In the clinic, we often encounter such a situation: parents bring a young boy to see a doctor, saying that after the child receives a physical examination at school (or kindergarten), the parents receive a notice to go to a certain hospital to do circumcision, otherwise there is a risk of inflammation, affecting the development, etc.; but the elderly at home say that it does not matter, everyone did not do it before is fine. In the end, young parents are at a loss as to what to do.
In fact, it is not difficult to determine whether the foreskin needs to be removed. First of all, let’s understand the normal development process of the foreskin: when a child is born, the foreskin is attached to the head of the penis (glans), and the glans is usually not visible. If the child does not have difficulty urinating, it does not need to be treated. Generally by the age of 3 to 4 years, due to the growth of the penis and glans and erection of the penis, most children’s foreskin can recede upward on its own and the glans can be revealed by turning out the foreskin.
Some children have a very small foreskin opening, so the foreskin cannot retract, preventing the glans and even the entire penis from developing. The opening of the foreskin is like the size of a pinhole, so that it is difficult to urinate, and sometimes a small bulge is seen in the foreskin when the child urinates. In this case, before the child is 2 years old, you can try to turn the foreskin up repeatedly every day, so that the opening of the foreskin gradually expands to reveal the glans. Pay attention to the gentle technique when operating to avoid tearing the foreskin and causing bleeding. When the glans is exposed, clean the foreskin, then restore the foreskin, otherwise it will cause embedded prepuce.
If the foreskin can never be turned up, or if the foreskin can be turned up but often shows inflammation such as redness, swelling and pus, then circumcision should be performed. There is no strict age limit for the operation, some countries (ethnic groups) perform it right after the birth of the child, and some do not operate until the problem is discovered during the premarital examination.
We generally recommend early surgery for those with frequent inflammation, otherwise surgery can be performed on the affected child before puberty. One, because the penis is sensitive after puberty and is accompanied by erection, which increases the pain; and two, if other problems are found before puberty they can be treated with early intervention.