At the beginning of my first boy pregnancy, I read all the internet wisdom, and the not-so-wisdom, the testimonials and judgement-laden blog posts, and the stats. I'm one of the growing number of American parents who landed on "no" regarding circumcision for any and all sons I might bear.
My two sons, born six years apart, came into the world chubby and fully-equipped. I waved off the appendage-alteration paperwork and kept it that way. With each birth I took my baby boys home and, aside from a short foray into the heated bath time retract vs. don’t retract debate early on with son number one, I rarely gave their foreskins another thought.
But when my second son, J.D., turned two, he began to complain now and then of pain when he peed. At random moments throughout the day he’d grab his crotch and cry. “My pee-noss hurts,” he’d say.
Our pediatrician’s tests for a urinary tract infection (UTI) came back clean each time, but she’d recommend (and we’d do) the antibiotics, just in case, each time. I should have connected the dots sooner and asked for a specialist referral. But these incidences came weeks apart in my busy working-student-single-mom-of-three-kids life. J.D. was almost three when round four of this dance landed him in the ER, fevered and screaming, and my mom finally figured out something was chronically wrong.
One urologist referral later and my little boy was diagnosed with phimosis, meaning simply, the opening in his foreskin was too tight and not properly separating. It’s a condition that, so the doc said, occurs in roughly 10% of American males. Because the foreskin was too tight to be properly retracted, the doctor explained, a small amount of urine was likely getting trapped each time J.D. peed. The trapped urine is what caused irritation and local infections, but not a UTI, hence the tests coming back clean and clear. Each subsequent infection, some of which probably went undetected, left a ring of scar tissue around the inside tip of the foreskin, effectively closing the opening even more.
After attempting levity with the requisite penis-too-big-for-the-foreskin jokes, J.D. and I left the doc’s office that day with a prescription in hand. The script was for a heavy steroid cream that had maybe a 30% chance of loosening the foreskin with six weeks of thrice-daily use, an insurance prerequisite for the almost-inevitable treatment: circumcision.
Don’t tell my insurance company, but I didn’t apply the steroid cream with all the warning labels and an unsatisfactory chance of effectiveness to my three-year-old’s tender little winky. At least, not more than once. My mama-sense said no. Instead, I used the six weeks to talk with J.D. about his body, and about surgery, and to accept this unexpected reversal of a parenting decision I thought I’d made for the best.
But now it was in the best interests of his health to decide otherwise. So at 6 a.m. on a Tuesday morning I scooped J.D. out of bed in his dragon jim-jams and drove him to the surgery center near our home. For the parents of the 10% phimosis boys out there, here’s what to expect when your not-baby boy gets circumcised.
1 | The procedure is outpatient, so no overnight hospital stay, but it is general anesthesia, which can be scary, particularly if your son is very young or has other medical concerns. Our family has a history of congenital heart disease, so consultations between J.D., myself, and our pediatric cardiologist, as well as between the cardiologist and the anesthesiologist, were necessary.
2 | Because it is general anesthesia, your son will be expected to fast for six to eight hours before going under. Our doctor eased the pain of not eating by scheduling J.D. in the first slot of the day. As long as J.D. hadn’t eaten or had anything to drink after midnight, he’d be alright.
3 | Because of his age, J.D. was put under in two stages: first with a small dose of a drug called Versed, or “goofy juice,” while he was still with me. The Versed made him sleepy and, well, a little goofy (there was a whole discussion about butter). But also, the nurses and anesthesiologist explained, helped him to not really be aware of being separated from me.
Second, in the OR, he was fitted with a sweet-smelling mask and connected to vaporized anesthetics which would keep him unconscious throughout the operation. Only once he was entirely asleep did the nurses insert an I.V., and this only for fluids and in case of emergency. On top of all the general anesthesia, the surgeon did a local numbing block of J.D.’s penile shaft.
4 | All outpatient surgery centers differ, but I was allowed to stay with J.D. right up until the moment they wheeled him into the OR, and he was allowed to keep his favorite blanket and stuffed sheep with him the entire time. After the procedure, when the anesthesiologist was satisfied with his state of consciousness, J.D. was taken to the recovery room where the nurses promptly settled us together in a comfy lounge chair, he on my lap, with pillows and blankets and apple juice. His entire recovery was spent in my arms.
5 | The doctor told me several times before the procedure that J.D.’s recovery time would be minimal, that in all likelihood he would be back to playing like nothing ever happened the very next day. The anesthesiologist and nurses at the center assured me that he would come out of “the fog” within 15 to 30 minutes in the recovery room, and would likely be “spunky.” “Grumpy” and “cranky” were also thrown around.
In reality, my little boy fell back into a deep sleep the moment he was lifted from the operating bed into my arms, and slept for nearly three hours there, only stirring to sip his juice and shift position now and again. When he woke, I might have called his mood subdued, or reserved, but not spunky. Not a grump. No crankiness to be found. He timidly barfed up all his apple juice, and meekly reached to be held closer to my heart.
At home, he slept several hours more and then, presumably when the local block began to wear off, and when he saw his swollen, bruised, and drastically changed penis for the first time, cried and cried from the pain. Based on the doc's “he’ll be fine the next day” prognosis, I had only planned on J.D. missing one day of preschool (me, one day of work), but we ended up missing two.
6 | Home care: The doctor explained that, because the skin of J.D.’s penis, formerly protected by the foreskin, had never before been exposed to open air, to clothing, to soaps, etc. it would be extremely sensitive and prone to chafing. And that chafing could lead to infection and, well, we’d been down that road.
He recommended that, for the first two weeks following the procedure, I coat the tip of J.D.’s penis in petroleum jelly three times a day. The same mama-senses that said no to the steroid cream chimed in, so I substituted pure lanolin in the petroleum jelly’s place (the effect – a protective layer – is the same).
J.D.'s doctor also recommended ibuprofen for pain, and that I continued giving J.D. – in a rotation with acetaminophen and the occasional ice pack straight to the family jewels – for four days. The sutures fell out on their own, after two weeks, with little blood.
7 | Because J.D. still rides in a five-point harness carseat, we had to minimize car rides for a while (think about where that buckle sits). Bikes were also not an option; no fun for a jealous little man whose big brother and sister got to roam the neighborhood on two wheels every night. Our high-sides wagon, with a layer of blankets in the bottom, became the best mobile option for J.D. for four days post-op, which is about how long he tip-toe walked like a bow-legged, saddle-sore city slicker on a dude ranch.
On the Thursday following J.D.’s Tuesday morning circumcision, he was back in preschool. By Friday he was playing normally, if carefully, and on Saturday he didn’t wince or cry as I cleaned his penis and applied the lanolin. One week after the surgery, J.D. was allowed to bathe again. And now, as I’m writing this, nearly two weeks out, his surgery is a thing of the past. We’ve talked about how the surgeon “took the lid off” J.D.’s penis so the owies would get out, and that some boys need to have surgery and some boys don’t. He’s three. What matters most to him is that the pain is gone. And although I would still make the decision not to circumcise at birth – because the odds of phimosis are so slim – what matters most to me is that he’s healthy now.