Circumcision for Older Boys

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Archived Q&A and Reviews

Questions

Circumcision for 9 year old? it hurts when he pees

May 2014

My 9 year old son is uncircumcised and his foreskin has not retracted. I have read everything I can find (including BPN) and I am comfortable with waiting for nature to take care of it ExCEPT that the opening is so small that it hurts him to go pee. The ointment is not helping after several weeks. The kaiser urologist is recommending circumcision (of course) but we don't want an unnecessary surgery. I know lots of people have gone through something similar, but what about the painful urination? There is ballooning when he pees, and spraying, but no infections so far. We are getting a second opinion from a different kaiser urologist tomorrow, but I fear that any surgeon will recommend circumcision. Also, our pediatrician is young and female so if anyone has a male kaiser doc to recommend, that would be helpful too. Thank you, BPN! Concerned mom

My son also had a foreskin which did not retract. His pediatrician watched for several years, but the situation did not resolve. Cream did not work. Finally he had a circumcision this year (He was almost 14). It bothered me greatly to have it done, but it was an easy recovery and I'm glad he won't have to worry about foreskin issues any longer. Now he matches his dad.

Sorry to hear this is happening for your son. Sounds awful! I don't have much to offer besides empathy and a doctor idea - my son sees Dr David Bacchus at Kaiser Oakland and he is great. GREAT. I would definitely feel comfortable talking to him and he is very understanding and flexible - I've never had him push anything on us. He will give his honest opinion and try to give you options and he respects what works for the family. Parker

I'm afraid I don't see the problem. Your poor son is having a dreadful, dreadful experience that sounds downright traumatizing. Hey, I'm all for not circumcising, I wouldn't have circumcised if I had boys, but if there were an issue, it's not like this is a major big deal either way, frankly. Snip it so he can pee in peace!

9 year old is worried about having circumcision surgery

Feb 2011

Our 9-year-old son was diagnosed with phimosis, where his foreskin won't retract. We tried cortisone cream twice in the past year, but it didn't work either time, so our son will be having a circumcision later this month. He is really distraught about it, and honestly, I am too. He is worried about the pain, but he's mostly freaked out about the idea of the general anaesthesia, of being put to sleep, etc. (this is also a personal fear of mine, so it's very hard for me to comfort him sincerely -- the idea of being put to sleep freaks me out too!). So I have two questions. First, has anybody out there had BTDT experience with a circumcision in a boy of this age -- anything we should know about the surgery itself, the recovery, any other ramifications? And second, I am worried about how the actual day of the surgery will go. I think there is a good chance he will refuse to cooperate when we get there, and/or get very emotional, and/or he might even physically try to ''escape.'' What can a parent do in this situation? The thought of restraining him while he is given medication to knock him out is really upsetting to me. Do doctors have to deal with this very often? Can anyone offer any advice or input about this? Worried for my boy

I am sorry that you and your son are experiencing so much anxiety regarding his upcoming surgery. Is his surgery scheduled to be done at Children's Hospital? I work in Surgical Services there, and we routinely prepare patients and parents prior to surgery, explaining what will occur on the day of surgery, how anesthesia will be administered, and what to expect post-operatively. If he is to have his surgery at Children's, you can call 510-428-3885 ext.2958 to schedule a Previw Clinic appointment. If his procedure is to be done at another facility, they may provide a similar service. Please feel free to contact me through the moderator if you have any questions. I would be happy to speak with you. Children's Hospital RN

So my husband is an anesthesiologist and being put to sleep is not remotely as scary as one thinks.A) I'm assuming you are doing this at children's hospital or have an anesthesiologist who works on kids? B) Your fear is your child's. Wrap your head around it and turn it into a positive. I would ask the doctor before the surgery what to expect pain wise post surgery and have everything on hand(ice packs, numbing cream)

I heard from a nurse who worked in a VA hospital that the men who had the procedure done after 18 had a painful recovery but I have no idea if that was for a few hours or a few days. Talk it through with your son. Explain that you are ok with it, he will be hooked up to all these cool machines to track his vital signs and in fact it might hurt a bit after wards but you will do everything in your power to alleviate the pain.

I'm also not opposed to outright bribing a kid into being brave and not screaming. When my then 5yo was sitting in front of Alta Bates with a band aid on half his face because the school called me and told me he needed stitches we had the following conversation,
''honey, does it hurt? Is that why you are crying?''
Snuffle, snuffle, NOOOOOOO!
''What is the problem then?''
snuffle, ''the lady in the office said I would need stitches, is that true?''
''Probably, yes you will need stitches.''
''Will it hurt?'' at this point I had two laser beams focused on me...
''Actually I had stitches in my forehead when I was your age and it hurt, but then it stopped. I will do everything within my power to make sure it doesn't hurt too bad.''
I could see the wail coming so then..''here's the deal, if you can be brave and hold still and not scream or be awful and make us all crazy, when we are DONE we will head to Teddy's Toy house and you can get whatever you want.''

