People choose to circumcise their boys for a variety of health, aesthetic, cultural or religious reasons. We never try to convince parents one way or the other, we are just happy to answer any questions you may have so you can make an informed decision.
The method used by Dr. Pakes has two steps. First, the foreskin is separated from the glans (tip) and then a small protective shield (a mogen) is placed over the foreskin and the foreskin is removed. The mogen has a clamp so there is little or no bleeding. This method protects the glans (tip) and minimizes the time taken to do the circumcision (generally around 1-3 minutes) and allows you (mom, dad, grandma or our nurse) to hold your baby during the procedure.
We prefer to do circumcisions with babies almost completely dressed and lying on a soft pillow on a parents/relative/friend’s lap. With this approach I have found that most babies don’t cry much and many do not even notice the procedure. If you (mom, dad or other family member) are not keen on holding baby, one of our nurses will be happy to donate their lap.
The Mogen procedure used by Dr. Pakes is very fast (as opposed to other 20-40min procedures you may read about on the internet). While we cannot guarantee that it is pain-free, we know that babies’ nervous systems are very immature at birth and they clearly do not experience pain the way we do. However, in order to minimize potential discomfort we will use a penile block in which freezing is applied to the nerves that supply the penis using two small (mosquito bite size) freezing injections. Baby will not feel anything at all during and for some time after the procedure – in fact, most babies sleep through the procedure. An additional option is EMLA cream, which is used to anaesthetize the skin and decrease pain. Unfortunately, EMLA also causes some swelling before and after the circumcision, which can make things appear a bit more uneven (though everything always grows in just fine). If you would like EMLA used please buy it at the pharmacy and apply it 45-60min before your appointment.
The main reason babies cry during the procedure is that are cold, so we try to keep baby swaddled and warm. I have never met a man who recalled his circumcision as an infant (or their birth only a week or two earlier, which was likely quite a bit more traumatic) but we do everything we can to make it as comfortable for babies and parents. It is up to you to choose penile block, EMLA cream, or both– I will be happy to discuss these options when you arrive at the clinic.
It is not unusual for a baby to sleep 6-8 hours after the procedure and to miss a feeding. Most babies will be irritable for up to 72 hours. They may feed a bit more irregularly or cry more often. Some babies can be very upset for 1-2 days – this is unusual, but some babies are like that even without a circumcision. Most babies are back to themselves within 2-3 days. Remember, what ‘normal’ behaviour is changes every week for a newborn. If you are concerned call/text/email Dr. Pakes.
No need to worry. As long as there is no active bleeding, this is normal and likely a good thing. You can just start using polysporin (or Vaseline) for about a week. If you are concerned that the penis is sticking to the diaper you can use a piece of gauze with vaseline in between the penis and the diaper.
The three layer gauze dressing usually falls of in 1-2 days. It may even come off at the first diaper change – this is ok. The inner layer is a special Kaltostat gauze that is designed to dissolve in saline-water, but it can get crusty. If this is the case, you can soak the gauze with warm water and Vaseline before removing it. Try daily soaks in warm water and email/text/call Dr. Pakes if its been 5 days or more.
Don’t worry about poop on the outer gauze. Try to clean it as best as you can, but avoid vigorous cleaning in the first few days. The scrotum was designed to keep poop away from the penis and it usually does a good job. If there is poop on the penis, you can gently sponge it clean but it is not a cause for concern.
The three layer gauze dressing should keep the urine away from the penis. Urinating should not be painful for baby.
A small amount of blood on the gauze or a very small amount of bleeding when the gauze comes off can be normal. The gauze may have taken a small scab off when it is removed. Take some gauze with polysporin on it and squeeze/hold the bleeding area with your fingers for two minutes. Baby will not enjoy this, but it should easily stop any bleeding. If it does not call Dr. Pakes. If there is blood actively dripping from the area, this is not normal. Call Dr. Pakes immediately or go to the Emergency Room.
If you are concerned, text, email or call and Dr. Pakes will be happy to discuss it. If you like, you can come back to have baby examined Dr. Pakes when he is next in clinic.
In babies 2-6 weeks old, it should heal completely in about 2-3 weeks. In older babies it may take up to a month. The raw skin on the shaft of the penis may not appear like the other shaft skin for many weeks.
Yes, other complications such as concealed penis or trauma to the glans are theoretically possible but they are very very rare and have never happened in Dr. Pakes’ practice.