Circumcision in the newborn is a surgical procedure that is not medically necessary.
Historically, circumcision has been practiced by those of Jewish and Muslim faiths for religious reasons. Circumcision for non-religious reasons has gone through various stages of favour and disfavour. There is evidence to suggest that circumcision reduces the risk of urinary infections in boys to 1/12 of what it would be otherwise. This potential benefit must be weighed against the fact that urinary tract infections in male infants are rare to begin with.
The overall benefits and risks are so evenly balanced that the Canadian Pediatric Society does not recommend routine circumcision.
Your decision with the knowledge of the potential risks and benefits must be based on personal, religious and cultural factors. If you are concerned about the boy looking different from other children or his father, remember that the implications of circumcision or non-circumcision are no greater than other natural physical differences such as hair colour, build, or size.
Choosing not to circumcise
The advantage of choosing not to circumcise are mainly the avoidance of the risks of circumcision as a surgical procedure; specifically bleeding, infection, and surgical trauma.
At birth, the foreskin is tightly attached to the head of the penis, and normally cannot be pushed back. The foreskin of many children spontaneously goes back by the age of 5 years. Pushing the foreskin back before it is ready and breaking down the adhesions may cause significant infection and could cause tightening of the foreskin around the head of the penis. It is therefore not recommended that the foreskin be pushed back. The penis should simply be washed daily without pushing back the foreskin.
Choosing to circumcise
Circumcision is the surgical removal of the foreskin, or prepuce. This procedure is performed at the clinic, and takes about ten to fifteen minutes. Using a freezing technique called “dorsal penile nerve block” a small amount of local anesthetic is injected under the skin at the base of the penis, to numb the area. The technique uses the Mogen clamp, which is fast and protects the head of the penis.
Most babies exhibit little discomfort after their circumcision. As with any surgery, there is always the risk of bleeding or infection. If your baby has a congenital malformation of the penis (i.e. hypospadias) this may not be evident until after the circumcision. Rarely, part of the glands may bleed following this surgery. The incidence of complications of circumcision in published articles varies from 0.2% to 2%. Most complications are minor but occasionally serious complications can occur.
Premature babies, those with bleeding problems, deformities of the penis, or other major medical problems should not undergo circumcision.
Preparing for circumcision
Bring extra diapers, soother, and 1tsp. sugar. There is evidence that having a baby suck on a sugar-coated soother is a great distraction during the operation.
After the circumcision
Instructions to look after the surgical site will be given to you after the circumcision. The tip of the penis will look angry and raw, and this is normal. With every diaper change, you will apply a generous amount of Vaseline over the area. A little bleeding is not unusual and can be stopped by applying gentle pressure with a clean gauze or cloth.
Circumcision is not a benefit covered by OHIP or any other health insurance. The fee is payable by cash, cheque, Visa, or Master Card and is due at the time of the surgery. The receptionist booking this visit will advise on fees.
Unless directed by your doctor, it is no longer necessary to bring in a urine sample. When a urine sample is requested, it is appreciated when obstetrical patients bring their urine samples with them to their appointments, instead of producing their specimen upon arrival. This helps us spend more time with you in the office and reduces waits for our limited bathroom space.
Please stop by reception on your way out for a labeled specimen container. (You do not need to refrigerate your specimen if produced beforehand.)
If you absolutely must produce the specimen at the time of your arrival, it is necessary for you to arrive 15 minutes prior to your scheduled appointment time. Thank you!