Circumcision

Dr Chris Threatt is a board-certified urologist who has been performing circumcisions since 2002. He completed his medical degree at the University of California, Irvine School of Medicine and residency program at Duke University Medical Center. He joined UCSF and Freyja Clinic in 2019 and works with the obstetricians and pediatricians to treat the whole child. Dr Threatt performs newborn circumcisions at Sequoia Hospital after delivery as well as in our clinic. He has worked at Sequoia Hospital’s newborn nursery for almost 20 years.

If you would like a predelivery consultation in person or by zoom, we would be happy to schedule at 650-568-1662.

What is circumcision?

Circumcision is the removal of the foreskin that covers the tip of the penis. After circumcision, the tip of the penis is always uncovered.

How should I decide if my child should be circumcised?

For many new parents, whether or not to circumcise their baby is a hard decision.
This handout answers some of the common questions parents have about circumcision. If you need more information, schedule a consultation with us.

Risks of circumcision
The risks of the circumcision procedure include:
• Infection
• Bleeding
• Pain
• Injury to penis

These risks are small, Dr Threatt’s complication rate is less than 1 percent. Some studies have reported equal sensation between circumcised men and uncircumcised men and no decrease in sexual functioning with circumcision.

Benefits of circumcision
The long-term benefits of circumcision include:
• Lower risk of cancer of the penis.
• Lower risk of bladder or kidney (urinary tract) infection.
• May help prevent sexually transmitted diseases, such as HIV.

However, these long-term benefits are small:

• Cancer of the penis is very rare (only one in 100,000 men). This risk can also be reduced with regular cleaning of the penis. The American Cancer Society does not recommend circumcision for protection against penile cancer.
• Urinary infections are also uncommon; only 1 percent of uncircumcised boys get a bladder or kidney (urinary tract) infection.

Other things to think about
The American Academy of Pediatrics “evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.” https://publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement

The decision to circumcise your baby is a personal choice. The latest statistics show that just over half of baby boys in the United States are circumcised.
If you decide to circumcise your baby, having the procedure done when he is still a newborn is best. Circumcising your baby after the newborn period has more risks, because general anesthesia is needed. Five to 10 percent of boys are circumcised after the newborn period. The most common reasons for having a circumcision later on are:
• Parents change their minds; or
• The baby has problems related to his foreskin.

How is circumcision done?
Infants must be stable and healthy to be circumcised in the hospital. If delayed due to infant health problems or parental indecision, the procedure may be done in the clinic. There are several methods of circumcision.

The three most common methods are the Plastibell, Gomco, and Mogen methods. Dr Threatt performs the Gomco Method. At the start of the procedure, a nerve block is performed with 1% lidocaine. This provides your newborn with minimal discomfort during the procedure and for pain relief that lasts several hours after the circumcision is completed. A sucrose pacifier may also be given to your baby for pain relief. The pain after surgery usually does not last more than a day.

The Gomco and Mogen Methods
The foreskin is removed from the penis using the Gomco or Mogen devices. These methods do not use a plastic ring.

Care of the circumcised penis
For the Gomco or Mogen Methods:
• Use generous amounts of petroleum dressing of choice every diaper change for the first 5 days.
• Clean your baby’s penis by gently washing with water and/or mild soap after bowel movements during diaper changes.

Care of the uncircumcised penis
If you decide not to circumcise your baby, taking care of his penis is easy. You do not need to retract (pull back) the foreskin to clean it for the first year of life. After 1 to 2 years of age, you can retract the foreskin partially for cleaning. Never force the foreskin back, just gently pull it back and clean with soap and water. When your child is 5 or 6 years old, teach him to do this himself when he takes a shower.

Many times, the foreskin cannot be fully retracted until your child is a teenager; this is not a reason to worry.

When to call for advice
Call Dr Threatt if you notice your baby has any of the following after circumcision:
• More than a few drops of blood on the penis.
• Redness, pain, and swelling around or on the penis after the first couple of days.
• A fever (more than 100.4ºF rectal).

Instructions for scheduling in the hospital
After the delivery of your son, notify the nurse that Dr Threatt is your urologist and that they need to contact him to schedule the procedure. It is best to notify nursing on admission the day of delivery. Do not hesitate to contact the office with any questions or concerns.