Infant Circumcision

Infant circumcision is a minor surgical procedure to remove the foreskin (prepuce) from the head (glans) of the penis. At Queen Square, circumcisions are offered for newborn males under 30 days old using the Plastibell method — a widely used technique that promotes healing and eliminates the need for stitches. The procedure is performed in-clinic by an experienced physician and includes pre- and post-procedure guidance for parents to ensure a smooth recovery.

While not medically required for all infants, some families choose circumcision for personal, religious, or cultural reasons.

Potential Benefits

Routine circumcision of every newborn male is not recommended by the Canadian Pediatric Society, Parents who decide to circumcise their newborn often do so for religious, social or cultural reasons. Other potential benefits of newborn male circumcision include:

• Easier genital hygiene

• Reduced risk of penile cancer (although extremely rare) and cervical cancer in their female partners

• Reduced risk of HIV and HPV infections

• Reduced risk of urinary tract infections

• Reduced risk of phimosis, a condition from scarring/thickening of the foreskin causing difficulty with retraction.

Potential Risks

Problems resulting from the procedure are usually minor. Although complications are very rare, they do occur. This includes:

• Too much bleeding

• Infection

• Risk of injury to other anatomical structures in the area

• Narrowing of the urethral opening (late complication) - this can be prevented almost completely by applying petroleum jelly to the glans for up to six months following circumcision

What to Expect

The visit will start with a consultation with the doctor that involves getting to know your baby's medical history, a physical examination, and a review of the procedure and its risks and benefits. Once consent has been obtained, your baby will be taken to our surgical room and the procedure will take approximately 30 minutes. Parents will not be allowed in the room.

You and your baby will then stay for another ~ 15 minutes afterwards to monitor for

complications and review after-care instructions before going home.

The Procedure

There are a few different techniques available for circumcisions. At Queen Square, we use the plastibell method, which involves inserting a plastic ring between the foreskin and the head of the penis. This causes the foreskin to fall off naturally by blocking blood supply, leaving an ideal cosmetic outcome. There are no stitches involved.

Pain Management

We ask that you give your baby Tylenol before coming in (see pre-visit instructions) as an additional layer of pain relief. Your baby will be awake during the procedure, which avoids the risks of general anesthesia. A local anesthetic block will be administered to numb the entire penis ensuring a painless procedure. The injections are very quick and take effect within 5 minutes and will last for at least 1 hour to cover the duration of the procedure and part of your journey back home. A sugar water solution is also given by mouth during the procedure to

prevent further discomfort.

Pre-Visit Checklist

The following checklist ensures that you are prepared for your visit. Any issues can cause a delay or cancellation of the procedure on the day of.

☐ Do NOT feed your baby 3 hours before (this reduces the risk of vomiting and possible aspiration).

☐ Give 1ml of infant's Tylenol 1 hour before.

☐ Bring any discharge paperwork from the hospital from your baby's birth.

☐ Bring your preferred payment option (card/cash).

☐ Bring milk/be ready to feed your baby after the procedure.

☐ Bring a diaper and wipes to change your baby after the procedure.

☐ Arrive 10 minutes before your scheduled appointment time.

Note: Only the parents/official guardian of the baby can sign the consent form for the procedure. They will need to be present during the visit.

Cancellation / Late Policy

Please call at least 48h in advance to cancel the procedure if you are no longer able to make it. Any no shows on the day or cancellations that occur within 48h of the procedure will be subject to a fee of $80. We will no longer book or accept the referral if two no shows or two cancellations have occurred.

If you are running late, please call our clinic ahead of time so we can organize our schedules accordingly. If you are more than 15 minutes late we will unfortunately have to re-schedule the appointment as we have other patients booked into our procedure room each day.

What to Expect After Surgery

The plastibell method was used for your baby's procedure. The penis will now have a plastic ring and string around it. The tightness of the string on the plastic ring stops blood flow to the excess foreskin area which will complete the circumcision. The ring, string, and excess foreskin will fall off on its own within the next 3-7 days. Once this occurs, there may still be a slight wound at the area including some swelling and bruising. This is normal and will often heal completely within 1-2 weeks.

If the ring has not fallen off within 10 days, please call our clinic to book an appointment with Dr. Brual so we can remove the ring manually

You might also notice some discoloration on the underside of the penile shaft. This is because we use silver nitrate solution to stop bleeding in that area. This can appear as a dark grey colour at the beginning before transitioning to a yellow/cream colour. Please do not clean or rub this away as this can reopen the wound and cause bleeding. It will eventually clear on its own once healing is complete.

What to Expect After Surgery

Cleaning

Avoid submerged baths for 24h after the procedure. After 24h, normal washing and bathing can occur. Gently clean the penis with mild soap and water 2-4 times a day until the ring comes off and the penis is healed.

Diaper Changes

Change diapers often. Apply a thick layer of petroleum jelly/vaseline on top of the penis and on the diaper with every change until the penis has completely healed.

Pain Management

Medication is not always needed and should be avoided if your baby appears comfortable and happy. If needed, Infant Tylenol 0.5mL every 4-6h can be given. Always read the instructions on the medication label and do not give more than the recommended daily dose.

When to Call the Doctor

It will take about 7 days for the plastibell to fall off and another 7 days or so for complete healing. However, some complications may arise during the process.

Contact us if the following occurs:

• Severe pain or distress that does not get better with pain medication.

• Fever above 38C or 101F.

• More than a few drops of blood on the penis or diaper or bleeding that does not stop.

• Pus-like drainage or foul odor from the penis.

• Redness that spreads from the tip of the penis towards the belly.

• Fewer wet diapers than before or not urinating at all.

• The head of the penis is blue or black.

• The plastic ring slips down past the head of the penis.

• The plastic ring stays on for more than 10 days or falls off in less than 3 days.

The best way to reach us is through our email at lab@qsdocs.ca. Please provide your baby’s name, the date of the circumcision, and a contact number we can reach you at. We will call you with instructions once your inquiry is received.

If your baby appears lethargic or unresponsive, please call 911 or bring him to the emergency department immediately.

Follow Up

The doctor will advise you of any follow ups at your visit. For most cases, if the circumcision goes smoothly, you do not need any further follow up with our clinic. Your baby can be followed up at their regular well baby check ups with their usual family physician.

Care for a Circumcised Penis for the First Few Years

It is important to regularly clean the area of the penis properly. The cells that have undergone necrosis (died), may grow back regularly and if an accumulation of these cells occur, a white substance known as smegma may begin to form. The formation of this substance is entirely normal and it is possible to become trapped if any adhesions between the glans and foreskin form. This usually requires no medical intervention unless the penis becomes inflamed or red in color.

As your boy grows and his body develops, he will begin to build up body fat. This can cause the development of a fat oad at the penis base. This should be pushed down whilst cleaning the penis. If you notice that the skin or the penis seems to stick the penis head, it is advised to use lubrication to avoid any further adhesions. As soon as your son reaches an appropriate age, teach them the proper way and importance to clean and bathe the area so they can do it independently.

Additional Resources

External Links

• Newborn male circumcision- Canadian Paediatric Society https://cps.ca/en/documents/position/circumcision