Not a peep and yes I asked for ice, numbing cream and finally the injection that really numbs it, he was telling the doctor about his possible toy selections when the doctor tied the last knot... mom to five

I have a 9-year-old and I can imagine how anxious he would be about having surgery, so I hear what you're saying. My son requires a huge bandaid and a lot of consolation for every tiny scratch or hangnail. There would be a lot of drama about even just the mention of going to the hospital.

My suggestion for you is to try role-playing with your son. Say ''OK, you be the doctor and I'll be you'' and then ask him some questions that you think he might be worried about - going to the hospital, having surgery, etc. Then you could reverse roles and you be the doctor. I've been role-playing lately with my 9yo about potentially anxious situations at school and it really does help.

My other suggestion is: he may be picking up on your own fear and anxiety so you have to find a way to feel calm about this. Even though a hospital visit is always stressful, the procedure itself is not such a huge deal, and it can actually prevent disease. Maybe you can look at it that way and not feel so anxious about it. Ginger

Recent news about circumcision and our uncircumcised boy

Dec 2006

Have you all read the recent news about circumcision reducing the rate of HIV infection? What do you all think of that? We did not circumcise our son at birth, and now that he's in elementary school it's really hard to think of doing that. But the studies are compelling. I can't figure out what to think about it all. Anyone have clearer thoughts? anon

[Editor note] here is the Dec 14 article from the New York Times: http://www.nytimes.com/2006/12/14/health/14hiv.html?_r=1=1166763600=63d0bc374f64b201=5070=eta1 

"Circumcision appears to reduce a man's risk of contracting AIDS from heterosexual sex by half, United States government health officials said yesterday, and the directors of the two largest funds for fighting the disease said they would consider paying for circumcisions in high-risk countries." (see link for the rest of the article)

My thought is: safe sex is close to 100% effective (make sure partner has been tested AND use protection), and it doesn't require surgery! my two cents

I have three sons, all of whom are circumcised. If they were not circumcised, would I circumcise them now? Probably not. However, if anyone asked me whether to circumcise their infant son I would say defintely yes. We've known for a few years now that circumcised men have a lower rate of STDs and other infections. Their partners fare better too - studies (in Western countries, not developing countries) show that circumcision significantly reduces the rate at which men infect women with the virus that causes cervical cancer. Now, this dramatic news about reducing HIV risk. There's a long history of circumcision among Jews and Muslims - it isn't some new thing people just thought up for no good reason. I see a lot of good reasons for circumcision and I don't see the downside. For me, it makes a lot of sense. Mom of boys

I am a pediatrician who didn't circumcise her son either, and I wouldn't do anything differently as a result of this new research (and even if I were to have another son tomorrow, I still wouldn't circumcise him). To my way of thinking, these kinds of decisions always involve analysis of risks vs. benefits which may differ over time and from one situation to another... the prevalence of HIV in Africa is much higher than it is here. Also, as far as I know, a similar study has not been done in U.S., meaning that circumcision may not confer the same benefits against HIV here because the various epidemiological issues are so different. I would also worry about a false sense of security--meaning that a man circumcised for this reason might feel he can safely forgo condom protection, which is definitely not the case. Also, it's such an irrevocable thing-- once you remove the foreskin, it's pretty hard to restore (although there are those men determined enough to try). What if your son grows up to be a man who decides his foreskin might have been really useful and important after all, and is bummed because his parents took that decision out of his hands? MAYBE mass circumcision makes some sense in Africa as a public health measure to address the overwhelming AIDS crisis, but I believe making the decision to circumcise or not an individual boy should take into account local realities. anon

Think about why you didn't circumcise your son in the first place. (I didn't circumcise mine either) If you're that concerned about him getting HIV (or any other STD), at the appropriate time, teach him about safe sex and/or abstinence; both are more than 50% effective at preventing the spread and contraction of HIV without causing him any physical pain Grace

I am a scientist who works with several medical doctors who specialize in the infectious diseases of East Africa. I haven't read the studies myself but the information in the NYT article is very well presented and makes sense from a scientific point of view. Circumcision probably does decrease the spread of AIDS in Africa.

I am also a mother with an uncircumcised son. We decided not to circumcise him because frankly we just didn't care one way or another and figured if he decided he wanted to get circumcised he could do that, but if we had circumcised him he couldn't get uncircumcised later.

One thing to keep in mind is that circumcision would reduce the risk of contracting AIDS following UNPROTECTED sex. I think that your son and mine would benefit much more from being taught to always, always, always practice safe sex than they would benefit from circumcision.

