Circumcision for Teens & Preteens

Archived Q&A and Reviews


Questions

Therapeutic circumcision for 10 year old to correct phimosis

Dec 2013

Looking for experience/advice about therapeutic circumcision that has been recommended for our 10 year old son who has phimosis (non-retracting foreskin). His constriction is pretty severe, down to a tiny pinhole at times. We've tried multiple rounds of steroid cream, but the opening has only gotten about 1-2mm in diameter (and tends to close back down once we stop the cream). He hasn't had any complications from the phimosis (no bladder infections or skin irritations.) I've read prior posts on this topic and the recommended links about unnecessary circumcision, but I think in our case something probably has to be done. My question are: 1. I'd love to hear of the experience of any other families that have been through this. 2. The surgeon is proposing general anesthesia - is this necessary? 3. What's the best age to have the procedure? 4. Any experience with Golden Gate urology? Thanks! Anonymous


Our son had a similar condition at around that age or a little younger. He had phimosis twice before puberty with no complications, and also it took a long time for his foreskin to fully retract. The pediatricians told us it would happen as early as age 3, but for some kids later. It wasn't until he was 13 (and started masturbating) that it fully retracted. His opening was very small also growing up. We tried the cream, which was no use. The discussion came up around your son's age of circumcision but I felt it was too severe an act, and opted to wait, which our pediatrician was fine with. Also, he never had the ballooning of the foreskin with urine which can indicate a more serious condition. I remember we were counseled that he could always get it done as an adult if he had to. I felt much better about that because I really would want him to have a say on something that important about his body. I just felt it was not justified at that young age, and I would advise you to wait at least until puberty and if your son is able to urinate normally and is not in pain, then don't do it. mom


we did circumcision at birth so I can't address the 10 yr old part. But I can say you really should have the surgery at Children's. My son had had surgery there three times under general and they are *amazing*. Really. I learned the hard way when my daughter needed ear tubes and we scheduled it for the surgery center on telegraph -- the nursing staff couldn't figure out the right dose for her (there was an issue with her weight and the scale) and they took her from me screaming -- when things started to go wrong I should have left but I never imagined it being so horrible. And then she had a really hard time coming out of it -- it was very scary. So, general anesthesia by doctors who treat children every day -- safe. But only at a children's hospital. good luck!


My brother had to have circumcision due to phimosis as well, though his was away worse and he had some infections and pain peeing from a very early age. He had his circumcision at 3 years old, which might have been for the best since I heard the earlier it is done the easier the recovery later on. I was older and remember that he was out of it for a while but recovered pretty quickly and had no issues since, though it will likely be different for a 10 year old. He did have general anaesthesia for the procedure, though I don't know if my parents had an option to ask for a local and chose general or if it was required. Good luck with your decision. anon 


1. I'd love to hear of the experience of any other families that have been through this. Sorry, can't speak to that. I do have a friend/coworker who had her son undergo the same procedure at the same age. He had a hard recovery, but genital tissue is relatively quick to heal, so there's that! Phimosis can be a real pain (no pun intended) but before you go the surgical route, is it possible to try balloon or metallic stretchers at home? Has this ever been discussed as an option?

2. The surgeon is proposing general anesthesia - is this necessary? YES. This is a very, intensely painful surgery, and recovery can be a bit rough for some, and not as rough for others. Insist on it, as well as an appropriate pain management program for the week or two post op.

3. What's the best age to have the procedure? Depends. It's one of those things where it can cause a lot of problems, and one of those things where the hole size can create serious issues like obstruction of the urethral meatus, causing urinary retention and possibly reflux (Which is how I can answer #4, although mine isn't from extreme phimosis.) So you don't want to let it go. On the other hand genital integrity is kind of a big deal, and I wouldn't want someone cutting off my foreskin if there was any way in the world to retain it. Some say that masturbation and sexual activity can improve phimosis b/c there is regular movement towards retraction stretching of the hole, but at 10, obviously this isn't happening. And if it continues further, it could impede his sex life in the future, in addition to possibly creating urological issues. Bottom line, if your son *wants* the surgery, and is ready to do this, you have your answer: 10 is the best age to do it.

