Circumcisions performed using the Gomco technique are quick and effective. Unlike other techniques, the Gomco technique has the advantage of fully visualizing and protecting the glans of the penis during the circumcision. It is also easier to determine the adequate quantity of foreskin to remove. As it is very safe and effective at applying symmetric circumferential pressure, it results in minimal bleeding.

Dr. Brulotte performs the infant circumcision using the Gomco technique, which is the most widely used method and is a much quicker procedure than the plastibell technique.

Dr. Brulotte has implemented 4 steps to minimize discomfort during a circumcision. With these, the vast majority of newborns under 3 weeks are asleep or suckling on a pacifier during the entire length of the circumcision.

The 4 steps are as follows:

  1. Administration of acetaminophen (Tylenol) 20 minutes prior to the circumcision.
  2. Application of topical freezing cream (EMLA) 15 minutes prior to the circumcision.
  3. Dr. Brulotte will perform a dorsal penile ring block (local freezing using xylocaine) during the circumcision.
  4. Administration of sucrose (TootSweet) during the circumcision.

A circumcision is easier to perform, is better tolerated and, will heal faster if it is performed at a younger age. We will call you within 24 hours of the completion of your online registration.

If you prefer a same day appointment, we will do our best to accommodate you. Please contact the clinic at 613-699-OVIC (6842) upon the completion of your online registration.

Since a circumcision is not covered by any provincial health plan, we gladly will see patients from any province or country.

Most parents are comfortable following-up with their family physician for routine care. But if you would like an appointment 1 week post-circumcision, Dr. Brulotte will be happy to see you for a follow-up visit. There will be no additional charge for this appointment.

Benefits

The benefits are many and are available to the man, the woman and the entire family.

  • Reduction in urinary tract infection – Although uncommon in males, it reduces the risk of urinary tract infection (UTI) since it eliminates the preputial space that provides a warm moist environment for pathogens and bodily secretions.

    In a systematic review of 12 studies including data on over 400,000 males primarily under 1 year of age, circumcision reduced the risk of UTI by almost 90 percent.

  • Reduction in penile inflammation and retractile disorders – In the uncircumcised male, balanitis (inflammation of the head of the penis) and posthitis (inflammation of the foreskin) usually occur together. A circumcision prevents this type of penile infection (balanoposthitis) as there is no foreskin. Please note, balanitis is still possible, but the rate is reduced. A circumcision also prevents phimosis and paraphimosis, both of which are conditions where the foreskin of the penis cannot be properly retracted.

  • Reduction of HIV and other sexually transmitted infections – It reduces the risk of contracting certain sexually transmitted diseases including Human Papilloma Virus (HPV), Herpes (HSV-2) and AIDS (HIV).

    Please note that the HPV vaccine (Gardasil) plays a much larger role in the prevention of HPV related diseases, and is now part of Ontario’s vaccination program.

  • Easier hygiene – Good genital hygiene (washing the entire penis, including the glans, with soap and water while bathing) is important for all males and is generally easier in the absence of a foreskin. Uncircumcised boys should be taught the importance of washing beneath the foreskin on a regular basis when the foreskin is fully retractable. Good hygiene may prevent many problems associated with the foreskin, but can be difficult to maintain in uncircumcised boys. Studies of middle class schoolboys concluded that penile hygiene is usually not well-maintained.

  • Avoid having a circumcision at an older age – It eliminates the need to undergo the procedure later in life, when up to 6% of boys will require a circumcision as a result of various problems. When performed later in life, the circumcision is more painful, more difficult to perform, and carries a higher level of risk along with a much longer recovery period.

These benefits are easily achievable in a simple and safe 15 minute procedure under local anaesthesia.

The vasectomy offers men the control over their reproduction, and alleviates the dependence on their partner’s compliance to their own birth control methods.

The vasectomy offers women the benefit of avoiding the risks of pregnancy and childbirth, the possibility of stopping hormonal birth control, and avoiding tubal ligation (female sterilization).

Potential Risks

Procedure related complications – Complications are rare; various studies have estimated the rate at 0.2%.

Some of the possible complications include:

  • Bleeding, which is usually mild and controlled with local pressure
  • Infections, which are rare and usually mild, and treated by local antibiotics
  • Adhesions (skin bridges), which are easily released by simple retraction
  • Trauma to the head of the penis

Day of Circumcision

Before you arrive

  • Plan to be at the clinic for approximately 60-90 minutes

  • Please bring the following to your appointment:

    • Infant Tylenol or Tempra
    • A thin receiving blanket
    • A soother (if you son uses one)
  • It is recommended to feed your son just before you leave your home to ensure that he will be comfortable during his visit at the clinic.
    You will also have time to feed him at the clinic.