Another thing to consider is that the rate of AIDS infection is astronomically higher in Africa than it is here. The risk of our sons contracting AIDS here is quite low, and if we teach them about safe sex it is very very low. By circumcising them, we might be reducing their risk of contracting AIDS by half but it might be more like reducing it from 0.0002% to 0.0001% rather than from 20% to 10%. (Note that I'm just pulling those numbers out of my head for illustrative purposes. I don't actually know what the risk of infection from AIDS will be in 15 years) Dr. Mom

I think that the news from Africa is significant, but I am not going to get my son circumcised as a result. My father-in-law sent us an article with the same question looming around it. I believe that when my son is old enough to be sexually active, we can let him know about the dangers (along with all of the other dangers of living) of HIV/Aids, if that will even be relevent in the US in fifteen years. We all make decisions with the best intentions given the information we have at the time. Anon

Considering circumcision for 4-year-old's recurring balanitis

June 2006

My 4 year old uncircumcised boy is having recurring balanitises (sp? balaniti?) and we're thinking about possibly considering circumcision. I really don't want to. My husband doesn't want to. My husband and other son are both intact and 1. We all think they should all be the same and 2. I really don't want to put him through the pain of surgery, which is one reason we chose not to do it in the first place. The problem is that we're having a terrible time keeping it clean, and teaching him to keep it clean. Whenever we go near ''the area,'' he practically freaks out and pushes us away. I can understand him not wanting to be touched, and feeling violated, but no matter how we try he doesn't understand that this needs to be done so that he doesn't have ''hot pee pee'' anymore (that's what he calls it. So sad!) Has anybody done this? Has anybody chosen curcumcision for an older child? Does anybody have any other suggestions? Thanks much Jill

My younger son had the same problem, if he went even a day without a good tub, he would get the infection. At first our doctor advised waiting it out, hoping the foreskin would become more retractable, but the sitiuation didn't improve. Finally when he was 7.5 we went to a urologist(this is all through Kaiser Oakland) who recommended a course of treatment with a particular cortisone cream, to reduce the scar tissue from previous infection( phimosis) and allow the foreskin to fully retract again- it was like a miracle- problem solved! He is now 9.5 years old and has not had an infection since the treatment almost 2 years ago! I don't remember the name of the cream but your doc. should be able to find it- it is well worth trying in order to avoid surgery,in my opinion! (By the way my son objected to the ''cream'' because he was afraid it would get him banned from his baseball team! He though he would get enmeshed in the Balco scandal by using ''steroid cream''!) Good luck- Susan

Good for you for wanting to keep your son penis ''as is'' and for looking for alternatives to circumcision. Our son is also intact and, while he hasn't had recurrent infections, he has always been very sensitive to anyone touching his penis, even himself. Does your son's foreskin retract at all yet? What we did at that age when we had to check his penis or treat it for something is tell him, while sitting in the bath, that either he had to pull back the foreskin or we had to. Sometimes we just had to repeat it, over and over. We wanted him to understand that it had to be done so that his penis could stay healthy. If he wanted to do it, fine. All he really had to do was pull it back and ''swish'' it around in the bathwater to get it rinse off. That was enough cleaning for him and for us. Better than nothing. Best of luck Ruth

Circumcision recommended for 2-year-old's Phimosis

February 2003

Our 2 year old uncirumcised son suffered an infection under his foreskin. Dr. Piser (urologist) labeled it a severe phimosis, and because he thinks it will recur, recommends circumcision as treatment. We are looking for alternative treatments. In the archives someone wrote in about using a steroid cream which softened the tissue and allowed it to retract. Any input on this subject would be helpful to us.

I am one of the parents who wrote in about phimosis treatments a few years ago. Our son was diagnosed with phimosis when he was about a year old. We saw two doctors--the first recommended circumcision; the second, Dr. Ngeyun at UCSF, prescribed the steroid cream. We decided to use the cream and it worked very well. Ater two years, our son has had no problems at all with recurring phimosis.

My main advice to you is to get a second opinion. Since the steroid cream has not been used as long in this country, not as many doctors know about it. In fact, when I later called the first doctor we spoke to and asked why he didn't prescribe it, he said he'd never heard of it! Try to find a doctor who does. The UCSF pediatric urology department had a very good staff, and Dr. Ngeyun was great to work with.

In the end, you may decide to follow the first doctor's advice. But if you get a second opinion, you will have more information to work with when you decide what to do. But I am very glad we were able to find a treatment that was non surgical. anon.

Our son's phimosis condition was so severe that his pediatrician sent us to the emergency room. At Children's Hospital, we were told that he would need an immediate circumcision. We were told that if the circumcision was not performed, he would have a recurring problem with phimosis.

He was about eight at the time and was very upset about the thought of his penis being circumcised (he was also very embarrassed by the whole situation). The doctor reluctantly agreed to continue trying to manipulate the foreskin back into place while our son was placed under anesthesia. She was very clear, however, that she did not expect this procedure to be a success and expected to have to perform a circumcision at that time.

It was a very anxious time as we waited. Afterwards, we were so glad that we had followed our intuition and our son's desire to remain uncircumcised. The procedure was a success and he never had another problem with phimosis. He is now 14. anon

Our son (10 months old) has seen several urologists and several pediatricians. One of the urologists has diagnosed him with phimosis. All of the other Dr.s vary in opinion between ''completely normal foreskin'' to ''somewhat tight''. The range of opinion is extreme. One common thread we keep hearing is that a boys foreskin is not really retractable until 3-4 years of age and up to that point it is in varying states of tightness depending on the individual. My advice: get a 2nd and 3rd opinion. Wait, if you and your Dr. are willing, until he is older to see if it changes on its own. Best of Luck.