4. Any experience with Golden Gate urology? Yes. I just switched to them after dealing solely with UCSF urology. I highly recommend GGU. Much better practice. And they see you at your appointment time, not 3 hours later as is the norm at UCSF. Anon Nurse Guy 


Well, yes, clinical circumcision can seem ''unnecessary,'' especially to persons without penises. As for ''the best age'' for intervention, probably the answer is ''Before the kid starts getting ulceration, bladder infections, that sort of thing.'' As for general anaesthetic--well, aside from the possibly disturbing weirdness of having someone making slices on your future sex organ while you're awake and numb, any possible pain should be avoided, and the tip of the penis, like the tip of the tongue, is pretty dense with nerves. A dad of three sons


I am an RN who has worked in the surgery department at Children's Hospital Oakland for many years. I would estimate that we care for 5-10 boys of all ages each week having this procedure. In my opinion, nothing is gained by waiting, if your urologist is recommending surgical intervention....but really, that is a decision for you to make. And general anesthesia...absolutely. Consider the alternative, if there is one. I am familiar with Drs. Chi Lee and Piser of the group you mentioned, as well as the excellent pediatric surgeons and urologists at Children's and I would recommend them all.


As a pediatric nurse, I would strongly advise that your son's surgery be done by a pediatric surgeon at a pediatric facility, with a pediatric anesthesiologist. At Children's we offer a pre-op visit with a Child Life specialist who will explain everything that will happen to you and your child, along with your child's siblings, if you wish. In my experience, a great deal of anxiety is alleviated by this appointment. A similar program may be available at other facilities, but I am only familiar with our program. Pediatric nurse


I am a pediatrician who opposes routine circumcision, but sometimes you gotta do what you gotta do. I understand your angst. I refer all my youthful patients needing urological attention to Golden Gate urology. Dr. Chi Lee did surgery on my own son and I think he is great. Dr. Lee fan


Just wanted to echo what an earlier responder recommended about taking your son to Children's Hospital Oakland if at all possible. Their anesthesiologists obviously specialize in children, which was very reassuring to us through two childhood surgeries for our son. anon


Circumcision recommended for 11 year old

June 2013

I am sorry if my post has too many TMI details.

My son who is 11 years old almost for sure needs to get a circumcision for the phimosis he has. And no it is not just a developmental phimosis, his opening closed down to the point it could hardly be seen, and he does have some trouble urinating. It is not an emergency yet, but we need to decide what to do soon. I still hope that another doctor will tell us there is another solution, but after a month on steroid cream with no visible improvement, his pediatrician and two urologists think a circumcision is the way to go. We are not from the US and his father and other men in the family are not circumcised, so we really don't know what to expect, and it terrifies me to the point of panic attacks.

I am looking for help and advise for a few questions. Do you know a doctor who looked at the similar situation and offered anything else but steroid cream and circumcision? I don't want my son to ask me in ten years why we just didn't go to that other doctor.

If circumcision is the best treatment, could you please advise are there different ways to do it? Does the doctor matter? How is it different for an older boy? Is it going to look the same as for the boys who were circumcised when they were very young? Any advise on the doctor?

Also any advise on the recovery is greatly appreciated. I asked the doctors, but other that he will be sore for a while and not to swim for a while I cannot really get anything meaningful.

We are not in Kaiser, and our insurance in network list of doctors is quite extensive but we will go outside network if we have to.

None of us have any experience with circumcision, and we are looking for help.

Thank you very much.
Anonymous


If you'd like another medical opinion, I'd recommend Dr. Lawrence Baskin at UCSF. His pediatric urology clinic is the best (nationally) and he is so very very nice. I absolutely trust that his advice is the most current & child-centered. The clinic always favors the least invasive option for the child, they would never rush to surgery. He kept my son on steroid cream (when the ped had given up and was ready for circumcision) and gave me all the time I needed to ask questions. Mom


I can't really comment directly on the medical condition, but I'd definitely go and see Dr. Piser. Very highly regarded, works with kids, and is also a Mohel.

Joel Piser Golden Gate Urology 2999 Regent Street, Suite 612 Berkeley, California 94705-2121 (510) 848-1727 -Best of Luck


When I was meeting pediatricians when pregnant with my son one male doctor sticks out in my mind (he has since passed away). I was asking him how would I ever know if sex for my son was better or worse after circumcision (we were leaning towards circumcision). Turned out his father had to be circumcised in his early 20's and claimed sex was great before and after. We did circumcise our son. I made myself watch (it was rough) and I imagine the procedure under general anesthesia to be more like plastic surgery than what I witnessed. However, I would find The Doctor who has done many of these and not settle for a doctor that you feel like you are settling for. I find UCSF and Stanford to have great clinics - just make sure it's an MD who does the surgery and not a resident. Your son will be ok - his parts will be his, your husband his. Good luck


Relax mama!! I know you are very worried but everything will be ok. My oldest son had to have a circumcision at age 5 due to frequent infections. He eventually developed scar tissue around his opening. After a while when he needed to pee the pee could not get out and it backed up onto his shaft causing his shaft to balloon out. I then had to squeeze it out of his shaft while he screamed in pain! It was horrible, horrible, horrible. Don't let it get that bad.

