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Circumcision: What Every Parent Should Know

  • Prof. Dr. Zahid Mahmood
  • August 3, 2026

Circumcision: What Every Parent Should Know

By Prof. Dr. Zahid Mahmood — General, Laparoscopic & Laser Surgeon, Lahore

Circumcision is one of the oldest and most commonly performed surgical procedures in the world, practised for thousands of years and, in our part of the world, most often performed as khitan — a religious observance in Islam. Because it is so routine, many parents don’t think to ask much about it beyond arranging the date. But I regularly see boys and men referred to me with problems related to the foreskin, some needing circumcision for genuine medical reasons, and many others where a little reassurance and correct information would have avoided worry altogether. This article covers both sides: what a normal, healthy foreskin looks like in a growing boy, and the specific situations — medical, not just religious or cultural — where circumcision is genuinely the right treatment.

What circumcision is

Circumcision is the surgical removal of the foreskin (prepuce), the fold of skin that covers the head of the penis (the glans). Globally, roughly 40% of males are circumcised, most for religious or cultural reasons rather than medical ones. In Islam, khitan is typically performed in childhood, at an age that varies by family and tradition; in Judaism, brit milah is performed on the eighth day of life. In our practice in Pakistan, the overwhelming majority of circumcisions I perform are for this religious observance, done electively in a calm, planned, well-prepared setting — which is exactly how it should be done, regardless of the reason behind it.

Understanding the normal foreskin in a young boy — most concerns need reassurance, not surgery

This is genuinely one of the most important things I want parents to know: at birth, the foreskin is naturally fused to the glans underneath it by soft, physiological adhesions. This is completely normal, not a defect, and these adhesions gradually separate on their own over the following years — often starting around age two, but sometimes persisting to age six or later in perfectly healthy boys. During this time, the foreskin simply not retracting easily is not a disease and does not need treatment; it is commonly and mistakenly labelled “phimosis” by worried parents when it is, in fact, entirely physiological.

Similarly, some boys’ foreskin balloons slightly outward during urination, as the natural separation between foreskin and glans is still developing — this is not a reason for circumcision either. If the spraying or ballooning is bothersome, a simple, gentle technique of partially drawing back the foreskin during urination is usually all that’s needed, taught to both parent and child, without any procedure required. Parents may also occasionally feel a small, firm, yellowish-white lump under the foreskin — this is usually a harmless collection of naturally shed skin cells called a smegma pearl, not an infection or growth, and it resolves on its own as the foreskin continues to separate. I mention all of this because a great deal of unnecessary worry, and occasionally unnecessary early circumcision, comes from mistaking completely normal childhood foreskin development for a medical problem.

When circumcision genuinely is the right medical treatment

With all of that said, there are clear, well-recognised medical indications where circumcision is the correct treatment, separate entirely from religious or cultural reasons:

  • True phimosis — unlike the normal, physiological non-retraction of early childhood, true phimosis is a tight, fibrous, scarred ring of foreskin that genuinely cannot retract, sometimes causing the foreskin to balloon painfully during urination or leading to recurrent infection underneath it.
  • Lichen sclerosus (also called balanitis xerotica obliterans, or BXO) — a chronic inflammatory skin condition of the foreskin, rare before the age of five, that causes the tip of the foreskin to become thickened, whitish, and progressively scarred and non-retractile, often with pain on urination. This condition usually requires circumcision, though some early cases respond to a trial of steroid cream first, and it needs follow-up afterward to make sure the urinary opening itself hasn’t also become scarred and narrowed.
  • Recurrent balanoposthitis — inflammation of the glans and foreskin together, causing redness, itching, discharge, and sometimes pain, typically from infection, irritation, or minor trauma. A single episode, or even two, rarely needs surgery and usually settles with hygiene measures and, if needed, antibiotics — but for boys or men with genuinely recurrent episodes, circumcision removes the problem at its source.
  • Recurrent urinary tract infections in boys with certain urinary tract abnormalities — in specific situations, such as high-grade reflux of urine back toward the kidneys or a blockage in the urine outflow tract, circumcision can meaningfully reduce the risk of infection reaching the kidneys, and may be recommended as part of that child’s broader urological care.
  • Paraphimosis — a true emergency, described in more detail below.
  • A tight, short frenulum (the small band of tissue on the underside of the glans) causing pain on retraction, or tearing during intercourse in adult men — treated either by a smaller procedure to lengthen the frenulum alone, or by circumcision.

One important exception is worth mentioning directly: circumcision should not be performed in a baby born with hypospadias, a condition where the urinary opening is not in its usual position at the tip of the penis, because the foreskin tissue is often needed later for the reconstructive surgery that condition requires. Any parent told their child has hypospadias should specifically avoid arranging a routine circumcision until the paediatric urology team has assessed the child.

Paraphimosis — a genuine emergency

Paraphimosis occurs when a tight foreskin is pulled back behind the head of the penis and then cannot be brought forward again. This traps blood and lymphatic fluid in the glans and the retracted foreskin, causing painful, worsening swelling that, if not relieved, tightens the constricting band further in a vicious cycle. This needs urgent attention — gentle manual compression to reduce the swelling is often successful, sometimes helped by a solution injected to reduce the oedema, or a small cut to release the tight band under local anaesthetic in an emergency. If these measures fail, circumcision is performed to resolve it definitively. If your or your child’s foreskin has been retracted and won’t return to its normal position, especially with increasing pain and swelling, this needs same-day medical attention rather than being left overnight.

