Baby & Newborn Circumcision at our Toronto ClinicToronto Clinic2018-07-18T17:13:35+00:00
Welcome to the Gentle Procedures Toronto. On this site, you will find information about circumcision for baby boys up to one year of age.
Infant circumcision is commonly done relatively early in the life of your son. Procedures completed in the first four weeks are considered newborn circumcisions.
Gentle Procedures Toronto circumcision clinic offers circumcision for babies up to one year old – but if you have taken the decision to have your son circumcised it is recommended toschedule the procedure as soon as possible in his young and new life.
You can contact Gentle Procedures Clinic to confirm our next available appointment in Toronto at our North York or Mississauga clinic locations at 416-551-7070. Appointments are usually available quickly (within a day of two). We work hard to deliver quality care in a timely fashion.
Our experienced medical team will exceed your expectations for quality of circumcision care.
Gentle Procedures Toronto was founded by Dr. Roland Sing and Dr. Neil Pollock. Dr. Sing is known in Toronto as a leading Urologist and surgeon as well as for baby circumcision.
Dr. Pollock is one of the most experienced circumcision providers in Canada, and he has safely completed over 40,000 infant circumcisions over the last two decades. Infant circumcision is our specialty and no other clinic group in Canada has the same experience in circumcising baby boys.
Our medical team has been carefully trained by Dr. Pollock and we are proud to use the Pollock Technique™ in providing safe and simple access to infant circumcision in Toronto. Our doctor and staff will support you after the circumcision surgery with a hotline for questions and detailed instructions on post-circumcision care for your baby son.
For full detail on the Pollock Technique™ circumcision method please visit the Our Method page.
For information on what to expect during and after a baby circumcision please see below.
The focused practice of our clinic permits us to optimize the circumcision procedure as well as the overall experience.
Having served thousands of babies and families we have developed specialized systems and processes to offer these services better than any other institution. We will exceed your expectations for quality circumcision care.
Preparing Your Baby Boy for Circumcision
You will receive detailed instruction on how to prepare your son for the brief circumcision operation. This includes how to best time feeding before surgery to maximize your babies comfort.
Babies will have Tylenol before and after surgery, and are given a sugary pacifier to distract and entertain them during the procedure. Some babies even sleep through the whole thing.
Circumcised Baby Follow Up
Guidance and follow-up continues afterwards, with written and verbal instructions on how to provide care after the circumcision. The goal is to minimize your child’s discomfort and promote healing.
You will be shown how to minimize the risk of infection and informed of warning signs to watch for in case of any complications. Our doctor is available by phone after surgery and will respond quickly to any questions or concerns.
The best time is between 7-28 days of age, although circumcisions are done at Gentle Procedures Toronto at any age. Since newborn babies are less aware, recover faster, and the risk of complications is lower, families should try their best to have circumcision done as close to this time period as possible. However, it is common for a variety of reasons that circumcision will be done at a later time.
Our clinic founder, Dr. Pollock, has published a study that shows our pain control process is highly effective. Many babies can sleep right through the entire under 60 second procedure. Most babies experience little or no pain at all.
It is not unusual for a baby to sleep 6-8 hours after the procedure and to miss a feeding. Some babies will be irritable for a number of minutes to hours afterwards. Behaviourally, most babies are back to themselves by the next day or two.
The gomco clamp is the most common technique used by other physicians. It requires much longer to perform and involves much more tissue handling than our methods.
The plastibell technique is also used by some doctors performing circumcisions in Toronto. With this technique the baby must go home with a small plastic device tied on to his penis that allows the foreskin to desiccate over subsequent days. This is also a lengthier procedure to perform by the physician.
Our procedure takes only one minute (10 times quicker than most hospital circumcisions). We use extensive pain control methods like Tylenol, sugar solution (which has been shown to reduce pain perceptions), soothing music, topical freezing cream, padded baby holders, and local anesthetic injection.
We have extremely low complication rates and no hospital administration fees are charged. Our clinic is designed to meet the needs of families for infant circumcision. Because of our focus on this procedure we are able to organize our staff and clinic operations optimally for baby circumcision. This makes us different from circumcision providers in Toronto who do not specialize in this service.