However, his circumcision was as simple as could be. He had no nervousness, no pain (he was back in school the next day) and his penis looks totally normal. We now have some kids uncircumcised and one that is -- it has never been an issue. I think some boys are born with a smaller opening making them more prone to infections.

My advice is to get the circumcision and don't worry! Hugs to you
Anon


Our now 10-year-old had a medically necessary circumcision at age 5 in a similar situation. He also used the cream with no effect. His ended up progressing to be worse so he was in a huge amount of pain when urinating, and it turned out he had so much scar tissue built up that circumcision was the only option.

His urologist at Kaiser said he was one of the very very rare people who needed to be circumcised since most people worldwide are not circumcised and it's normally not medically indicated at all, as we all know (but that made me feel he was not pushing circumcision unnecessarily).

The procedure was done under general anesthesia and actually the recovery was not a big deal at all, amazingly. It was so much better than the pain he had been in before. I can't remember if he even needed to take pain medication. The only thing was that taking the bandages off was painful (he soaked in the bath, we tried taking them off slowly but that was agonizing so my husband pulled them off quickly and then it was over and didn't hurt after). We gave him a gift from the ''Penis Fairy'' afterward, of course he was younger than your son but he thought it was funny. Other than that he was fine and the whole thing was an enormous relief because he felt so much better. Now he barely remembers it. I think visually he looks the same as other circumcised boys, I'm not sure. Good luck!


Urologist for 19-year-old's circumcision

April 2009

My 19 year-old son has been talking off and on about wanting to be circumcised. Certainly, now, it is his decision. We've always told him we would pay for it but encouraged him to wait until he was at least 18 and hopefully mature enough to not impulsively do something he might regret. My question is do you have a recommendation for a urologist who does adult circumcisions. Also, if you know what the recuperation is like and approximate cost that would be helpful. Thanks. glad it's not me


I would try Joel Piser or Jing Piser. They are highly regarded are medical urologists and highly regarded are mohels (Performers of Jewish Circumcision). I am not sure where they practice...either Childrens' or Alta Bates?? This is the number I called for Circumcision. Maybe they can give you the office number. 510-654-8004 Good Luck


My 16 year-old son wants to be circumcised

Jan 2007

My 16 year-old son wants to be circumcised. He feels that it is abnormal to not be circumcised. But, more importantly, his sex ed classes at school have apparently told the kids that it is much safer/healthier to be circumcised. How safe is a circumcision for a 16 year-old? Is there really any advantage? Thanks for any info.


Our son was circumcised around 15 years of age. He did it in conjunction w/ a hernia repair that needed to be done. His foreskin was particularly tight so it made cleaning difficult and painful. It was painful after surgery, but in the end he felt it was worth it. My father was circumcised in his late 20's on entering the army in World War II, so my son had a family role model! We also celebrated it as a coming-of-age experience and gave him an Indian arrow with a flint arrowhead from a store on Solano Avenue. been there


My sister's stepson had a circumcision in his 20's so I do not think age is a factor. The stepson had the circumcision to solve a problem with painful erections. DF


Uncircumcised teen now wants circumcision

When my son was born I was told by my midwife that circumcision was not a medical necessity and that with the improved hygiene of our modern day lives that unless I wanted to do it for religious reasons, it wasn't necessary. Not wanting to put my newborn infant through any unnecessary pain, I opted not to do it. However, now my son is a teenager and wants to get circumcized to be like everybody else I guess. Has anyone else been through this and what did you do?


F.Ralph Berberich, MD, a pediatrician at the Pediatric Medical Group, in Berkeley, is also a mohel. A mohel is the person who performs circumcisions within the Jewish culture, observing various traditional ceremonial aspects of the procedure, as well as the physical ones.

He is well versed on all aspects of the subject, and helped us make an informed decision for our son. He might offer good advice for your family. His office phone number is 510-849-1744.


I have heard that Dr. Sumner Marshall (sp?) in Berkeley is an awesome urologist. Perhaps your son should talk with him about the pros and cons of being circumcised.