Introduction

Baby circumcision is commonly done relatively early in the life. Procedures completed in the first four months are considered newborn circumcisions. If you have made the decision to have your son circumcised, it is recommended to proceed as soon as it is convenient for your family. Appointments are usually available within days. Please review the “Getting Started” section to ensure you are fully informed about the procedure prior to booking.

In this section you will find information about circumcision for newborns. We focus on high-quality, safe, and reliable care to ensure that parents and their son have a safe and positive experience. Over 35,000 circumcisions have been performed using our technique over the last two decades. Our goal is to make it simple for you to get the information and services you require. Our doctors and nurses will support you after the circumcision surgery with a hotline for questions and detailed instructions on post-circumcision care for your baby son.

The Pollock Clinic Process

All the following preparatory steps are taken to ensure your son is as comfortable as possible during the procedure. You will see that four actions will be taken to provide a safe and gentle experience for your child.

Baby Tylenol Just Before You Come to the Clinic

We will have you give your infant son 1 ml of Tempra or Tylenol (also called acetaminophen) just before you leave home. Please do not give any other medication besides Tylenol or Tempra (i.e. No Ibuprofen, Advil etc.) because it may effect bleeding time.

Topical Anesthetic Cream to Numb the Skin

In our office, your child will have topical anesthetic applied to his penis. This is an anesthetic cream that numbs the skin. This surface painkiller is the second step we take to minimize discomfort during circumcision.

Pain Blocking Injection – Local Anesthetic

Next, once the skin is numb, your son will be given an injection called a dorsal penile ring block into the soft tissue alongside the penis. Our doctors use a combination block of both short and long acting anesthetic. This provides comfort and coverage for both the procedure and for hours after. Since the topical anesthetic has already numbed the skin, the injection is hardly felt.

Sugar Pacifier During the Brief Circumcision Operation

Ten minutes after the injection, the penis is fully desensitized and the circumcision can be done. During the circumcision soothing music is played, room temperature is increased and your son will receive sugar pacifiers to suck on for additional comfort. Studies show that the sweet flavours distract babies and reduce their perception of pain.

Caring Team Always Available

As parents we understand that safety concerns are always number one. For your peace of mind, your doctor will be available 24 hours a day. All clients are given our 24 hour contact information so they can reach the doctor directly 24/7 should any concerns arise.

Although the circumcision takes about 30 second to 1 minute, we request that you be in the clinic for about one hour and fifteen minutes in total, so that we can carefully review with you all post procedure care and answer your questions before you take your child home.

Patient Instructions

Before Circumcision

On the day of your son’s circumcision, we recommend you feed your baby just before you leave your home to ensure comfort in our office. You should also give your son 1 mL of Tempra or Tylenol. Do not give Motrin, Aleve, Advil, Ibuprofen etc (any anti-inflammatoris or NSAIDs). If your baby is hungry when you arrive, you can feed him for 15 minutes as soon as you arrive. Please also remember to bring 2 receiving blankets.

After Circumcision

How to care for your baby in the first 24 hours following the circumcision:

  1. Keep your son snugly swaddled (especially his legs). The more he kicks his legs, the less comfortable he may be. After 24 hours, you no longer need to swaddle him unless he finds comfort in doing so.
  2. There will be a square white gauze with Vaseline placed over the head of your son’s penis. Leave the gauze in place and remove it after 24 hours. If it has fallen off, not to worry- just replace it with a fresh 3×3 gauze with some Vaseline on it and put it over the penis then close the diaper.
  3. Please check your son’s diaper every hour for the next 24 hours to look for any abnormal bleeding.
  4. If the white gauze is soiled with urine don’t worry just leave it alone. If it is soiled with stool, remove the gauze gently and rinse his bum with warm water and replace the gauze with Vaseline on it.
  5. There will also be a long white gauze wrapped around your son’s penis. Leave this gauze in place for 24 hours as well. If it falls off earlier, don’t worry just leave it off. If it is dry or stuck when you are trying to remove it after 24 hours, you may need to pull slightly harder and expect that there may be a little bleeding when you do this. This is normal and you may need to apply some direct pressure on the head of the penis as we taught you in the clinic. You may use some warm water to wet the dressing to help remove it. If there is some bleeding, maintain firm pressure for 3-5 minutes.
  6. No gauze bandages are required after the first 24 hours, just ointment.
  7. It is normal for your son to be a little irritable or very sleepy for the first 24 hours following the circumcision.

Here you see the square white gauze with Vaseline that you will replace for the first 24 hours if it falls off. You also see long white gauze and bandage around it that will be removed in 24 hours or if it falls off earlier you may leave it off.

