You do not need to bring any medications to the appointment 

When you come for your circumcision appointment, we will apply EMLA cream which will numb the area before the injection of the anesthetic. We will also give acetaminophen (Tylenol/Tempra) to your baby to ensure he gets the correct dose.  

Please bring the following:

• Your baby’s Alberta health care number
• 6 diapers
• Baby wipes
• Blanket
• Soother if your baby takes one
• Formula, if your baby is not fully breastfeeding 

Please buy the following:

• Infant Acetaminophen (Tylenol/Tempra) – ensure the bottle reads 80 mg/ml
• Petroleum Jelly (Vaseline) 

Please make sure you eat a meal before the appointment.

We generally run on time. If you are late for your appointment, we may need to reschedule. This will ensure that none of the other babies and tired parents are inconvenienced.   

The appointment will last approximately 1.5 hours. You will be given written instructions about how to care for your baby after the circumcision. We usually book a follow up visit (virtual or in person) in one week to check on the healing. You will be given a phone number to reach Dr. Zwiers directly if there are any concerns. If you have any questions, do not hesitate to call us. 

On the day of the procedure, please be sure that you come to the correct clinic! 

When you arrive, please check in at the front desk. Please ensure that we have your correct address and phone number on file. If you have not been to our clinic before, please bring your newborn’s Alberta health care number. Payment is required prior to the procedure.  Although the actual procedure lasts only a few minutes, you can expect to be in our clinic for a total of 1.5 hours.

Before the circumcision, you will meet with Dr. Zwiers. She will ensure you are well informed and answer any questions. We encourage you to stay with your baby for the whole procedure.  He knows your calming touch and voice. If you stay, you do not have to watch the circumcision.

When it is time for your appointment, you will be brought into the procedure room.  Please undress your son and put him into a clean diaper. Wrap him in his blanket to keep him warm. Please put 3 spare diapers and a package of diaper wipes on the bed for future use.  Please feed your baby if he is hungry so that he will be more settled.

Your baby will be made very comfortable for the procedure. When you first arrive, we will apply a numbing cream (emla) to the skin of the penis.  We will also give Acetaminophen (Tylenol/Tempra) for pain relief. We will ask you to continue giving acetaminophen regularly for 24 hours after the procedure.  Just before the surgery, we will inject the penis with a short and a long acting anaesthetic (xylocaine and bupivacaine).

We offer a sugar and water solution to your baby during the procedure to help with soothing. There will be a rare baby who cries during the procedure.  We can reassure you that this is not due to pain.  It is important to remember that babies fuss for many reasons including diaper changes and tiredness!

When ready to do the procedure, the nurse will kneel on the footstool. We will wrap your baby’s arms in the blanket so that he will feel safe and secure. The nurse will gently hold onto your baby’s legs. Parents are welcome to sit next to their baby, touching and talking to him. A soother or your baby finger will be placed into your baby’s mouth for him to suck on.

The surgery is done using a small clamp called a “Mogen clamp”. The surgery starts with  stretching the opening of the foreskin.  The foreskin is then pushed down so that the head of the penis is fully exposed. Dr. Zwiers will make sure that the penis is normal before the skin is removed. If a problem is detected, the circumcision may not be done at this time. Your child would be referred to a urologist.

Once Dr. Zwiers is satisfied that the penis is normal, the foreskin is pulled back over the tip of the penis. The correct amount of skin to be removed is measured, and then the excess skin is pulled into the Mogen clamp. The opening of the clamp is very small in order to avoid the tip of the penis getting caught in it. The clamp is closed and locked tight. This action squeezes the layers of skin together, sealing the inside and outside skin layers together like closing a zip lock baggie. This helps prevent bleeding from the skin edge and permits the procedure to be done without stitches. Next, the excess tissue is cut off and the clamp is removed. 

We will explain how to care for your baby during the recovery. Everything we say is written in the section on AFTER CARE. 

We will keep you for 5-10 minutes after the surgery to be sure there is not too much bleeding. Please stay in the room with your son until Dr. Zwiers checks inside his diaper and tells you it is time to get him dressed and go home.  You will put him in the car seat normally. Don’t loosen the straps. 

