What is circumcision?
The practice of male circumcision has been around for centuries and may be performed for medical or non-medical reasons.
The World Health Organisation report estimates that around 30% of males in the world have undergone circumcision.
Circumcision rates Australia
Difference between infant, boy, and teen circumcision
Religious, social and cultural reasons
Male circumcision is an important religious practice for some faiths, such as Judaism, Islam, and some Christian communities. It is also an important non-religious cultural practice in some communities.
There is a lot of discussion and debate about the pros and cons of circumcision in the community. Even so, our practice respects the right of parents to choose to have their child circumcised for cultural or religious reasons. The procedure is offered in a safe and supported medical setting, with clear parental consent and appropriate after-care.
The Royal Australasian College of Physicians (RACP) Division of Paediatrics position statement acknowledges the benefits and risks of male circumcision. The RACP statement concludes that the evidence is not sufficient to recommend routine circumcision for all infant males. However, the statement supports that parents have the right to make their own choice about their children.
A significant number of children may require circumcision for medical reasons.
- Phimosis: Phimosis is when the opening at the tip of the foreskin is tight, and the foreskin cannot be retracted. Phimosis in infants and young children is often normal and physiological. As the child grows, the foreskin starts to retract further back naturally. However, the child should not have symptoms of pain, irritation or infection in the foreskin. At around age 7, boys should be able to retract their foreskin without difficulty.
- Balanitis and posthitis: Circumcision may be required to treat children in whom infection and inflammation of the foreskin and glans occur repeatedly.
- Balanitis Xerotica Obliterans (BXO): This is a progressive condition affecting the foreskin with chronic inflammation, and a dense, whitish thickening at the tip of the foreskin. Circumcision is the recommended treatment.
Circumcision has been shown to significantly reduce the risk of urinary tract infections in boys with urological problems associated with an increased urine infection risk. It also reduces the risk of infection in boys who experience recurrent urinary tract infections with no underlying urological anomalies.
Male circumcision is practised in Australia and around the world.
Parents have the choice to select male circumcision for their children.
There are social and medical reasons for male circumcision.
We offer circumcision for newborn infants under local anaesthesia. This is ideally done in the first few days of life. Under ultrasound guidance, local anaesthetic is administered to numb the circumcision site. Then the foreskin removal is performed surgically using soft tissue laser.
After 6 months of age or older, infants and children are more aware and mobile. Circumcision is then offered safely as a day procedure under a full general anaesthetic, and takes less than one hour.
Is circumcision recommended by doctors?
In Australia, both the benefits and risks of circumcision are noted. The evidence does not support routine circumcision for all male infants. However, there is a consensus that parents can decide what is right for their child from a religious, social or cultural point of view.
If circumcision is chosen for your child, then we are trained to offer the procedure in a safe and supportive paediatric surgical environment.
If circumcision is medically indicated for your child, we will discuss this with you. We will make recommendations based on what is medically in the best interests of your child.
Circumcision pros and cons
Less urinary tract infections, especially in the first year of life. (10-fold less).
Less local infection of the foreskin (posthitis) or the head of the penis (balanitis) (50% less).
Reduction in the risk of sexually transmitted infections including HIV (60% less), Herpes (31% less), and Human Papilloma Virus (33% less). HPV is the cause of genital warts in anyone, and of cervical cancer in women.
Reduction in sexually transmitted infections in female partners of circumcised men (Bacterial Vaginosis decreased 40%, Trichomonis decreased 48%).
Eliminates phimosis, an often painful inability of the foreskin to pull back over the penis.
Easier hygiene for circumcised vs uncircumcised penises.
Significantly reduced risk of cancer of the penis .
Some studies suggest less sexual dysfunction later in life.
No need to circumcise later in life when the risks are higher, costs are higher, and impact on patient is higher. It is estimated that between 6% and 10% of boys will require circumcision in their lifetime due to medical reasons.
Risk of bleeding. This is about 1%. Mostly this is a small amount of bleeding and it can be stopped with gently applied pressure by dressings. Rarely, there can be excessive bleeding that will require stitches. Very rarely, a blood transfusion may be required.
Risk of Infection. This is about 1% and is usually responsive to oral or intravenous antibiotics.
Suboptimal cosmetic outcome. Most often the circumcision heals with good cosmesis. Occasionally, either too much or too little skin is removed. Uncommonly, this can require a second surgery for a better outcome.
Meatal Stenosis. Uncommonly, the opening of the urethra on the head of the penis (glans) can narrow down after a circumcision. This is called meatal stenosis and it can be safely addressed by minor surgery.
Preputial adhesions. The shortened foreskin can occasionally reattach to the head of the penis.
Constricted, trapped or buried penis. Occasionally, as infants grow, the penis can develop a buried appearance. The circumcision scar can drape over the glans and constrict and tighten, trapping the glans behind it. This can usually be prevented by daily retraction of the penile shaft skin starting from 3 days after the procedure. If trapped penis does occur, it can be corrected by day-case surgery.
Trauma to the penis. Great care is taken to ensure there is no trauma to the penis during surgery. Rarely, the penis itself can be damaged by the procedure, requiring urgent surgical care at the hospital. Damage can be done to the urethra (the hole where urine comes out), the glans (the head of the penis), or the shaft of the penis.
Post-op care after circumcision.
For the first two to three days after the procedure, your child may require regular oral pain relief. These should be given as per the instructions on the medication bottle or packet.
The operation site will look swollen and bruised for up to three to four weeks after the procedure. The healing areas may develop scabs which will clear on their own. Blood spotting on clothing is normal for a few days after the procedure.
Please see the PDF attachment provided which explains the post-operative care in detail. It can be printed for easy reference.
How much does circumcision cost?
We strive to deliver the highest level of paediatric surgical service to families. All children, whether they are newborn, toddlers, young children or teenagers, deserve excellent support and care. As surgeons we believe that it is essential to address paediatric urology and surgical problems in accordance with world’s best practice.
If children require surgery, our role encompasses building a reassuring environment to prepare your family for the surgery, and of course to provide expert surgical care and follow-up. At WA Paediatric Surgery and Urology, both our surgeons and our team will be here to assist you with kindness and support.
Tongue tie surgery
Lip tie surgery
Groin & scrotum conditions
Foreskin & penile conditions
Contact our paediatric surgeons and urologists
Dr Andrew Barker
Dr Naeem Samnakay
85 Monash Avenue, Nedlands, WA 6009