Hello, I'm Dr. Kirschner with Pediatrics Northwest. We're honored that you've chosen our practice for your son's circumcision. Your son's comfort is our primary concern. We will help him stay comfortable during the procedure by doing an injection of anesthetic on either side of the penis. We'll also give him sugar water, either off of a gloved finger or a pacifier. Both these things decrease their perception of pain. With that, I've had some boys fall asleep during the procedure. I've had other boys start to cry as soon as we take their diaper off. So, we'll promise you we're doing everything we can to keep your son comfortable. We can't, of course, promise that your son won't cry. You can choose whether or not you want to watch the procedure. Some parents are highly curious about the process, while other parents find not being able to provide comfort during the sterile parts of the process more uncomfortable for them. Know that you are not required to be in the room with us. We have nursing staff there who can help comfort your son during the procedure, and you can always be the one to comfort him afterwards. There are a variety of techniques to circumcise a penis. All of them have the same outcome -- a circumcised penis. Not all penises look the same, just like not all noses look the same, but regardless of the process chosen, they'll all look circumcised. At Pediatrics Northwest, we've chosen to do the process that uses a device called the Plastibell. And a Plastibell is a plastic ring that'll slip over the head of your son's penis. And we'll pull some of the foreskin up, and tie a string to it, and trim some of that skin off. You'll go home after that procedure then with that ring and the string still attached. That then comes off on its own, generally in 3-10 days. The benefit to this technique is that that string is providing constant clamping pressure to the blood vessels that get cut, and so there's a lower risk of bleeding. Spots of blood in the diaper up to a quarter in size are fine, but if it's getting bigger than that, or soaking in more than that, then you would need to let us know. Occasionally, there is some oozing of blood as well. You can treat that with a cloth and just apply some pressure to the area that has been cut for 3-5 minutes. If it's still bleeding after that time, we'd want you to call us as well. With this procedure, we'll expose new skin at the tip of the penis, and that skin is sticky, and if it sticks to the diaper, then the next diaper change is gonna be uncomfortable. So the most important thing you can be doing is applying some kind of ointment -- Vaseline petroleum jelly, Aquaphor, A+D, a product like that, at least to the tip of the penis. There's no such thing as too much, so put on as much as you want during each diaper change. With those diaper changes, using wipes to the bottom are fine, but for the front side we'd recommend just a damp cloth and that you kinda just sponge things clean. No aggressive rubbing, and no full bath for the first 2 days after the procedure. If stool does get on the area, using a little bit more water to kinda rinse things a little bit more can help keep it clean. As the ring starts to separate, sometimes you'll get more separation along one side than on the other, and so the ring might flop some. That's fine. Just leave it alone until it fully comes off. Again that generally takes between 3 and 10 days, and if takes longer than 2 weeks to come off, you should let us know. Typically, boys don't have too much pain after the procedure. The medicine we've used to anesthetize things will last for an hour or two. After that, discomfort can initially be treated with wrapping and feeding and soothing. If that's still not enough, we'll go over dosing of Tylenol in the office. After the procedure, the ring should sit so that the tip of the penis is just barely visible. A known, but very rare occurrence with this procedure is that the ring can slide further down on the head or even onto the shaft of the penis. And if that occurs then it can become like a string or rubber band too tight around your finger, and compromise the blood flow. If you see that happen, you need to call us and let us know. It doesn't mean you have to dial 911 and rush into the emergency department right away. But it's also not a, "Well, their office is closed, I don't want to bother anybody. Let me wait and see what happens." Any time of day or night you should contact our office. The same phone number will get you in touch with somebody who is on call, even if the office is closed. There are a few cases where the skin that remains after the circumcision can slide back over the head or reattach to the head of the penis. This can be prevented by applying gentle backwards pressure during diaper changes. Your provider will show you if your son is at higher risk of this happening. Please don't hesitate to ask us any questions before we do the procedure today, and know that we will be with you every step of the way as your son heals.