Circumcision, also known 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).
Circumcising a child usually only takes a few minutes and is performed under local anesthesia. Most children recover quickly within a couple of days.
Post-operative 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 linked to how diligently parents follow the post-operative care instructions.
There are several reasons why parents might choose to have their child circumcised. In some cases, it’s to treat a medical issue such as phimosis, a condition in which the foreskin can’t fully retract past the head of the penis. However, if a child’s foreskin isn’t fully dilated, this a good enough reason to get a circumcision, as this issue usually resolves naturally over time.
Alternatively, some parents choose to have their child circumcised for religious, cultural or personal reasons.
At our private urology clinics in the Greater Montreal Area and Quebec City, every circumcision procedure is preceded by an initial consultation and thorough examination. This includes a short questionnaire, a checkup and a conversation with the parents about the available techniques. Children aged 2 to 6 are the most difficult to circumcise. Occasionally, during the examination, if the child is deemed too young or too restless to follow instructions during the procedure, it may not be possible to proceed 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.
- Recurrent balanitis. This condition causes redness, discharge, discomfort or itching in the glans.
- Paraphimosis. The 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 children under 2?
For pre-pubescent children whose penises aren’t yet developed, we use the largest diameter Plastibell. Circumcision with the Plastibell method is performed under local anesthesia and no bandages are required following the surgery.
The Plastibell technique has been used in Europe for many years, particularly in various clinics throughout England. However, it has been generally unavailable in Quebec. Currently, the Plastibell technique is primarily used for newborns and infants. This technique involves covering the head of the penis with a plastic ring that detaches on its own after the procedure.
This safe circumcision method causes little to no bleeding and doesn’t require any sutures, as the head of the penis is protected by the ring throughout the entire procedure. The ring falls off on its own within 10 days of the procedure, and no bandage is needed.
What circumcision technique is used for children over 2?
How is anesthesia used during the circumcision?
- A meeting and exam are scheduled with one of our urologists. They’ll explain the circumcision procedure and provide post-operative 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 2 parent must be present during the entire procedure to comfort the child.
- To facilitate the child’s cooperation, 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 their 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 cooperate during the procedure.
- The anesthetic is administered while the child is lying on their back. A dorsal penile nerve block is administered by injecting a local anesthetic at the base of the penis. This is the most unpleasant part of the surgery but only lasts about 5 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 an hour.
- After the anesthetic is administered, the parent can comfort and reassure the child.
How is a circumcision performed on a child under 2?
- Child circumcision for boys under 2 is performed using a Plastibell ring. This is the same technique that’s used for 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 secretions and detaching the frenulum. The circumcision itself takes less than a minute.
- A small incision is made in the foreskin and an appropriately sized ring is fitted over the head of the penis, using a 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 is liberally applied to the area.
- The ring should fall off by itself within 10 days of the circumcision. The residual foreskin will become white or black, like a newborn’s navel after the umbilical cord has been detached. The results are generally very satisfactory and the scar is perfectly symmetrical.
How is a circumcision performed on a child over 2?
When the surgery begins, the foreskin is drawn back with small surgical pliers and a circumcision clamp is secured to the appropriate area. The clamp is then tightened for a minute to produce a hemostatic effect. The 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 surgical glue and without any visible sutures. However, sometimes a few sutures are needed. Finally, a compressive bandage is wrapped around the penis.
What are the risks and complications of child circumcision?
- There’s a very low risk of infection.
- There’s a low risk of bleeding with the Plastibell technique. The risk of bleeding is slightly higher following a circumcision with a clamp. Bleeding can generally be controlled using a compressive bandage.
- The risk of the Plastibell ring not detaching by itself is low. However, it’s slighter higher in infants, as they may experience more swelling. If this happens, the child must be brought back to the clinic to have the ring manually removed.