Dear Dr Ombeva,

I was talking to a colleague who was wondering when is the best time to circumcise her son considering it’s not part of their culture and they are not big on doing a ceremony afterwards. In fact, they want to do it quietly because of stigma.  Can you explain the circumcision procedure, the pain and how long it takes to heal and compare when a child is older and younger or even an infant.


Dear Mary

Circumcision is the surgical removal of the skin covering the tip of the penis. Circumcision can be done at any age after birth, though its more complex in babies. The benefits of circumcision outweigh the risks. Circumcision can also be a matter of family tradition, religious teaching, personal hygiene or preventive health care. Sometimes there’s a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans.

It is recommended for older boys or men to reduce the risk of certain sexually transmitted infections, since circumcised men might have a lower risk of contacting certain sexually transmitted infections, including reducing risk of sexually acquiring HIV by more than 60 per cent.

Circumcision is associated with decreased risk of urinary tract infections, which are more common in uncircumcised males. It leads to prevention of penile problems, since the foreskin on an uncircumcised penis can be difficult or impossible to retract causing swelling and pain called phimosis that causes inflammation of the foreskin. Circumcision is associated with decreased risk of penile and cervical cancer, which is less common in circumcised men; and cervical cancer is less common in the female sexual partners of circumcised men.

Due to increasing risk of infection if not done in sterile and hygienic conditions, and the fact that some patients may have underlying medical problems, circumcision should be done in a health facility, and might not be an option if certain blood-clotting disorders are present. In addition, circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery. Circumcision doesn’t affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners. The most common complications associated with circumcision are bleeding and infection. Side effects related to anesthesia are possible as well.

Rarely, circumcision might result in foreskin problems, where the foreskin might be cut too short or too long; or the foreskin might fail to heal properly or the remaining foreskin might reattach to the end of the penis, requiring minor surgical repair. Newborn circumcision is often done in the hospital nursery, usually within one to 10 days after birth.

Two main methods have been recommended, either use of a special clamp or plastic ring, especially in young babies; or the more traditional method for older boys and adults, where the procedure might need both cutting and suturing, to prevent excessive bleeding.

When was the last time you wrote someone a letter on paper?