The genuine health benefits worth knowing about

Beyond treating the specific problems above, there is real medical evidence for benefits associated with circumcision, which is worth mentioning honestly and without exaggeration. Good hygiene is easier to maintain with a circumcised penis, since there is no foreskin space for smegma, moisture, and bacteria to accumulate. Circumcision performed in early infancy has also been shown to reduce the future risk of penile cancer substantially — this protective effect is much less pronounced when circumcision is performed later in adult life, and the leading theory is that avoiding years of chronic irritation from trapped smegma under the foreskin is what matters. Evidence has also emerged that circumcision reduces the risk of acquiring HIV, since the virus does not survive as well on dry, keratinised skin compared with the moist inner surface of the foreskin — this evidence has been significant enough that large public health circumcision programmes have been run in parts of Africa specifically for HIV prevention. None of this means an uncircumcised male is at high risk of these problems — good hygiene and safe practices matter enormously regardless — but it is a fair, evidence-based point in favour of the procedure where it is being considered for other reasons too.

How the procedure is performed

The exact technique varies mainly by age. In early infancy, circumcision can often be performed quickly under local anaesthetic using a simple device — a PlastiBell or Gomco clamp are commonly used tools designed specifically for this age group, applying gentle, controlled pressure while the foreskin is removed, with minimal bleeding. In older boys and adult men, circumcision is performed under general or regional anaesthesia: the foreskin is carefully measured and marked, a circumferential incision is made at the appropriate level, the inner lining is separated from the glans, and the foreskin is removed in two layers, taking great care to preserve exactly the right amount of skin — neither too much (leaving the foreskin effectively unfinished) nor too little (leaving the penile shaft skin too tight). Bleeding vessels, particularly around the frenulum, are carefully controlled, and the skin edges are then closed with fine dissolvable sutures or, in some techniques, surgical glue.

Choosing when to have it done

Families often ask me whether earlier is better. From a purely surgical standpoint, infancy does offer real practical advantages: the procedure is quicker, can usually be done under local anaesthetic alone using the simple clamp devices described above, bleeding tends to be minimal, and a baby’s recovery is generally straightforward, with far less awareness of the procedure itself than an older child would have. Circumcision performed later in childhood or in adulthood is a somewhat bigger undertaking — it requires a general or regional anaesthetic, a longer healing period, and a more deliberate period of activity restriction afterward. None of this means later circumcision is unsafe; it simply means the practical experience for the patient and family differs meaningfully with age, and this is worth factoring into family decisions about timing where there is flexibility. Whatever age is chosen, I always recommend it be planned calmly and electively — with a proper pre-operative check, appropriate anaesthesia, and a suitable recovery period — rather than arranged in haste around a family event.

Circumcision in adult men

Adult men come to me for circumcision for a genuine mix of reasons — some for the same medical indications described above (a tight foreskin causing pain during intercourse, recurrent balanitis, a torn or overly tight frenulum), and others electively, for hygiene or personal preference, having perhaps not had it done in childhood. The procedure itself is very similar in principle to that performed in an older boy, though healing does take a little longer and requires a somewhat more deliberate period of abstaining from sexual activity and vigorous exercise — typically around four to six weeks — to allow the wound to heal fully and the sutures to be completely absorbed before the area is put under any strain. Adult men considering this electively should have a proper individual consultation beforehand, since the assessment, anaesthetic choice, and aftercare advice for an adult are somewhat different from those for an infant or young child.

Being honest about risks

Circumcision is a routine, generally very safe procedure, but like any operation it is not entirely without risk, and I believe in discussing this honestly with parents and adult patients rather than presenting it as entirely risk-free. Possible complications include bleeding, wound separation, infection, a tight or irregular scar, adhesions reforming between the remaining skin and the glans, narrowing of the urinary opening (meatal stenosis) which needs monitoring in boys who’ve had circumcision for lichen sclerosus in particular, removal of too much or too little skin, cosmetic concerns about the final appearance, and — rarely, with careful surgical technique — injury to the urethra or glans itself. The great majority of circumcisions, performed by an experienced surgeon in a proper clinical setting with appropriate equipment, go smoothly with no complications at all — but I want parents and patients to understand that “routine” does not mean “without any risk whatsoever,” which is exactly why it deserves to be performed as a proper, planned surgical procedure rather than treated casually.

What to expect afterward

Some swelling and mild discomfort in the days after circumcision is normal and expected, generally well controlled with simple painkillers. The area should be kept clean, with gentle washing rather than harsh scrubbing, and loose-fitting clothing helps avoid friction on the healing area. Most boys and men are back to normal daily activities within a few days to a week, though vigorous physical activity, cycling, and swimming are usually best avoided for a couple of weeks until healing is complete. I always ask patients or parents to come back for a check if there’s significant bleeding, spreading redness, fever, or if the swelling seems to be getting worse rather than better after the first few days — these are the signs that shouldn’t simply be waited out. In young children, a little pink-tinged discharge and a whitish-yellow coating over the healing area in the first week or two is a normal part of healing, not a sign of infection — but genuine spreading redness, worsening swelling, or fever is different and should always be checked rather than assumed to be normal.

What you should do

If you’re planning a religious or cultural circumcision for your son, there’s no need to wait for a specific problem to appear — this can be planned electively at a time that suits your family, ideally performed by an experienced surgeon in a proper clinical setting rather than an informal one. If, on the other hand, you’re noticing what looks like a genuine problem — a foreskin that seems truly stuck rather than just slow to separate, recurring painful infections, or any of the specific signs described above — that’s worth a proper assessment rather than guesswork at home, since the right treatment depends entirely on distinguishing normal childhood development from a true medical problem.

To book a consultation with Prof. Dr. Zahid Mahmood, call 0300 413 0159 or visit professorzahid.com.

This article is for general awareness and does not replace a personal medical consultation.

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