Complications are rare. Occasionally, there can be bleeding from the circumcision many hours after the procedure. This is treated by putting some pressure with gauze on the penis for 2-3 minutes to close the oozing blood vessel. (This will be demonstrated to you by our staff).
Very rarely, more serious bleeding can occur which may require a visit to the hospital. Infection is also a possible complication. It is extremely rare and can be associated with redness, pus, and a foul smell from the circumcision. It is treated by putting Polysporin five times a day on the penis which usually resolves any infection within one or two days.
Suboptimal cosmetic result is another possible but very infrequent complication.
No – doctors have different beliefs and practices regarding anesthetic use. We perform circumcisions using the Pollock technique, which is performed on thousands of patients every year. This method has been proven safe and effective on 50,000 patients over the last 25 years, and minimizes pain and discomfort with multiple combined anesthetic methods.
A Toronto Baby Circumcision Clinic
When looking for the right facility for your son’s circumcision, please consider that the techniques for providing this surgery can vary from doctor to doctor. Our Pollock method has been refined and standardized over 50,000 procedures. Your boy will benefit from the highest standard for care and safety available in infant circumcision today.
Hospital Infant Circumcision Procedures
Toronto hospitals do not generally offer baby circumcision for newborns in a convenient and timely way, and OHIP does not cover routine circumcision.
Some hospitals may have offered circumcisions for infants before mother and baby leave the maternity ward, but this is no longer the case in many hospitals in the GTA, and in Ontario.
Where to Get an Infant Circumcision
It is sometimes possible to get the operation in a hospital on an outpatient basis, but these institutions cannot offer the service level and experience of a specialized private clinic.
Large institutions manage hundreds of different services and must prioritize urgent situations over hospital circumcisions for newborns.
Potential Benefits of Infant Circumcision
Toronto parents undertake a circumcision procedure for their son in order to fulfill cultural and religious traditions, as well as to seek improved health outcomes for their children. Some parents decide to circumcise their son for cosmetic and personal reasons. The important thing is to make an informed decision that you will be happy with.
There are many potential benefits from baby circumcision:
Improved genital hygiene
It is well known that microorganisms accumulate under the foreskin which fosters inflammation which can lead to conditions such as balanitis/balanoposthitis (inflammation of the head of the penis). The incidence of balanitis is twice as high as those who are uncircumcised. Smegma, which is a cheesy like secretion, can also accumulate under the foreskin combining with bacteria to produce an offensive odor.
Reduced risk of urinary tract and bladder infections
Because microorganisms can accumulate under and adhere to the foreskin, bacteria have a greater chance of migrating up the urethra causing urinary tract infections (UTIs) especially in infancy. Studies suggest an over 10-fold decrease in risk of urinary tract infection in circumcised infants. UTIs are a potentially painful and dangerous condition as it can result in kidney inflammation and scarring. Studies suggest that the protective effect of circumcision against UTIs when done as a newborn continues into adulthood.
Reduced risk of phimosis after circumcision
Phimosis is a condition where the foreskin becomes so tight that it cannot be pulled back fully, resulting in UTIs, local skin infection, pain when passing urine, retention of urine, kidney stones, and sexual dysfunction. Circumcision eliminates the risk of phimosis, which affects 1 in 10 older boys and men.
Reduced risk of penile cancer
Studies have shown an over 20-fold reduction in the risk of invasive penile cancer which is thought to arise from adherence of high-risk human papillomavirus to the foreskin and smegma causing chronic inflammation and recurrent infections resulting in phimosis. Invasive penile carcinoma is highly associated with a history of phimosis.
Reduced risk of prostate cancer
Uncircumcised men have a 1.6-2.0-fold higher incidence of prostate cancer, which is thought to correspond with a higher chance of sexually transmitted infections resulting in a chronic state of inflammation.
Reduced risk of HIV/AIDS
Circumcision reduced the risk of getting HIV/AIDS by 3-fold during sex with an infected woman. This is because the HIV virus enters through the inner lining of the foreskin which is thin and vulnerable. Ulceration and tearing are also more common in uncircumcised men, adding to the risk of HIV entry.
