Baby and newborn circumcision


Baby and newborn circumcision

Approximate time25 min

Newborn circumcision, also called neonatal circumcision, is an elective surgical procedure in which the foreskin is removed. The surgery generally lasts only a few minutes and is performed under local anesthesia. Newborn circumcision requires a recovery period of several days, but most babies heal very quickly.

Post-operative complications occur in about 2% of cases. However, these issues are usually minor if the surgery was performed by an experienced urologist. These complications are closely linked to how diligently parents follow the post-operative care instructions. Generally, parents choose to have their child circumcised for religious, cultural or esthetic reasons. Statistically, circumcision is less frequent among francophones, particularly in Quebec.

Are there ever medical reasons to circumcise a baby?

According to the Canadian Paediatric Society, there’s no medical justification for systematically circumcising newborns. On the other hand, it has been shown that circumcision reduces the risk of urinary tract infections in infants tenfold. Urinary tract infections, however, are generally rare in infancy.

Later in life, circumcised males are statistically less likely to contract certain sexually transmitted diseases such as HIV and HPV, as well as penile cancer. Moreover, women who are partners of circumcised men are less likely to get cervical cancer.

Circumcision can also prevent other medical problems such as phimosis and recurrent balanitis.

It’s important to note that ninety per cent of uncircumcised boys can’t manually pull back their foreskin before the age of 5 or 6. This is natural. The skin should never be forcibly pulled back, as this can harm the child.

What are the risks associated with newborn circumcision?

Bleeding disorders such as hemophilia can be caused by newborn circumcision.

Other risks include hypospadias (a birth defect that affects the urethra) and a buried penis, both of which can be diagnosed by a urologist during an examination.

Is there an optimal time to circumcise a baby?

The best time to circumcise a newborn is 2 weeks after birth or shortly after that. Younger infants are less bothered by the surgery, which makes the circumcision easier to perform. Moreover, post-operative care is more manageable for parents when the child is young.

Once they’re several months old, some children start to become chubby and may, as a result, have a partially buried penis. This can make post-operative care much more complicated. Additionally, the risk of post-operative adhesions is greater for chubby infants.

What technique is used to perform newborn circumcision?

There are various circumcision techniques, some of which don’t involve any stitches.

Whichever circumcision instrument is used, the key consideration is how much of the skin and mucous membrane is excised. The primary challenge the surgeon faces is to stretch the foreskin enough to be able to introduce the circumcision instrument.

During the circumcision surgery, the surgical site must be aseptic (free of bacteria, viruses and other micro-organisms). Additionally, the excision must be neither too large nor too small, the glans must be completely exposed and the bleeding must be carefully stopped.

Our urologists use the Plastibell technique for neonatal circumcision. This technique has been used for many years. It involves covering the head of the penis with a plastic ring that detaches after the procedure. The ring is gently fitted around the glans, and the foreskin is laid over it. A cord is then wrapped around the ring, cutting off blood circulation to the foreskin.

The Plastibell is easy to put in place and doesn’t cause any bleeding. The circumcision is complete when the ring falls off on its own. This occurs about 7 days after the procedure. The resulting circumcision scar is perfectly straight. Moreover, the risk of removing too much skin is low as the ring protects the glans throughout the entire procedure.

This is the safest circumcision technique for babies and has been effective for more than 30 years. Moreover, it’s the most widely used method among Quebec surgeons who perform newborn circumcision.

In addition, the procedure is fast, nearly painless under anesthesia and results in minimal post-operative bleeding. For these reasons, our urologists prefer to use the Plastibell technique for newborn circumcision over the Pollock technique, which uses a Gomco or Mogen clamp.

Given that the risk of bleeding is very low, you can leave the office shortly after the circumcision procedure is complete.

How is a circumcision performed on a newborn or an infant?

First, we’ll schedule a consultation with the parents to examine the infant. One of our urologists will tell the parents what they need to know about the surgery and provide instructions for post-operative care. If the parents and the urologist choose to proceed with the surgery, an anesthetic cream will be applied to the penis directly after the exam. Next, the circumcision will be performed in an operating room that’s fully equipped for minor surgeries. A urology nurse will be there to assist the urologist.

Before the surgery, sugar drops will be given to the infant. These have a euphoric effect, which improves the efficacy of the anesthetic. The urologist will then administer a dorsal penile nerve block by injecting a local anesthetic at the base of the penis. This is the most unpleasant part of the procedure, but it only lasts about 5 seconds. The parent in the operating room is encouraged to console the baby or give them milk for a few minutes.

During the circumcision, the baby will be placed on its back. Most newborns cry a little as their legs are held in place with straps. Preparing the glans for circumcision is the longest part of the surgery. It takes a few minutes and involves dilating the foreskin around the glans, cleaning secretions and detaching the frenulum. The circumcision itself takes less than a minute.

The circumcision begins with a small incision in the foreskin. Next, an appropriately sized ring is fitted over the head of the penis and secured with a cord. After a few minutes, the skin at the distal end of the cord is excised. At the end of the circumcision, Polysporin is liberally applied to the area. The ring should fall off by itself within 10 days of the circumcision. The residual foreskin will turn white or black, like a newborn’s navel after the umbilical cord has been detached.

What are the possible complications of neonatal circumcision?

  • Minor bruising at the base of the penis is common after administering the anesthetic
  • Bleeding occurs in some cases but very rarely
  • Infection occurs in some cases, but very rarely if post-operative care is properly administered
  • Redness and swelling in the foreskin may occur but don’t last long
  • In rare cases, the ring can get stuck and need to be manually removed by the surgeon
Contact us to learn more about newborn circumcision or to schedule an appointment at a urology clinic in Montreal, Laval, Greenfield Park or Quebec City.

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Prepare for the operationHow to prepare for newborn circumcision

The day of the procedure
Buy and bring with you a tube of Polysporin and a small bottle of Tempra for newborns. Bring at least 3 spare diapers.
How long is the procedure?
Allow approximately 2 hours for the procedure.

Recommendations after newborn circumcision

10 days after the procedure
If the ring doesn’t fall off after 10 days, you must come back for an assessment to prevent the ring from getting stuck. It may be necessary to cut the cord and manually remove the ring. If this happens, it might be necessary to administer a local anesthetic. The residual swelling will subside in the following weeks.
1 month after the procedure
After the ring has fallen off, continue applying Polysporin to the area and gently pulling on the skin of the penis (toward the pubic bone) to fully release the head. This can be done at diaper changes in the first month following the procedure.
2 months after the procedure
We will schedule a follow-up appointment 2 months after the procedure.

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