Rarely has a topic like circumcision generated such a heated and contrasting debate of opinion. Every pediatric surgeon and urologist will face this topic almost daily, from parents of children seeking advice, to parents wanting to change the appearance of their child’s genitals, to pediatricians debating the pros and cons of this procedure of ancient origin.
Even in the last 30 years, the American Academy of Pediatric Work has made three different recommendations for the treatment of circumcision.
The indications for circumcision vary, with some suggesting that circumcision may reduce the incidence of penile and cervical cancer. However, there is also information that there is no significant difference between Israel, where circumcision is routinely performed, and the Nordic countries, where circumcision is not universally practiced and where the standard of living is high, where the incidence of both cancers is low. It has been suggested that circumcision reduces STD transmission, but there is a lack of substantial clinical data to support this. The advantage of circumcision is that it reduces urinary tract infections, especially foreskin infections and priapism, but after all, it is a surgical procedure, and there is still debate about the benefits of the procedure compared to the surgical risks it entails.
The definition of prepuce is a narrow foreskin opening where the foreskin cannot be flipped to reveal the head of the penis Physiological prepuce is seen in almost every normal newborn and infant. When a child is born, the foreskin opening is small but the skin is normal and elastic, and the foreskin is attached to the head of the penis. Generally after 4 years of age, due to the growth of the penis and the head of the penis, the foreskin can retreat upward on its own, and the exposed foreskin can reveal the head of the penis.
For those who have symptoms, you can also repeatedly try to turn up the foreskin first, in order to expand the foreskin mouth. The procedure should be gentle, not overly eager to retract the foreskin up. And when the head of the penis is exposed, the foreskin should be restored. Most children treated by this method can be cured as they grow older, and only a few need circumcision.
The current consensus absolute indications for circumcision are: 1. fibrous narrow ring at the foreskin; 2. recurrent episodes of penile head circumcision For narrow foreskin after the age of 5, the foreskin cannot be retracted to reveal the head of the penis.