Reduced cervical cancer in women
Circumcision reduced cervical cancer risk of a man’s female partner by 5.6 times as there is less risk of adherence and colonization of human papillomavirus.
While the circumcision procedure performed on babies at our clinic can be considered routine and low risk, there is always some degree of risk with any surgery. Potential problems include:
Bleeding after circumcision – In 1 in 500 circumcisions there may be some bleeding that is usually stopped with pressure or less commonly with stitches. If a bleeding disorder such as hemophilia is present, then our doctors will need advice from a pediatric hematologist prior to proceeding.
Infection – There is always a possibility that there could be a generalized infection requiring antibiotics after the surgery (1/4000). Serious infections are rare (1/5000).
Concealed penis – When there is a good amount of fat around the penis (pubic fat), the penis may retract inward and increase the chances the penis gets partially buried and requiring medical intervention (1/800).
Meatal stenosis – This is a narrowing of the urethra that may occur after the procedure requiring medical intervention (1/1000).
Phimosis from circumcision – This is a narrowing of the shaft skin opening over the head of the penis requiring medical intervention (1/500)
Trauma resulting in permanent damage to the head of the penis (never in our practice) Suboptimal cosmetic result (1/500)
More serious complications including death (never in our practice).
Baby Care After the Circumcision at Our Toronto Clinic
We understand that parents will sometimes have concerns and questions in the days after a baby boy’s circumcision. Please see the detail below for information on how to care for your baby post-circumcision, and do not hesitate to contact us with any concerns that you feel require Dr. Sing’s attention.
How to care for your son in the first 24 hours following the circumcision:
Keep your son snugly swaddled (especially his legs). The more he kicks his legs, the less comfortable he may be. After the first day, you no longer need to swaddle him, but can continue to do so if he finds it comforting.
This image shows initial application of the gauze with Vaseline. Replace it if it falls of in the first 24 hours. The image also shows the long gauze and bandage around the penis that will be removed in 24 hours, or if it falls off earlier you may leave it off.
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 only after 24 hours. If it has fallen off, just replace it with a fresh 3×3 gauze with some Vaseline on it and put it over the penis then close the diaper.
Please check your baby’s diaper every hour for the first 24 hours to look for any abnormal bleeding.
If the white gauze over the penis 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.
There will also be a long piece of 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.
No gauze bandages are required after the first 24 hours, just Vaseline.
On 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.
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.
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 mucosal adherence (see image) and/or skin bridging which results from the mucosa and/or skin respectively attaching to the head of the penis. If you are unsure of the appearance of your son’s penis, bring him to see our doctor, and we will adjust the skin for you if required.
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.
Most babies sleep quite well following the circumcision. The best sleeping position for your baby is on his side, supported by a blanket roll.
Healing is promoted by keeping the area clean and dry. Warm water and a cotton-ball or washcloth are preferred for cleaning the area around the penis. Avoid moistened towelettes, alcohol, powders, and lotion since these may cause irritation. Don’t give your son a bath before the doctor has said that it is ok to do so (generally after 3 – 4 days).
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.
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 to the new circumcision.
Healing Post 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. This inflammation will subside within a week or two. In the first two days, there may be an off-white or yellowish, patchy appearance 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 look green and yellow. This is NOT pus. It is healing tissue. It can look this color for up to two weeks after the circumcision.
You will also notice that the glans appears red and glossy sometimes purple. 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 yellow patches on the head of the penis as it heals. This is a normal part of healing.
The head of the penis can often be purple, blue or red after circumcision. This is normal.
Circumcision Scar? – Appearance of the Baby’s Penis
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. 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.
After a few days to week, some parents notice swelling of the mucosal tissue behind or under the head of the penis and believe it looks “like a blister”. This type of swelling is normal. It is not a blister, and it will gradually subside. Scarring from infant circumcision is rare, even if there is swelling in the first week.
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 our GTA clinic to consult with Dr. Sing immediately.
