Circumcisions are not performed beyond 21 days after birth; please ensure that your child has an appointment scheduled before this time.
Definition of Circumcision
Circumcision means cutting off the foreskin or ring of tissue that covers the head (glans) of the penis. Neonate circumcisions are performed when your baby is at least 1 day old and not older than 21 days.
Followers of the Jewish and Moslem faiths perform circumcision for religious reasons. Nonreligious circumcision became popular in the English-speaking countries between 1920 and 1950 because it was thought that circumcision might help prevent sexually transmitted diseases. Over 80% of the world’s male population is not circumcised. Circumcision rates have fallen to 1% of newborn males in Britain, 10% in New Zealand, and 30% in Canada.
At birth the foreskin is normally attached to the head of the penis (glans) by a layer of cells. Over the next 5 to 10 years the foreskin will naturally separate from the head of the penis without any help. It gradually loosens up (retracts) a little at a time. Normal erections during childhood probably cause most of the change by stretching the foreskin. The foreskin may also serve a sexual function, namely, protecting the sensitivity of the glans.
The foreskin generally causes no problems. However, overzealous retraction before the foreskin has fully loosened can cause it to get stuck behind the head of the penis, resulting in severe pain and swelling. If retraction causes bleeding, scar tissue may form and interfere with natural retraction. Occasionally, the space under the foreskin becomes infected. Most of these problems can be prevented.
Benefits of Circumcision
There is no medical reason for circumcising baby boys and the long-term health benefits are minimal. The Canadian Pediatric Society’s current position (last updated in 1996) on circumcision is as follows: ” Circumcision of newborns should not be routinely performed”. OHIP supports this position and does not pay for neonatal circumcisions to be performed.
The American Academy of Pediatrics’ evaluation of current evidence indicates that “the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.”
Removal of the foreskin prevents infections under the foreskin (posthitis) and persistent tight foreskin (phimosis). However, both of these conditions are uncommon and usually due to excessive forceful attempts to retract he normal foreskin.
Circumcision does not prevent sexually transmitted diseases later in life, but it does decrease the risk for some of them. Although it does protect against cancer of the penis, good hygiene offers equal protection against this rare condition.
The best argument for circumcision may be so the boy will “look like other boys in his school” or “like his father”. The psychological harm of being different from the father has never been documented. Boys may not mind looking different from other males in their family. However, they may mind looking different that their friends in the locker room or shower if they are circumcised.
Risks of Circumcision
Like any surgical procedure, circumcision may cause complications (in less than 1 per 100 circumcisions). Complications that might occur are skin infections, bloodstream infections, bleeding, gangrene, scarring and various surgical accidents. One study showed that 1 of every 500 circumcised newborns suffered a serious side effect.
Although rare events, infection of the urinary opening (meatitis) and scarring of the opening (meatal stenosis) occur almost exclusively in a circumcised penis. In addition, the procedure itself causes some pain. However, this pain can be minimized with the use a local anesthetic to block the nerves of the foreskin. Dr. O’Mahony uses this freezing technique.
Delaying the decision also carries a risk. If you initially decide not to have a circumcision, and then change your mind after your son is 2 months old, the procedure will likely require general anesthesia. Dr. O’Mahony does not perform circumcisions after your baby is 21 days old. So try to make your final decision during the first 3 weeks of your baby’s life. In the final analysis, nonreligious circumcision is mainly a cosmetic surgery. The decision to circumcise is a parental decision, not a medical decision.
How Do We Arrange for a Circumcision?
It is helpful if you have discussed this with your partner prior to delivery. As the procedure is not covered by OHIP, you must pay to have the procedure performed. Dr. John O’Mahony performs this procedure from his office at 481 London Road every Wednesday afternoon. The total fee will be $250 and this includes physician, nursing, equipment and administrative expenses. Please click on the BOOK A CIRCUMCSION button on the home page and our office will call you within 48 hours to book your appointment or give you more information. You can also call the office at 519-491-7965 or fax us at 519-491-7494. Make sure you book your baby’s circumcision before they are 21 days old.
- Infants’ Tylenol (Acetaminophen)
- Extra Diapers
- Car Seat
- Blanket and/or change of clothes
- Be prepared to breastfeed or formula feed as your child will be kept at the clinic for observation for approximately two hours following the procedure
Please bring $250 cash at the time of your appointment (personal cheques will not be accepted). Please arrive 15 minutes prior to your scheduled appointment and plan to be at the clinic for approximately 3 hours.
The Care Following the Circumcision Procedure
- Wash hands before caring for the circumcision.
- Gently clean circumcision site with warm water to remove stool and urine.
- Apply Vaseline to gauze square after each diaper change and place loosely over the circumcised area.
- If dressing becomes stuck or dry, moisten with warm water before removing the dressing.
- Continue to use the gauze squares, when they are all gone put a generous amount of Vaseline to the front of the diaper to prevent the circumcised area from sticking to the diaper – the gauze squares will likely be used for 2 days.
- Baby can be tub bathed 24 hours after the circumcision procedure.
- Bruising and slight swelling at the base of the penis is normal due to the injection site of the local freezing.
- Normal yellow/white discharge forms over the healing area within 2-3 days. Do not try to remove this as it protects the wound area.
- During diaper changes be careful that the baby does not kick the circumcision area as this may start bleeding from the site – have all your supplies ready before starting the diaper change, and
- Tylenol may be given as instructed by Dr. O’Mahony at the time of the circumcision.
- Foul odour and discharge (pus) from the site is abnormal and should be reported to your baby’s doctor.
- Slight oozing from the site is normal but any active bleeding should be reported to Dr. O’Mahony or your baby’s doctor – if this occurs apply firm pressure to site using a folded washcloth or gauze – apply this pressure for 5-10 minutes and repeat as necessary and make arrangement to go directly to the Emergency Department if it does not stop.
- Normal wet diapers should continue as before the procedure.
- If a small blood clot has developed do not try to remove it, as this may start some bleeding from the site. The blood clot will gradually release with normal healing.
- If you have any questions or concerns – call Dr O’Mahony’s office (519 491 7965) OR Telehealth at 1-866-797-0000.