Circumcision

Elective circumcision is not available in public hospitals, including children's hospitals, in NSW.

Circumcision is an operation where the foreskin is cut off, the fold of skin that covers the tip of a boy's penis. Circumcision may be done for cultural or religious reasons. It is rarely needed for medical reasons. The risks of routine circumcision are believed to be greater than the potential benefits (see the Royal Australasian College of Physicians guidelines).

In Australia, boys are not routinely circumcised unless it is requested for religious or cultural reasons.

The foreskin

The foreskin covers the tip of the penis (glans). It extends from the skin that covers the shaft of the penis and has a thinner and more sensitive inner surface that is attached to the shaft where it joins the glans. As well as its sensitive inner surface, the foreskin protects the tip of the penis. Under the foreskin, the skin of the glans is thin and moist.

When a boy is born, the inner layer of the foreskin is normally stuck to the glans and the foreskin cannot be pulled back (retracted). As the boy grows, the inner skin separates and the opening becomes more elastic so that by the time he is fully grown he should be able to retract it without discomfort. Some boys can do this by the time they are three to four years of age. Others may not be able to do this until puberty. As the foreskin separates, dead skin cells form collections of white material under the foreskin (smegma) which may look like cysts. This is normal.

Hygiene

With normal personal hygiene, the circumcised penis is no cleaner than the uncircumcised penis.

Urine infection

Some research in North America has shown that boys, who were circumcised as small babies, have less chance of developing urinary tract infections in the first year of life than those who are uncircumcised (there is no difference in older boys). However, the numbers of uncircumcised boys who will get urinary infections is small. If 1000 well boys are circumcised, 8 infections will be prevented, but 20 will have a complication related to the circumcision. So the risks of circumcision surgery outweigh the benefits. In those boys with an underlying urinary tract problem, circumcision has been shown to reduce the risk of recurrent urinary tract infections, particularly if still in nappies.

Sexually transmitted diseases

It is unclear whether the risk of getting a sexually transmitted disease is altered by circumcision. What we can be sure of is that circumcision does not guarantee protection from infection. Normal safe sex practices must be used to prevent sexually transmitted diseases.

Penile cancer

Penile cancer is an uncommon disease of elderly men. It is very rare in either circumcised or uncircumcised men who practice good hygiene.

Risks of the Circumcision

Even with the most skilled and careful hands there are small incidence of risks from both the operation and the general anaesthesia. There is a risk of bleeding and infection following the operation. The risk of death or serious disability due to general anaesthesia is 1:80 000. Very rarely the penis may be permanently damaged. After circumcision, irritation of the exposed penis tip can cause narrowing of the urine opening (meatal stenosis) that may require further surgery. About 5% of children who have been circumcised require further surgery to correct problems it causes.

If you decide to have your boy circumcised

The Australian and New Zealand Association of Paediatric Surgeons (ANZAPS), the Australasian Urological Society and the Royal Australasian College of Physicians (RACP) do not recommend that boys be circumcised routinely. However, if you want your son circumcised, it should be done under a general anaesthetic by doctors with the appropriate skills. Thus it is recommended that you wait until he is at least six to 12 months old because the operation and anaesthetic are safer then. If you want more information you should discuss the risks and benefits of circumcision with your doctor.

Elective circumcision is not available in public hospitals, including children's hospitals, in NSW.

Circumcision for medical reasons

Very few boys need circumcision for medical reasons. However, recurrent infections under the foreskin (balanitis), or abnormal tightness of the foreskin (phimosis) may lead to the operation being recommended. If you think that your boy has a medical reason for circumcision, discuss this with your doctor. Usually foreskin problems can be treated without the need for an operation.

Summary

Most doctors feel that routine circumcision of boys is not necessary. If there are religious or cultural reasons for this, it is better performed after six to 12 months of age by an experienced surgeon, under general anaesthetic given by a suitably trained anaesthetist.

• Circumcision may be requested for cultural or religious reasons.
• Circumcision is rarely needed for medical reasons. There are often other treatments available.