It will pull back over the bulb by the age of three or four years. Sometimes the cuff of this sleeve is too long or too tight to allow the sleeve to pull back. This may cause ballooning and pain in the foreskin when your child passes water. Or it may cause infection which makes the foreskin red, swollen and painful. It is not the fault of either parent.


The operation

Your child will have a general anaesthetic and will be completely asleep. The narrow cuff of the foreskin sleeve is taken away. The remainder of the foreskin is stitched to the base of the bulb end of the penis. It will look as if the foreskin is always pulled back. A dressing will be put on the wound. Your child will then be woken up.


Any alternatives

If you leave things as they are, there is a roughly even chance that by the time your child is 16 the foreskin will stretch up. If your child gets repeated infections in the area of the foreskin, then the foreskin will get thicker and narrower and the problem will get worse and worse. This could lead to quite a lot of problems over the years. Simply peeling back the foreskin under an anaesthetic is worthwhile for a milder case. Sometimes a plastic ring is used instead of stitches.


Before the operation

Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that an anaesthetic can be administered safely. If your child has a cold in the week before admission to the hospital, please telephone the ward and let the ward sister know. The operation will usually need to be put off. Your child has to get over the cold before the operation can be done done because by having an anaesthetic the cold could turn into a serious infection in the chest. 

Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, your child may be checked for past illnesses and may have special tests to make sure that he is well prepared and can have the operation as safely as possible.. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You and your child will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for these checks.


After - in hospital

Your child may have some discomfort. If necessary he will be given a painkiller. A general anaesthetic will make your child slow, clumsy and forgetful for about 24 hours. With the support of the nurses you will be able to help your child with everything he needs until he feels better. Your child will be able to drink a couple of hours or so after the operation. He should be able to eat normally the next day. There will be a moist dressing on the wound probably held on with elastic net pants. You can take this off next morning. Leaving the wound open to the air after the first day helps healing. Once the dressing is out you can wash your child and there is no problem if soap and water come into contact with the wound. The wound is usually stitched with stitches that dissolve away after about 10 days. There may be some swelling of the surrounding skin which improves in two to three days. This is to be expected and you should not worry about it. After 7 to 10 days slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line, but these settle down after discharging a blob of yellow fluid for a day or so. If the foreskin has to be freed from the bulb of the penis at the time of the operation, there is usually some grazing of the bulb. This scabs over and may take 10 days or so to flake off. Usually you can take your child home the same day. You may be given an appointment to bring your child to the outpatient department after leaving hospital. Sometimes the family doctor handles the check-ups.


After - at home

Your child may need frequent sleeps for a day or two. There is no need to limit what your child does as long as he takes precautions not to damage the the wound area. It is better not to put dressings on the wound since they can be painful. Let your child go about without pants if clothing is uncomfortable. You can give your child a bath each day. Salt water is not necessary. There is no need to try to wash the crusts off. If your child goes to school he can return to lessons in 10 days or so. He can restart any sport in one month.


Possible complications

As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he can have the operation in the safest possible way and will bring the risk for such complications very close to zero. 

Occasionally the stitches stay in for more than 10 days. This is not something you should worry about. As long as the stitches are comfortable they can be left in until they drop out. 
The wound may look a little lumpy at first with some bunching of the skin. This settles down in a month or so. 

The chance of complications according to the most reliable studies is between 2 and 10%. If you think that all is not well, please let the doctors or the nurses know. The commonest complications are bleeding and infection. Bleeding is usually stopped by applying some extra pressure on the side of the wound. Very rarely, your child will need another operation to stop the bleeding. Local infection on the area of the wound can happen and is usually well controlled by taking antibiotics for one or two weeks. 
Other complications happen very rarely and include: 
• not removing enough foreskin (incomplete circumcision) 
• removing too much of the foreskin 
• removal of more foreskin in one area compared to another resulting in bending of the penis to one side 
• necrosis of the skin of the penis or the tissues under the skin 
• damage (trauma) to the glans 
• trauma of the urethra (the pipe that drains the urine from the bladder through the penis to the outside). 
• If any of these very rare complications happen, your child will need another operation to fix the problem.


General advice

These notes should help you and your child through the operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

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