General care following the circumcision:

  1. For the following weeks after circumcision, put a generous amount of Vaseline on your finger and rub it over the incision site placing a thick layer of ointment over the entire head of the penis.
  2. It is important to push the skin down off the head of the penis if it has moved up a little to ensure it heals properly just behind the back rim of the head. Do not do any pushing on the skin for the first two days because it will be swollen from the surgery. It is important to avoid “skin bridging” which results from the shaft skin or mucosa attaching to the head of the penis. If you are unsure of the appearance of your son’s penis, bring him to see one of our doctors, and they will adjust the skin for you if required.
  3. Most babies like to nurse in a quiet environment following the circumcision. A baby who cries for more than a few minutes is usually suffering from air swallowed during the circumcision and needs to be burped.
  4. Healing is promoted by keeping the area clean and dry but do not bathe your son until our doctors say it is okay to do so (generally after 3-4 days). In the meantime, warm water and a wash cloth are preferred for cleaning the area around the penis. Wiping his groin area and under the scrotum with warm water and cloth every day is good enough. Avoid moistened towelettes, alcohol, powders, and lotion since these may cause irritation.
  5. Disposable diapers are strongly recommended for the first week since they tend to be less irritating, and they help keep the area dryer and cleaner.
  6. It is better both before and for about three days following the circumcision to restrict the handling of your baby to just a few people. Also, avoid unnecessary travel as car seats can be irritating after circumcision.

Here you see a part of the mucosa attaching to the head of the penis. This is an example of “bridging” that requires a simple adjustment by our doctors. 

The healing process after circumcision:

Healing is usually rapid and occurs in several stages. Remember that a circumcision is like any other cut. There are many factors that influence healing; but most importantly, every child heals differently.

First, the cut edge seals and bleeding ceases within minutes, hours, or even over the course of an entire day. The area just behind the glans (especially the underside) will become swollen. Sometimes parents mistake this for a blister. In fact, this is NORMAL and will subside within a week or two.

In the first two days, there may be an off-white or yellowish, patchy appearance or discoloration of the glans. These patches are a type of scab and are associated with normal healing. After a few days the area where the skin was cut may look green and yellow. This is NOT pus or infection. It is part of the normal healing process and it can took this color for up to two weeks after the circumcision. Some physicians are not familiar with this healing process and may mistake this for infection. Please follow up with our doctors if you are concerned.

You will notice yellow patches on the head of the penis as it heals. This is not infection and is in fact a normal part of healing. 

You will also notice that the glans appears red and glossy sometimes purple or blue. This is because the skin covering the glans of an uncircumcised penis is mucous membrane (like the skin inside your cheek). Once exposed, the mucous membrane will toughen (or keratinize), and, in time, take on a normal appearance. It takes about a month for the penis to take on a normal, healed appearance. 

You will notice the head of the penis can often be purple, blue or red. This is all normal. 

The appearance of the penis during healing:

A common concern for parents is aesthetics. Remember that penises come in all shapes and sizes. While most penises “look normal” within days of the circumcision, some do not take on a “completely normal appearance” until after the penis starts to grow. For example, there may be more mucosal tissue on one side compared to the other; this is a normal anatomical variation after circumcision that will resolve with time after your son grows older.

                                                         

You will notice a mucosal ring at the base of the penis head. Sometimes it is more prominent on one side than the other. This is normal and no cause for concern.

Furthermore, although the penis may appear smaller after circumcision, it is not! This appearance is mostly due to the relaxation of skin surrounding the penis, which prior to circumcision holds the penis more erect.

On occasion, a poor aesthetic result occurs when too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. The latter is sometimes caused by the presence of a hydrocele or penile erections. In nearly all these cases, the penis will heal properly, and, in time, take on a normal appearance. If you are concerned in anyway about the appearance of your son’s penis, please call to consult us immediately.

Sometimes parents come to us worried about a band on the bottom of the penis fearing that it needs to be cut. This band is called the frenulum which carries the frenular artery and is normal. It is similar to the band under the tongue (the part that is cut in some babies with tongue-tie)

You may notice a band on the bottom of the penis after circumcision. This is normal and no reason for concern.

Common Concerns From Parents After Circumcision

It is not unusual for your son to sleep 6-8 hours after the procedure and to miss a feeding or meal. Some patients will be irritable for a number of minutes to hours afterwards. Behaviorally, most babies and children are back to themselves by the next day or two.
In general, complete healing occurs in about four weeks but most newborns or children show signs of healing by 1 week.
It may sting a little on the first day, but after a day it should not be painful.
It is normal to use some force to pull off the gauze bandage. To make this easier, you can soak the gauze with warm water and Vaseline before pulling it off. In the end, you just may have to pull a little more firmly to get it off. Remember the direct pressure technique if you notice any bleeding.
A small amount of bleeding is normal. Take some gauze with Vaseline on it and squeeze the bleeding area of the penis with your fingers for 3-5 minutes.
This is not important. You may leave it off. Reapply a white gauze pad with Vaseline and place it over the penis until the 24 hours is up. Then, just use Vaseline as instructed at the incision site on every diaper change.
Not to worry just try to clean the area as best you can using warm water and a cloth. Then place the white gauze with Vaseline on until the 24 hour mark is achieved.
If you are concerned about skin bridging, come back to have the baby examined. Usually it is very easy for us to make an adjustment.
For newborns, our physicians will let you know when at your follow up when you can start immersing your son in water.

View Our Video

For those who would like to visualize what the circumcision will be like, here is a video that was recorded for patient reference.