The Pollock Technique™ is associated with the optimal cosmetic outcomes. Scarring on the penis is very uncommon, but do share any concerns you have in the weeks after your boy’s procedure.
Frenulum – Band of skin underneath the penis
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 (see image). 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.
It is not unusual for your son to sleep 6-8 hours after the procedure and to miss a feeding. Some babies will be irritable for a number of minutes to hours afterwards. Behaviorally, most babies are relatively normal after a day or two.
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 method if you observe any bleeding. See detail below.
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. Repeat if necessary. Call Dr. Sing directly at the Toronto clinic if bleeding persists despite pressure.
Visible scarring on the mature penis is very rare with our circumcision method. It is normal for there to be swelling and discoloration in the week after surgery and the penis will likely take on a normal appearance over time.
For newborns, our physician will let you know at your follow-up when you can start giving your baby a full bath where he goes under water.
Post-Circumcisions Issues and Treatments
Circumcision is associated with few and infrequent complications, although with any surgical procedure there are occasional problems. For example, bleeding. In almost all cases bleeding is controlled by direct pressure. Please see detail below on how to treat bleeding after circumcision.
The frequency of complications after infant circumcision varies with the skill and experience of the physician amongst other factors.
Even though complications are rare, do not hesitate to consult Dr. Sing at our Toronto clinic if you have any questions about the appearance of the penis. Remember, early treatment (if any is needed) is always best.
Please check your baby’s diaper for any bleeding every hour or so for the first 24 hours after circumcision. If the baby is sleeping, you can just look at the front edges of the diaper from the outside. If it is not discolored, he is likely not bleeding abnormally. When you open the diaper, it is normal for the covering gauze to be a little red from bleeding. You need to remove the gauze to check for active bleeding only if the whole gauze has become soaked with fresh, red blood. You treat active bleeding from the penis the same as you would for the tip of a finger:
Apply pressure to the penis for 3-5 minutes; no less. Do this by grasping the penis between your thumbs and two fingers using a piece of gauze with some Vaseline to prevent sticking.
After applying pressure, inspect the area for continued bleeding and repeat step one if necessary.
Once the bleeding has stopped, apply a fresh gauze square with Vaseline and close the diaper. Recheck the diaper after 10 minutes for any signs of more blood on the gauze.
It is reasonable for you to try the pressure technique twice, for 3-5 minutes at a time, before calling Dr. Sing as most bleeding will stop with this.
If the penis is dripping any blood, and you cannot stop the bleeding with the pressure technique that we have demonstrated to you, call Gentle Procedures Toronto.
When the length of the penile shaft is no greater than its diameter or when there is a good amount of pubic fat, the penis will tend to retract inward. This is normal. This characteristic is only a concern for the first month or two since the healing circumcision can adhere to the surrounding skin resulting in a “concealed penis”.
If your son fits this profile, you can reduce the chance of concealed penis by applying a very thin layer of Vaseline to the entire glans, once a day, until the glans takes on a healed appearance (about 1-2 months). To expose a glans that has retracted inward, place gentle downward pressure on either side of the base of the penis.
Consult Dr. Sing if the penis cannot be fully exposed, or if any connecting skin bridges form between the shaft skin and the head of the penis.
Although rare, there have been reported cases of infection. Common signs of infection include: a pus like discharge, a foul smell, excessive swelling or redness, local warmth, a fever, or a rash anywhere in the area of the penis. With any of these signs, or if your son has not urinated in over 12 hours, consult Dr. Sing at our Toronto circumcision clinic immediately.
There will be a long gauze strip (1/2×8 inches) wrapped around your son’s penis. This strip may fall off within the first 24 hours. If it falls off early, do not worry, this is normal, just leave it off. You can place the small gauze given to you at our office (with some Vaseline on it) on the penis for the remainder of the 24-hour period. If after 24 hours the gauze strip is still in place, it will have to be removed.
To remove the gauze strip:
Apply Vaseline liberally and completely over the stuck surface.
Close the diaper and allow 10-15 minutes for the bandage to soften.
Gently peel away surfaces that are no longer stuck. Repeat the process as necessary. It is okay to do this a little at a time over the course of the day – it always comes off.