Circumcision - how do I discuss it with my 3yo?

[Gracie123]

Long story, but basically DS needs a circumcision for medical reasons.

We have decided to go privately as the NHS version looks horrendous and private doctor will come to our house, less scarring, faster healing time, shorter waiting list... etc...

I'm not here to have people make me feel guilty about a toddler getting circumcised. He needs it for medical reasons and it's been a very emotional decision already.

What I'm hoping is that someone has been through something similar and can help/advise me on how to talk to him/prepare him for it.

The surgery is booked for 2 weeks time. Should we be discussing it now, or will that just make him scared for longer? Should we bring it up on the day for the first time?
How much detail would you go into?

He's my first baby and the only boy in our family (sister had all girls) so we've not really had anyone to talk it over with.

No, it won't be because the foreskin is cut to begin with

No cultural/family issues. No one in my family has had it done, and although DH is (it's routine at birth where he was born) his family were quite against us getting it done.

The surgeon we have hosen is not the only one recommending it. The NHS paediatric urologist, 2 x GP, nurse practitioner and general paediatrician have all told us they think it's necessary. The surgeon we have chosen is willing to do it based on their recommendations. He isn't some lone guy trying to make a fast buck.

He's been very understanding of my sons fear of doctors and hospitals and has agreed that both he and his assistant will come in plain clothes so as not to scare him any further.

I think they have been incredibly compassionate and understanding regarding our situation and concerns over DS's comprehension and I don't see why you would think he is trying to take advantage of us

doublelife thank you for your thorough post. It was very helpful. I have actually had a lot of people PM ing me with similar stories, just to scared to post on the main board.

So you're trained in using the plastibell then? I presume you've done thousands of circumcisions have you?

Otherwise how dare you be so condescending and rude as to assume that the specialist, and by extension I, have no clue what we're talkin about.

The cutting of the foreskin to place the plastibell is only necessary on a baby under 3 months old (I have been told this by the surgeon, and several mothers who have had their sons experience it).

The mothers are the ones who told me their sons were happily chatting whilst it was being done. What had they got to gain from lying about this? Why would you call them all liars?

The local anaesthesia we will use is not the same one you have for most uncomfortable procedures. As my son has special needs they have agreed to use a complete block so that he is in no pain.

Ever seen someone having surgery whilst they are awake? C-section? I suppose you'd tell a first time mother that her section will be agony and the anaesthesia won't work and she'll be screaming in agony, despite never having had one or experienced one for yourself?

Yes I'm aware that he isn't having the same anaesthesia that is used in a section, but he is having a complete block, which means he will feel nothing for 8 hours, by which time the nerve supply would have been cut off completely and he will not be in any pain.

I don't really care if you believe that or not. But please stop trying to make me feel bad about something my son has to go through.

If your child broke their leg, I wouldn't tell you its fine to punch him in the leg because it won't be as bad as the initial injury.
Even if going in a car seat won't be as uncomfortable as the surgery, I chose not to do anything else that may compound his discomfort. I'm his mother for goodness sake!

We had my DS cicumcised at 6 weeks. My partner is Jewish so was for religious reasons. The trauma I went through as the day got closer and closer was insane! It wasn't that I didn't want it done, it was the thought of him being in pain. We took him to Portland hospital in London. Was very expensive but I knew he was getting the best treatment. We met te surgeon, lovely lady. We was there when she put the numbing cream on - that took about 15 mins to work. Then a lovely nurse took him to have it done, he was back with us in about 5 mins. No tears, nothing!

For the days that followed he was his usual happy self. I was more upset than him!! You'll be fine, he'll be fine :) remember to get calpol ready for him and wine for u!! Good luck

Just to add, we visit lots of hospitals before he had it done. NHS and Private, It was near impossible to find a good one near us (west country) that would do it before he was 3.

We actually had him booked in to one and left once we saw the doctor, mucky nails

The Portland were fantastic. Clean, reassuring, they made me feel like he was in good hands! This did mean we had to travel for 2 hours from home but, he slept the whole way back in his car seat no problem.

Gracie i must admit when i first saw your post i was a bit shocked at the thought of this being done at home but having read further you have obviously done a lot of research into this procedure and are making a decision about your child's future based on this.

I can't comment on the procedure as i have no experience however as for preparation Talking to him gently about it for the week before might be a good idea. Talking about his current problems and how the doctor is going to help it get better. Probably best not to have one big conversation but lots of small ones adding in more information as you go.

eg 1st conversation your willy gets really sore doesn't it wouldn't it be nice if we could make it better so it doesn't keep on getting sore

2nd conversation you know we were saying it would be nice if your sore willy got better well mummy & daddy have found a doctor who thinks he can help fix it

and build on it like that. I also think the teddy idea is great to practice on. Make sure you stay calm and that will help him if you are confident and happy then he will pick up on this likewise if you are anxious. Also if possible have him sitting on your lap with the other parent distracting him with fav toys, book, dvd but on hand to help hold if he does start to get upset.