We will book a follow up visit in one week to check on the healing. You will be given a phone number to reach Dr. Zwiers directly if there are any concerns.

Bandage

• A medicated bandage called Surgicel has been place around the cut mark on the penis. This medication prevents bleeding.  Don’t remove this bandage. It will fall off when it is ready (sometime between 1 hours and 3 days).  When it falls off, there should not be any dripping blood. If there is dripping blood, you will hold him against your chest and follow the instructions for bleeding.
• It is normal for the bandage to turn black with the blood touches it.
• If poop gets on the bandage, you can wipe it off gently with a wipe. Don’t worry if the bandage turns a little yellow when the poop touches it.
• If you see the bandage covering the hole where the urine (pee) comes out, just move it out of the way.
• If the bandage has not fallen off by 72 hours after the procedure, please soak your baby in a warm bath of water and gently peel off the bandage. If it does not come off easily, you can try again in 24 hours.

 Bleeding

• Check in the diaper every 3-4 hours for the first 24 hours.  It is normal to see a little bit of blood in the diaper.  It is also normal to see a blood clot on the tip of the penis.
• There should not be blood dripping from the penis. If you see dripping blood, put the diaper back on, and hold your baby tight against your chest for 15 minutes.  After 15 minutes of applying pressure, If the dripping restarts at any time, or if ever the diaper is heavy with bright red blood, go directly to the hospital or urgent care centre.

Normal healing

• The shaft of the penis will be bruised and swollen. The tip of the penis will be red and sore.  You will notice a white sticky substance (wet scab) and yellow wet discharge around the cut mark and over the head of the penis. You may see a blister at the bottom of the penis where the injection was given. The penis will look its worst at 24 hours.  It will then stay the same for a few days, and then slowly improve.

Seek medical attention if

• There is worsening after 24 hours with more pain, redness, swelling, or thick and smelly discharge.
• You are worried about the amount of bleeding.
• Your baby has not wet his diaper for 12 hours after the circumcision.
• Your baby develops a fever (temperature 38.0 degrees Celsius or higher), or your baby seems to be sick.

When is the best time to book a circumcision?   

Studies show that the safest time to have circumcision done is before 4 weeks of age.  Your baby must be over 2800 grams (6 lbs 2 ounces) to have circumcision done. 

Can I bring other children to the appointment? 

Yes you can. The appointment will last approximately 1.5 hours. Please bring snacks and toys/books/games/downloaded shows to keep them occupied.

FRIENDLY REMINDER: EVERYONE NEEDS TO BE HEALTHY TO ATTEND THIS APPOINTMENT. 

Do I need to stay in the room for the procedure?  

Although it is helpful to have a parent in the room for the procedure, we understand if this is too difficult.  Please let us know if you would like to leave the room for the circumcision. 

Does my baby need Vitamin K at birth? 

YES.  In Alberta, babies automatically receive a shot of Vitamin K at birth.  The only time this is not given, is when the parents refuse.  If a baby does not have Vitamin K at birth, it increases the risk of serious bleeding with circumcision.  If your baby did not receive Vitamin K at birth, please consult your doctor or midwife so this can be arranged. 

Will my baby cry during the circumcision? 

We use both a freezing cream followed by an injection to make the area numb.  Your baby will be wrapped comfortably and be able to suck on a sugar and water solution.  Most babies are very calm during the procedure.    

How do I care for the circumcision when I go home? 

At the appointment we will give you an information sheet.  You will be given a number to reach Dr. Zwiers if you have any additional questions.  Please refer to the section on after care for further information. 

Is there a follow up appointment? 

There is an appointment in one week after the circumcision to check the healing.  The follow up can be done in person, or by secure messaging and telephone.  If any concerns develop after the first week, please call the office for an appointment.  

What should I do if I have concerns after the one week follow up? 

Please call the clinic at any time in the future if you have concerns. The receptionist will book you a follow up appointment with Dr. Zwiers (phone or in person).  Please do not contact Dr Zwiers via cell phone or secure messaging for non-urgent problems after the first week. Visit the Follow up Visits page for more information.