Step-By-Step : At the clinic

  • Arrive 20 minutes prior to your scheduled appointment.
  • At this point, we will give your son the appropriate dose of Infant Tylenol or Tempra.
  • You will then meet with Dr. Brulotte, where he will gladly answer all of your questions and concerns. You are welcome (but are not obligated) to be present for the circumcision.
  • Next, Dr. Brulotte will perform a dorsal penile ring block. This involves the injection of a freezing solution (xylocaine 1%) through a tiny needle into the area that has already been numbed by the topical cream.
  • After a few minutes, the penis will be frozen, and Dr. Brulotte will perform the circumcision. Throughout the circumcision, which will be done within a few minutes, your son will receive sucrose (sugar solution), to further alleviate any discomfort.
  • 20 minutes after the circumcision, we will show you how to care for your son’s newly circumcised penis. To make sure you are fully comfortable with the aftercare, we will do the first diaper change with you and show you how much Vaseline to apply.
  • If needed, your baby can be given a second dose of acetaminophen (4 hours from the original dose) once the local anaesthetic has worn off. Based on your son’s weight, Dr. Brulotte will determine how much medication to administer.

How to care for you crcumcised baby

Vaseline

Apply a generous amount of Vaseline to the provided gauze, and apply it over the penis to form a ‘Peepee-Teepee’. Apply this ‘Peepee-Teepee’ for the first 24-48 hours or until you run out of gauze. Then, apply Vaseline directly onto the area of the diaper that will be in contact with the penis.

To promote prompt healing

  • Keep the area clean and dry. Use disposable diapers for the first week; they tend to be less irritating and help keep the area drier and cleaner.
  • Gently clean the area around the penis using a warm washcloth. You can use regular wipes for all other areas but the penis. DO NOT use alcohol, powders or lotion as these may cause irritation.
  • Apply generous amounts of Vaseline in order to prevent the exposed foreskin from adhering to the diaper or forming adhesions with the penis glans.
  • Apply gentle traction at the base of the penis to minimize the risk of adhesions.
  • AVOID unnecessary car travel as car seats can be irritating to a newly circumcised penis.

First few days

  • It is normal for your baby to be a little irritable for the first 12-24 hours. We encourage you to keep him snugly swaddled since the less he kicks his legs, the more comfortable he will be.
  • The best sleeping position for your baby is on his back or his side, supported by a blanket roll. Most babies sleep well following the circumcision.
  • For the first week, give your baby sponge baths only.
  • Avoid changing your son’s diaper too frequently as it may be uncomfortable for him. Only change him immediately after a bowel movement or after feeds, as per usual.
  • With each diaper change, it is normal for the penis to be discoloured and for the gauze/diaper to be lightly stained with blood. A normal part of the healing process is to see a green-and-yellow-coloured membrane around the penis, especially on the underside, at the 6 o’clock position.
  • If the skin has moved up slightly over the head of the penis, gently apply pressure on the sides of the penis to ensure it heals properly without any adhesions. DO NOT push on the skin for the first 48 hours because it will be swollen from the procedure.

What to watch for?

ACTIVE BLEEDING: How to stop it?

  • As previously mentioned, we will re-examine your son’s penis 20 minutes after the circumcision. We will show you how to properly change your son’s diaper and make sure that there is no active bleeding.
  • Minimal amounts of blood are normal, but active bleeding is not, and we will make sure that everything looks normal prior to your departure.
  • Although rare, the most common reasons for bleeding to occur once at home are overly aggressive cleanings, not enough Vaseline applications, or too much pressure placed at the base of the penis for retraction.
  • If bleeding occurs, treat it like a nose bleed and apply mild pressure. Grasp the gauze-covered penis between your thumb and two fingers, and apply pressure at the bleed site for 1-2 minutes. Then, inspect the area for continued bleeding. Repeat pressure if necessary.
  • Leave the gauze in place, as removing it may lead to renewed bleeding. Make sure to apply Vaseline on the gauze. If needed, you may call the clinic for telephone advice or to book for a reassessment.
  • Dr. Brulotte has never had a patient call or return to clinic because of bleeding.

Infection

Although rare, infection can occur. Common signs of infection include:

  • Puss-like discharge, foul smell, local warmth, or fever.
  • If your son exhibits any of these signs, or if he has not urinated in over 12 hours, call Dr. Brulotte immediately.
  • Dr. Brulotte has never had a case of infection after a circumcision.