Circumcision is a procedure to remove the end portion of skin (known as foreskin) that covers the head of the penis. In an otherwise healthy newborn who is being considered for circumcision, the procedure will most likely be done within the first weeks after birth. It usually takes between 30-60 minutes and is often performed under a local anesthetic in a clinic setting.
Factors to consider when deciding on circumcision
Most parents choose circumcision for religious, cultural or cosmetic reasons. Other parents might consider routine circumcision for medical reasons. However, there is conflicting evidence about the benefits of routine circumcision.
Circumcision can reduce penile and urinary tract infections (UTIs) that can occur in uncircumcised children with a history of reoccurring UTIs or underlying urological issues. It can also remove other issues, such as the inability to retract (pull back) the foreskin, known as phimosis.
Newborn and infant circumcisions can result in complications such as infection, too much bleeding, the removal of too much skin, pain and side effects of pain relief. Leaving the foreskin intact may provide additional sensitivity at the top of the penis and protect the urethra from meatal stenosis, a type of scarring.
Routine newborn circumcision is contraindicated (not recommended) in the case of some medical conditions. These include bleeding disorders such as hemophilia or thrombocytopenia. Until the child is evaluated by a urologist, other contraindications include hypospadias and buried penis.
The Canadian Paediatric Society does not recommend routine circumcision of newborn males. Instead, it advises parents to thoroughly discuss their options with a knowledgeable health-care professional so they can understand the risks and benefits of circumcision and make an informed choice.
In Ontario, circumcisions recommended by a health-care provider are covered by OHIP. Circumcisions performed for other reasons are NOT covered by OHIP, and the patient’s family are responsible for the cost of the procedure. The cost of the procedure will be different depending on the health-care provider and the institution where it is performed.
What to expect if you choose a newborn circumcision
Different techniques can be used for circumcision; but, in general, the procedure involves excising (cutting off) the foreskin using a clamp-like device The procedure[BG5.1] usually takes 30-60 minutes and children usually receive acetaminophen and local anesthetic to manage pain. Unlike circumcisions in older children, a newborn circumcision does not require stitches and may include the use of surgical glue.
Most babies recover quickly from a circumcision. At first, the incision (cut) will be red and the glans (head of the penis) will look like it has been scraped. The area may be tender, but this will lessen over the first couple of days. The penis may also have some redness and swelling and have some yellow pus on the head for up to a couple of weeks. This is completely normal and is not a sign of infection.
What to expect if you do not choose a newborn circumcision
Over 90 percent of uncircumcised children will be able to retract their foreskin naturally, without any treatment, by the time they reach puberty. This is a natural occurrence, so do not try to retract the skin in a way that could cause trauma.
If the foreskin does not retract or if an infection develops, your child’s health-care provider may prescribe a mild steroid ointment/cream. This topical therapy may be applied twice daily for up to 12 weeks to make retraction easier. If the steroid cream fails or the foreskin is truly infected, your child’s health-care provider will refer your child for a consultation with a urologist to discuss other options.
What to expect as your child heals after a circumcision
Once your child is circumcised, the health-care provider will apply a lubricant gauze dressing to the area. The lubricant helps to prevent the dressing from sticking to the glans. The gauze usually falls off on its own within 24 hours.
Over the following days, your child will heal from the surgery in stages. Every child heals differently; it can take up to a month for the penis to appear fully healed.
Bleeding
Within minutes, hours or an entire day, the cut edges of the glans close and bleeding stops. It is normal to have up to a 3 cm-sized patch of blood in the diaper for up to 2 days.
Colour changes
Immediately after the circumcision, the glans may appear red and glossy or even purple. This occurs because the skin covering the glans of an uncircumcised penis is a mucous membrane. Once the membrane is exposed, it thickens and becomes darker.
Your child's glans may have off-white or yellowish patches in the first few days after surgery. These are a type of scab and are completely normal. Two or three days after the circumcision, the skin may look green and yellow. This is a sign of normal healing.
Swelling
You may notice some swelling behind or under the head of the penis and believe it looks like a blister. The swelling is simply another sign of healing and will disappear within a week or two.
Changes in size
The penis may appear smaller after circumcision. This is mostly because the skin surrounding the penis is relaxed, while before circumcision, it usually held the penis more erect.
How to care for your child after a circumcision
Your child’s health-care provider will give you detailed instructions on how to care for your child’s circumcised penis based on the technique they used during the procedure.
Here are some general tips:
- Clean the area with soap and water.
- Change your child’s diaper as you would normally.
- Apply petroleum jelly to the top of the penis every time you change your child’s diaper (approximately every 2-4 hours) for one month after the procedure. The lubricant will prevent the glans from sticking to the diaper while the area heals.
Check for bleeding
Blood staining of the diaper is common after circumcision. During the first 24 hours, check your child's diaper at every diaper change for active bleeding. It is normal to see spots of blood no bigger than 3 cm in diameter (about an inch wide). You should contact your child’s health-care provider if this continues past a few days, and you should go to the emergency department if there is active bleeding that does not go away on its own.
Bathe your child frequently
After circumcision, your infant can be bathed the next day or 24 hours after the procedure, and the lubricant gauze can be removed at that time. It is okay if the gauze falls off on its own before the first bath: just ensure that petroleum jelly is being applied with every diaper change afterwards. When the gauze comes off, it is normal for the penis to be discoloured with drops of blood and pieces of skin at its tip.
Prevent skin sticking
Gently push back the edges of the penile skin from the glans after the first two weeks of healing. This will prevent the skin from sticking to the glans as healing continues.
Apply petroleum jelly
Apply petroleum jelly on the end of the penis after every bath and with each diaper change until the penis has healed completely. A topical barrier prevents the penis from sticking to the diaper.
Give pain relief if needed
Infants may be fussy and in pain for some hours after a circumcision, but this usually does not last more than a couple of days. Signs of pain can include crying and problems with sleep and feeding. During the first 24 hours after circumcision, you may give acetaminophen regularly as prescribed by your child’s health-care provider to manage your child's pain. Ask how much acetaminophen your child has received in the hospital and at what time, so you know when to give the next dose.
When to see a health-care provider after a circumcision
Go to the nearest emergency department right away if your child has excessive bleeding (small pools of blood or spots larger than 3 cm in diameter. To help slow down any bleeding before you go the emergency department, use your thumb and index finger to create a ring around the top of the penis and squeeze for five minutes.
Also go to the nearest emergency department if your child has:
At SickKids
You can book a newborn circumcision (for infants under 8 weeks of age) at the SickKids Urology clinic by calling 416-813-8286 or visiting Circumcision Clinic | SickKids.
After newborn circumcision, your child will not have an in-person follow-up appointment with the SickKids Circumcision Clinic. Instead, you will be asked to email pictures of the circumcision site to the health-care provider who completed the procedure two days, seven days, and six weeks after circumcision. If your child is healing normally, you can also follow up with your child’s primary health-care provider within a week of the circumcision.
If you have questions or concerns before then, please contact the urology clinic nurse via phone or email between 9 am and 5 pm, Monday to Friday. If you have concerns after working hours, see your primary health-care provider or go to the nearest emergency department. If you need to leave a message with the clinic, you can expect a call back within 24 hours.
The Urology Clinic is at 555 University Avenue, the Atrium, 6th Floor, Unit D. Use the Atrium elevators (near the cafeteria), exit at the 6th floor and look for the unit D.
Sources
Canadian Paediatric Society, 2015. Circumcision in newborns: Position statement. Paediatric Child Health 2015;20(6):311-15.
Canadian Paediatric Society, 2015. Circumcision of baby boys: Information for parents.