Newborn Male Circumcision

Question 1

What is the rate of circumcision in Canada at present?

Answer 1

32%

Question 2

When would you expect the foreskin to separate?

Answer 2

The foreskin separates gradually.
by 6 years - 50% of boys can retract the foreskin
By 17 year - 97 % of boys can retract foreskin

Question 3

What are the symptoms of a nonretractile foreskin?

Answer 3

poor urinary stream

Question 4

What is circumcision?

Answer 4

partial or complete removal of the foreskin

Question 5

What is phimosis?

Answer 5

Scarring and thickening of the foreskin that prevents retraction back over the glans

Question 6

Why does phimosis occur?

3

Answer 6

recurrent infections
inflammation
lichen sclerosis

Question 7

What is posthitis and how do you treat it?

Answer 7

It is the inflammation of the foreskin, frequently associated with inflammation of the glans (balanoposthitis).
Both conditions resolve with medical therapy: topical steroids BID to the foreskin with gentle traction.

➡️ thins the tissue and release the adhesions

Question 8

How effective is medical treatment of posthitis?

Answer 8

works in 80%

Question 9

Is there anything you can do to hasten retraction of non-retractile foreskin?

Answer 9

you can use the topical steroid

Question 10

Why do uncircumcised kiddos get UTIs?

Answer 10

because the preputial sac provides an environment for colonization of the urethra with uropathogenic organsism that can cause UTIs

Question 11

How frequently does a UTI cause renal scarring?

Is this important?

Answer 11

15%

No current evidence that these renal scars cause HTN and renal impairment

Question 12

Why are uncircumcised kids at a higher risk of HIV

Answer 12

theory: the inner surface of the foreskin is rich in Langerhans and other HIV target cells

Question 13

Does circumcision lower risk of HIV?

Answer 13

unclear. There are studies in the developing world that show a decreased risk in circumcised males in heterosexual sex. It is unclear though if these finings can be applied to the developed countries where routes of transmission are MSM (46%) and IVDU (13%)

Question 14

Does circumcision decrease the risk of male to female transmission of HIV?

Answer 14

No evidence. The only evidence is for female to male transmission

Question 15

Is circumcision protective against Gonorrhea or chlamydia

Answer 15

No

Question 16

What STIs is circumcision potentially protective against?

Answer 16

HPV
HSV 2
Trichomonas vaginalis, BV and ulcer

Although all evidence is controvercial

Question 17

Are there any cancers that are decreased with circumcision?

Answer 17

Squamous cell carcinoma only occurs in uncircumcised men (especially with phimosis)
Maybe a reduced risk of cervical cancer, but hard to know how the HPV vaccination will affect this

Question 18

What are the risks of circumcision?

Answer 18

Pain –> ? long term changes to pain response
minor bleeding
local infection
cosmetic stuff

severe: partial amputation, death from haemorrhage or sepsis

Late: meatal stenosis and adhesives (rarely need steroids or surgery)

Question 19

What is the complication rate of circumcision

Answer 19

In neonates: 1.5%

Childhood: 6%

Question 20

Can you prevent meatal stenosis as a late complication?

Answer 20

Yes by applying petroleum jelly to the glans x 6 months

Question 21

Is there a negative impact on sexual function with circumcision?

Answer 21

no evidence

the foreskin has an abundance of sensory nerves

Question 22

Is there anyone who should NOT get a circumcision

Answer 22

hypospadias

bleeding diathesis

Question 23

Which kids get circumcised later in life?

Answer 23

Phimosis
paraphimosis
balanoposthitis

Question 24

Should all kids be circumcised

Answer 24

no.

need to consider pros and cons for each individual kid

Question 25

List the benefits of circumcision

Answer 25

UTI reduction
Penile cancer reduction
STI reduction: HIV, HPV, HSV 2, BV, trich vag
cervical cancer reduction