I totally repect your decision and think that the home environment will be much more relaxing for him than a hospital setting. As for it being sterile surely they will use sterile fields around everything that needs to be kept sterile after all many complex wound dressing are done at home by district nurses and as these are open they definitely need to be sterile.

Good luck with it all it would be great to hear how it all goes so that other mums who face a similar decision can benefit from your experience.

By the way my ds is circumcised due to hypospadias his was done under ga as part of much larger surgery he was 9 months old and crawling around with his catheter bag taped to his nappy the next afternoon. Children really are amazing.

Thanks for your kind words.

I will speak to the surgeon about having him on my lap. I'd just assumed that would be how it worked if I'm honest.

We've had lots of conversations about his willy being ouchy, and that taking this medicine or using this cream will make it better. Unfortunately it is only ever a temporary relief, so he doesn't believe me any more

Could you also have a ceremonial throwng away of the creams etc beforehand too as part of the preparation? DS might enjoy it and if he's stopped believing you that they'll make him better it might help?

Gracie123. Hope this reaches you in time to be of use. First to answer your question; how to talk to your little boy? Timescale is longer for three year olds than for adults. A week is quite enough to get used to the idea, any more only extends the period of concern he might have. Just say that a nice man and a friendly nurse have heard about his willy problem and will be coming to make it better. They will fit a little plastic ring over the end of his willy and it will fall off after a few days. When it does, he will be able to see the little round end which up to now has been covered with skin. Now the skin will have gone (or you can say 'it's been pushed back') he won't have any more problems weeing or soreness. Because it is better, the doctors won't need to look any more.

I wouldn't mention pain from the procedure. There really shouldn't be any except possibly for the moment of first injection. After that he shouldn't feel anything. By the time the LA wears off, the foreskin beyond and under the tied thread will be numb. (BTW they do trim off the excess just beyond in front oft the tie but he won't feel that.) It may feel a bit odd and strange at first wearing the ring and weeing, but not painful. Again he will feel different after the ring falls off. He will need a few days to get used to the permanently exposed head touching his clothes but this should only tickle a bit. It's worth enthusing about his 'new' willy but the only downside of that is he might want to shout off to everyone he meets!

Good luck!

OP I'm sorry if I've offended you with my opinions. I've never questioned your DS's need for a circumcision. The issue that sits uncomfortably with me is the fact that you are having it done at home, when a hospital environment is more suitable. I was with a Paediatrician friend yesterday and she also raised her eyebrows at it. Please speak to the surgeon prior to the procedure (ie days, not minutes) and ask him about the restraining positions to prepare yourself mentally (and probably physically). However, good luck with it all. Please do come back and tell us how it went, I'm sure people will gladly give you advice etc again re pain relief and any other coping mechanisms if need be.

Love the idea of a ceremonial throwing away of creams Leeloo I think DS will enjoy that

sausage I'm not offended, just tired of repeating myself. I'm sorry we don't agree on the suitability of home. I just know it will be much more comfortable for DS and I too have friends who are peadiatric nurses, who know DS, and they wholly support this and think it's the best option.

I'm not Jewish but some of my friends are. I just confirmed by asking and they tell me almost all Jewish circumcisions are done in the boy's home. The môhels and môhelets who perform them are well trained in this procedure. They create sterile fields around the site and follow good routines just as any conscientious doctor would. Some of them are doctors of course, but not all. I read once in my research that their skill and low complication rates for circumcision are the envy of many in the medical profession.

It's worth noting that many NHS hospitals are hotbeds of cross-infection and their record in controlling them are nothing to boast about. The rates of MRSA and C-difficile highlighted by the media come to mind.

Given this, a clean home and a good sterile routine around the surgery is probably the safer option.

Okay, so here's the update for those who were interested.

DS was circumcised 20 minutes ago. At the moment he is happily eatin marshmallows and playing trucks with his daddy

It was not a pleasant procedure, he was terrified and shouted the whole way through it that he wanted the doctor to leave. However, the minute we put his nappy on he stopped crying and asked if he could have some sweets.

DH asked if he was ouhy and he said yes and showed him a small cut on his hand that he got from his train track a few days ago

So it seems that the anaesthesia is actually very good.
He is complaining that it hurts when he does a wee. The surgeon tells me this is not true, but that it will feel funny. Tbh, the dentist told me the same when he wanted to pull my teeth out, and that did bloody hurt, so I'm inclined to believe my son. It does only seem to hurt for the few seconds that he is actually doing a wee, then is okay.

It was a bloodless procedure and the surgeon said he was very happy wig the results and we should have no more problems.

So... There we go. It's done now. It wasn't pleasant, and I personally would not do it to a child this age again without a compelling medical reason. I would however have any future sons done at birth to avoid the risk of this needing to be done.

