By Nancy Ripton
We had our first son, Bode, circumcised two days after his birth and assumed things would be the same with our second. What we hadn’t anticipated was Beckett’s 11-day stint in the Neonatal Intensive Care Unit. By the time I called the doctor a few days after my son’s discharge, I was told to bring him in immediately or she would not perform his circumcision — the surgical procedure to remove the layer of skin (called the foreskin or the prepuce) that covers the head (glans) of the penis and part of the shaft. Who knew there was such a limited time span for circumcisions?
While the Canadian Paediatric Society does not recommend routine circumcision for newborn boys, if you have decided to have your child circumcised due to personal, religious or cultural reasons, the ideal time to have him circumcised is between 24 and 72 hours after birth. “We don’t recommend before 24 hours because the newborn could have an undiagnosed medical issue and we don’t want to subject him to an elective procedure,” says Dr. Rui Martins, a family physician with privileges at Toronto’sÂ Sunnybrook HealthÂ Sciences Centre and at Women’s College Hospital where he performs circumcisions. The attending pediatrician or family doctor needs to see your baby prior to any circumcision to ensure the baby is healthy before it is carried out. Once you’ve been given the okay, you should proceed as quickly as possible. In the first few days after birth, babies tend to bleed less and fuss less during a circumcision. Dr. Martins adds, “As the baby grows, the foreskin develops a greater blood supply, which may cause more bleeding during and after circumcision if it is done after two or three weeks of age. This can pose additional risks to the baby,” says Dr. Martins, who does not perform a circumcision once the baby passes two weeks of age if born full-term, adding, “In my view, the decision to circumcise should be made either before the birth or soon after.”
Many doctors believe that after babies reach two weeks of age they become much more aware and experience more discomfort. But, “there is technically no difference between performing a circumcision on a six-month-old and a nine-year-old,” when it comes to trauma and recovery, says Dr. Joao Pippi Salle, chief pediatric urologist at The Hospital for Sick Children in Toronto. The use of an anesthetic during newborn circumcision is debated, but certainly after the first few weeks, doctors agree that circumcision requires a general anesthetic and many doctors don’t like to perform the procedure on any child under five for several reasons, including the problem that younger children will try to touch their penis while it’s healing.
Which brings up the question: If you miss the two-week window, should your child be circumcised at all? Michael LePatourel and his wife Lizelle of Edmonton had their son in Taiwan, where doctors do not perform circumcisions. “I’m circumcised and I would like my son to be as well,” says LePatourel. “But by the time we moved back to Canada, Miguel was almost two. We’re worried it might be too traumatic now [at three and a half].”
Dr. Martins says, “In my view, if the child is doing well I wouldn’t take the risk,” which can include pain and excessive bleeding. And since it’s an elective procedure, you may be bumped for more urgent operations. You can also expect to pay $1,000 to $2,000 for the procedure (newborn circumcisions are about $200).
There are a few reasons why a child would benefit from a non-newborn (medical) circumcision. The most common is phimosis, a condition where the foreskin cannot fully retract from the head of the penis. There is some evidence that circumcision can also help boys who are prone to urinary tract infections and/or who have backflow of urine from the bladder to the kidneys. There are studies that show circumcision can lower some cancer rates and reduce the risk of developing a sexually transmitted disease (most notably, a French National Agency for Research on AIDS and Viral Hepatitis study that found three times fewer circumcised participants had acquired HIV compared with control participants). “These are more an issue in countries where there is not the regular use of condoms,” says Dr. Pippi Salle. “I don’t see it as a major “pro circumcision’ reason in Canada.”
Nancy Ripton is a freelance writer and co-founder of justthefactsbaby.com. She lives in Toronto with her husband and two sons.