FAQs – Dr. Mark A. Greenberg B.Sc, MD, CCFP(AM)

Frequently
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Q: How long does the procedure take? – The circumcision itself is very quick, usually taking about 1 minute. The doctor will check on the baby about 20 minutes after the procedure. You’re total time in the office wild tend to be between 45 minutes and 1 hour.

Q: How long does it take for the circumcision to heal completely? –In babies under 2 months, it should heal completely in about four days. In older babies, it should heal in about seven days.

Q: I ran out of ointment. What should I do? –The antibiotic ointment need only be applied for 3 days following the procedure. If you’ve run out in this time frame, you’ve been using too much. If It’s already been a day or two, you can use Vaseline instead. If it’s been 3 days, you don’t need to worry about using the ointment.

Q: What is the ideal age to do a circumcision? –The best time is between 7–14 days. I will circumcise babies from 5 days up until 8 weeks of age in my office, so long as the baby is a minimum weight of 2.5kg (5.5lbs). It is best to do it in the 7–14 day window because the babies are less aware at this age.

Q: I can’t find Infants’ Tylenol. What should I do. –While it is ideal to give your child Tylenol, it is not essential. As such, if it is not available, you need not worry was your child will be aenesthatised at the start of the procedure.

Q: What types of complications are possible from circumcision? –Occasionally there will be a small amount of bleeding from the site many hours after the procedure. This is treated by applying pressure to the penis for about 3 minutes. Infection can also occur, however it is extremely rare. It is evident by seeing excess redness and pus, accompanied by a foul smell. It is treated by applying an antibiotic ointment and resolves within 1-3 days.

Q: Will it hurt my baby? –Published studies validate the use of local injectable anesthetic and have shown that the pain control protocol is very effective. Using a local injectable anesthetic together with acetaminophen will give your baby peri-operative and post-operative anesthesia. The use of local injectable anesthetic allows many babies to sleep right through the procedure and to have a very comfortable, pain free post operative period. There is NO JEWISH LAW PROHIBITING THE USE OF LOCAL INJECTABLE ANESTHETIC.

Q: May I apply EMLA cream/patch prior to the procedure? EMLA whether as a cream or patch is generally not effective in reducing pain from circumcision. In most cases, it is not applied correctly so it doesn’t work. The use of EMLA can cause swelling of the foreskin and/or makes the field very slippery thus making the procedure far more difficult and lengthy. Finally, there have been side effects reported with the use of EMLA. Given that it does not contribute to any significant pain reduction Dr. Greenberg DOES NOT ENDORSE THE USE OF EMLA CREAM OR OTHER SIMILAR TOPICAL ANESTHETICS APPLIED PRE-OPERATIVELY.

Q: Do all doctors use the same anaesthetic method? –No. Doctors have different beliefs and practices with respect to anaesthetic use. EMLA and other topical anesthetic creams are not very effective and in some cases can cause problematic side effects. Dr. Greenberg does not recommend the use of EMLA. Dr. Greenberg uses local injectable anesthetics (as mentioned above). The literature supports the use of local injectable anesthetics for babies undergoing circumcision. When choosing a doctor or Mohel (circumciser) to do your son’s circumcision or Bris, you should ask about the doctor or Mohel manages pain.

Q: What can I expect my baby to be like after the circumcision? –It is not unusual for the baby to sleep for 6-8 hours after the circumcision and to miss a feeding. Some babies will be irritable for a few hours afterwards. The baby should void feeding within 4 hours of the circumcision.

Q: What methods of circumcision are used by other doctors? –The Gomco Clamp – This is the most common technique used by physicians. It requires much longer to perform and involves much more tissue handling.
The Plasty Bell – With this technique the baby must go home with a small plastic device tied on to his penis that allows the foreskin to rot off over subsequent days. This is a more lengthy procedure and open to more problems.
Brit Milah

Q: Who is obligated to be circumcised? –A male born to a Jewish mother, or a male going through a conversion process.

Q: Why do some call it a Bris and others a Brit? –The word Brit/Bris is the same word pronounced differently. Brit is the Sefardic pronounciation, and Bris is the Ashkenazic pronunciation.

Q: What does the word Brit/Bris mean? –The literal meaning of the word Bris is covenant. The covenant we are referring to is the covenant G-d made with Abraham recorded in Genesis. Milah is the Hebrew word for circumcision. Hence, Brit Milah means Covenant of Circumcision.

Q: When should the Brit be performed? –Under normal circumstances, if the baby is healthy, the Brit should be performed on the eighth day after birth. The day the baby is born is considered day one. A day is defined as the time period between sundown and the following sundown. For example, Monday begins from sunset Sunday and continues until sunset Monday night. Therefore it would follow, that if a baby was born on Sunday night after sundown, the Bris/Brit would come out the following Monday. It would also hold true, that if a baby were born one minute before sunset on Sunday, the Brit would fall out the following Sunday.

Q: Where should the Brit be performed? –A Brit is usually performed in the home, or synagogue. On occasion, I will perform the Brit in my office when requested to do so by the family. As I observe Shabbat, Brits that need to be done on Shabbat or Yom Tov (Jewish Festival/Holiday), must be held within walking distance of my home. Should this circumstance arise, I will discuss the options with you.

Q: Are there exceptions to the rule? –Yes, Friday night. If a baby was born naturally Friday evening between sunset and about forty five minutes after sunset, the Bris/Brit would be performed on Sunday. However, if the baby was born more than forty five minutes after sundown the baby would be circumcised on the following Shabbos/Shabbat/Saturday, provided that the baby was born naturally, as opposed to a Caesarean Section.

Q: What is the ruling as far as a Caesarean Section? –The only difference is that a baby born through a Caesarean Section may not be circumcised on Shabbos/Shabbat/Saturday.

Q: Can a bris/brit be performed on a Festival such as Rosh Hashanah, Yom Kippur, Sukkos/Sukkot, Simchat Torah, Passover, or Shavuos/Shavuot? –Yes, a Brit may be perfomed on a Jewish holiday provided the baby was born the previous week, and the 8th day falls out on the Jewish holiday. Like Shabbos/Shabbat, the rules regarding birth by caesarian section apply.

Q: When is the baby considered born? –The definition of birth is considered in Jewish law, when the majority of the head, or the majority of the body, not including the head, has exited the body of the happy mother. This comes into play if there is a long labour, and the head came out a minute or two before sunset and the rest of the body followed after sunset. The Brit would be performed corresponding to when the head came out.

Q: What is the difference between a Bris (Brit Milah) and a circumcision? - A Bris (Brit Milah) is a religious ritual practiced by those of the Jewish faith. The circumcision is just one aspect of the Bris. In addition to the circumcision, prayers are recited at the Bris and the baby is then given his name as he will be called within the Jewish Nation. The circumcision is done using the Mogen technique but WITHOUT THE USE OF A CLAMP. Orthodox authorities do not permit a clamp to be used at a Bris as the blood of the circumcision is symbolic of the covenant.

Q: Does a Mohel need to be Physician? - This is a question that I have been asked many times. While there are many skilled Mohalim who are not physicians, I believe that your son would be best served by a Mohel who is a physician.

Q; What type of follow up is provided? - Parents are given the option of seeing Dr. Greenberg in his office or to see their own primary care provider (Family Physician, Paediatrician Midwife). Dr. Greenberg is available by cell phone, text or email at any time after a procedure.