The penis. The evocation of the word can of course lead to schoolboy sniggering, but even many adults find it difficult to discuss the subject.
However, discuss it we shall, and as a pediatric urologist I often do. The reason for this is that there is an array of issues – some more concerning than others – that parents of newborn boys should be aware they may need to deal with.
Circumcision
The first of these is the question of circumcision. This procedure can be safely completed at any time, though typically it occurs shortly after birth – usually while the baby is still at the hospital or, in the case of many Jewish families, generally on the eighth day after birth during a bris ceremony. Muslims generally hold a similar ceremony, khitan, at different ages depending on their local customs.
Debate has gone back and forth over whether the medical community should encourage circumcision or not. Due to cultural and familial preferences involved, the American Academy of Pediatrics (AAP) has maintained the medical benefits of circumcision outweigh the risks – but it neither promotes nor opposes the practice.
We at Montefiore Einstein and White Plains Hospital are in compliance with the AAP on this, with the following notes:
- Different studies estimate a 75%-90% lesser chance of a circumcised boy developing a urinary tract infection (UTI) during infancy
- Some evidence indicates that newborn circumcision can lessen the chance of developing penile cancer, which typically takes place in the foreskin. However, the risk of developing that cancer in the U.S. and other developed countries is very low for circumcised and uncircumcised alike.
Potential risks include bleeding and/or infection, as with any surgery; the removal of too much (or too little) skin; and irritation of the tip of the penis, which can affect the urinary opening and lead to UTIs.
Hypospadias, Torsion and Chordee
A less familiar term for parents is hypospadias, a birth defect where the opening of the urethra is on the underside, rather than on the tip, of the penis. This is relatively common – taking place in approximately 1 of every 150 children assigned male at birth.
Sometimes related conditions such as penile torsion or chordee may be present. Torsion is when a baby’s penis appears rotated or twisted, usually to the left; typically this does not present a problem for the baby and is not even detected until a circumcision is performed. If the parents prefer, a penile torsion surgery can be performed at 6 months, which essentially involves readjusting the urethral opening from a “3:00” position to the standard “6:00” position.
Chordee is a condition where the head of the penis curves downward or upward where it meets with the shaft. As with most torsion and hypospadias cases, chordee does not necessarily present problems at a young age; unlike the others, an untreated case may inhibit sexual function later.
While corrective surgery for these conditions is often low impact, in some cases multiple surgeries may be required to decisively address the situation. A six-month interval between surgeries is usually observed.
Again, as with many pediatric surgeries, the earlier the better; additional complications can arise as one matures. I recommend a thorough physical exam of all babies, circumcised or not, to catch the above problems sooner rather than later.
After all, when it comes to your child’s health, you can never be too careful.
Dr. Amanda C. North is Chief of Pediatric Urology and an attending physician at the Children’s Hospital at Montefiore (CHAM). To make an appointment, call 914-849-5437.