The surgeon was very nice, despite DS being incredibly rude, and I wouldn't hesitate to pass his number along to anyone who needs it.

Hope this helps.

Thank you for the update - and your honesty in telling it like it was. I guess your son's fear and shouting came from being held by strangers rather than actually being hurt.

Local anaesthetic is very good. Only one of my boys whimpered when the needle went in but other than that nothing. I just stroked their hand as they were cut. (the old fashioned way in our case btw.) Of course unlike your son, mine were babes of a few weeks old and had no idea anything was happening to them. Even so LA is far less risky and upsetting for them at any age.

I'm pleased you wrote "I personally would not do it to a child this age again without a compelling medical reason. I would however have any future sons done at birth to avoid the risk of this needing to be done."

This is the conclusion I came to after seeing my nephew suffer for a long time before and a short time after this circumcision. To see a boy in tears with an infected, tight, foreskin is a sad memory and it convinced me I wasn't going to risk it happening to any sons of mine. Obviously you now feel the same way and I feel vindicated in my own decision by your story. Thank you for posting it it.

Forgot to mention, we did try lots of ideas (throwing away creams etc...) but none of them made him okay with the idea of the dr coming to our house. He just said 'no' everytime we brought it up.

Eventually we got him to agree that it was a good idea. How? By telling him that after the doctor puts the plastic on you have to have two baths, everyday. I knew he loved baths, but I couldn't believe this is what finally got him to agree to lie still!

Oooh gracie - my friend had her ds done at 3.5. She felt the same as you.

I know this boy well and a few months on he had no recollection of it at all.

It's done now and you must be so relieved.

DS woke at 5am this morning with tears, but went straight back to sleep with some calpol.

He is saying today that he can't sit because it's ouchy, and has eaten breakfast reclining on a bean bag, but he doesn't seem too distressed. Calpol from 5 must still be working, but we haven't had to top up with nurofen at all.

It does look swollen and there's some bruising coming out, but again, he seems to be okay with that. He's very proudly announced to my parents that he has plastic on his willy but he was very brave and soon it will fall off.

Word of caution to anyone else getting this done: DH watched it happening. I don't know why, but he now wishes he hadn't. He says he felt really sick and couldn't stop thinking about it last night, even though DS had long gone to sleep and was happily snoring away.

Interesting about your DH Gracie. Mine was circumcised as a baby and is happily so to this day. He doesn't remember anything about it, but he left me to do all the research and take the decision to circumcise our boys. Browsing the subject, I became familiar with all the gory details but some videos are hard to watch (not all btw).

DH came with me to the clinic where both our boys were done but stayed in the waiting room as he's quite squeamish about blood and injury and can't watch operations on TV. Even Holby City LOL!

I went in to comfort my baby and was almost too concerned to look. The actual surgery only took a second. One moment the foreskin was there, then it was gone and the glans popped out. A minute later it was bandaged, so there was very little to see. As the LA worked on both occasions and they didn't cry, I was not in the least upset by the experience.

DH was circumcised as a baby and doesn't remember it either, but he felt with a older child it was different. We chatted about it and he felt like he couldn't justify allowing this to happen to DS and not having he balls to face up to it. Personally I don't agree. Me fainting or gasping would not have helped DS at all. I can't watch holby city either

Everybody deals with it differently I suppose, but by not looking I was able to be there to reassure DS. DH felt it was important to watch. It's up to him, but I can't really understand it (he's quite squeamish too).

PUMBA - wriggling toddlers have to be physically restrained for a blood test? A GA is a very significant procedure in its own right?

Thanks for the update Gracie, so glad it went okay and sure he'll make a full recovery. He's also young enough not to think 'hey, my willy looks different' :o

Update day three: happy, giggling, running around, sitting comfortably, normal boy again!
No calpol since 10am yesterday and no complaints either.

Only tears were over the fact that he isn't allowed bubbles in his bath (we're using salt water and dettol for the next week to prevent infection.

I think the next significant change will be when the plastic comes off (dr says some boys are upset by this) so I'll let you all know when that happens. Should be the next 5-10 days.

glad to hear it all went well

Glad it went well but I'm a bit shocked that you would consider a medical procedure at birth when it may be completely unnecessary! A large percentage of boy's foreskins do not retract for several years without causing any problems.

I know bubbley. I would have said the same thing myself a few years ago, but knowing what DS went through (and now finding other friends having the same at 7,8 and 14 years old) it seems it's more common than I thought, just no one talks about it.
If a small procedure which is over in seconds and healed in 48 hours (true for babies under 3 months) can guarantee my next child will never have to go through this, it's something I would definitely do.
It's been an emotional rollercoaster, and 2 years ago I'd have said no way would I let someone do that to my son. One I've lived through it there is no way I'd want to again.