Circumcision for Child, Infants and Boys

Circumcision, also known medically as a posthectomy, is a surgical procedure that involves fully or partially removing the foreskin (the thin layer of skin that covers the head of the penis).

Child circumcision usually only takes a few minutes and is performed under local anesthesia. Most children recover quickly, with a recovery period of a couple of days.

Postoperative complications occur in about 2% of cases. However, these issues are usually minor if the surgery was performed by an experienced urologist. Moreover, complications tend to be closely tied to parents’ compliance with the postoperative care instructions.

There are a number of reasons why parents might choose to have a child circumcised. In some cases, it’s to treat a medical issue such as phimosis ,a condition in which the foreskin can’t properly retract past the head of the penis. However, if a child’s foreskin is not dilated, this isn’t in itself a good reason to get a circumcision, as this problem usually resolves itself in time.

Alternatively, some parents want their child circumcised for religious, cultural or personal reasons.

At Dr. Carlos Marois’ private urology clinics in Greater Montreal and Quebec City, every circumcision procedure we perform is preceded by an initial consultation and examination. This includes a short questionnaire, a checkup and a conversation with parents about the available techniques. Children aged two to six are the most difficult to circumcise and sometimes, during the examination, the child is judged too young or too agitated to be able to follow instructions during the procedure. As a result, it may not be possible to go ahead with the circumcision.

What are the medical reasons to have a circumcision?

Phimosis : the foreskin is too tight and prevents the foreskin from being pulled back.
Balanite : redness, pus discharges, discomfort or itching in the glans.
Paraphimosis : foreskin is too tight and becomes stuck behind the head of the penis in a contracted state (this condition is rare in children).

What circumcision technique is used for a child under two?

Dr Marois favours the Plastibell™ technique for children aged two and under. Because it’s so rapid, this technique is especially practical for little ones who are anxious and can only be expected to co-operate for a short time. For pre-pubescent children whose penis isn’t yet developed, we use Plastibells™ with the largest diameter Circumcision with the Plastibell™ method is performed under local anesthetic. No bandages are required following the surgery.

The Plastibell™ technique has been used in Europe for many years, particularly in various clinics in England. However, it has been generally unavailable in Quebec. Currently, the Plastibell™ technique is used principally for newborns and infants. The techniques involves covering the head of the penis with a plastic ring that detaches after the procedure.

This safe circumcision method causes little bleeding and requires no stitches, as the head of the penis is protected by the ring throughout the procedure. The ring falls off by itself within ten days following the procedure, and no bandage is needed.

What circumcision technique is used for a child over two?

For children over two, Dr. Marois uses an adapted technique involving a specialized clamp. It isn’t much different from the technique used for adults. However, the length of the procedure may be longer. We use surgical glue at the end of the circumcision, and sometimes a few stitches are also needed. In addition, a bandage is applied. It will need to be changed every day for the first week. There is little risk of bleeding, though not as low as with the Plastibell™ technique.

How is anesthesia used during the circumcision?

A meeting and examination is scheduled with Dr. Marois. He will explain the circumcision procedure and give postoperative care instructions to the parents.
After the child is examined, an anesthetic cream is applied to the penis.
The circumcision is performed in a fully equipped minor surgery room with the assistance of a urology nurse.
At least one of the parents must be present during the entire procedure to reassure the child.
To facilitate the child’s co-operation, a palliative syrup and a low dose of Ativan may be orally administered before the circumcision.
If the child becomes agitated despite the medication and his parents’ reassurance, the surgery will have to be cancelled and rescheduled for a later time when the child is more mature and more likely to co-operate during the procedure.
The anesthetic is provided while the child is lying on his back. A dorsal penile nerve block is administered by injecting a local anesthetic at the base of the penis. This is the most unpleasant moment of the surgery for the child but only lasts about five seconds. The skin around the base of the penis then becomes swollen with liquid, resembling a ring around the penis.
The circumcision itself isn’t painful, as the foreskin is completely anesthetized. The anesthetic dissipates within the hour.
After the anesthetic is given, you can take your child to comfort and reassure him.

How is a circumcision performed on a child under two?

Child circumcision for boys under two years of age is performed using a Plastibell™ ring and involves the same technique that’s used with newborns.
Preparing the glans for the circumcision is the longest part of the procedure. It takes a few minutes and involves dilating the foreskin around the glans, cleaning any secretions and detaching the frenulum. The circumcision itself takes less than minute.
A small incision is made in the foreskin and an appropriately sized ring is fitted over the head of the penis, using the detachable handle. Next, the ring is secured with a cord and the skin outside the ring is excised. At the end of the circumcision procedure, Polysporin ointment is liberally applied to the area.
The ring should fall off by itself within 10 days following the circumcision. The residual foreskin will become white or sometimes black, like a newborn’s navel after the umbilical cord has been detached. The results are generally very satisfactory, as the scar is perfectly symmetrical.

How is a circumcision performed on a child over two?

Preparing the glans for the circumcisionclamp is the longest part of the procedure. It takes a few minutes and involves dilating the foreskin around the glans, cleaning any secretions and detaching the frenulum. The circumcision itself takes less than minute.

When the surgery begins, the foreskin is drawn back with small surgical pliers and a circumcision clamp is applied at the appropriate spot. The clamp is then tightened for a minute to produce a hemostatic effect. Excess skin is then excised with a scalpel. Next, the clamp is removed. Bleeding can be controlled using low intensity electrocauterization.

Lastly, the edges of skins are esthetically closed. This can be done with a surgical glue and without any visible stitches. However, in some cases, a few stitches are needed. A compressive bandage is wrapped around the penis at the end.

What are the risks and complications of child circumcision?

There’s a very low risk of infection.
There’s a low risk of bleeding when the Plastibell™ technique has been used. The risk of bleeding is slightly higher following a circumcision with a clamp. Generally, bleeding can be easily controlled using a compressive bandage.
The risk of the Plastibell™ ring not detaching by itself is low, though slighter higher among infants, as they may experience more swelling. When this occurs, the child must be brought back to the clinic to have the ring manually removed.

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Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

Cancellation of appointment:

To ensure the smooth running of the clinic and a minimum of courtesy towards other patients and our staff, we ask you to notify us 48 hours in advance for the cancellation of a consultation, 5 working days in advance for a surgery at the office and 21 working days in advance for a major surgery. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur, so we ask you to provide us with at least a 24-hour notice for any change in their appointment; we will be happy to accommodate you, the best we can. However, if you fail to inform us within this timeframe or do not show up, we will charge a $ 100 fee.

Thank you for your understanding.

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Dr. Marois is a urologist who is not a member of the Régie de l’Assurance Maladie du Québec (RAMQ). As such, if you require his professional services, you will have to pay directly the Cliniques Marois for the services rendered.

Cancellation Policy:

To ensure the smooth running of the clinics aa well as a minimum of courtesy towards other patients and staff members, we ask you to notify us 48 hours in advance for cancelling an appointment, 5 working days for cancelling a minor surgery in the office and 21 working days for major surgery at the CMC. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur and schedules change, so we ask patients to give us at least a 24-hour notice for any changes of appointment. We will be happy to reschedule another one for you. Failure to provide such notice within this timeframe will result in a $ 100 fee.

Thank you for your understanding.

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