Views on newborn circumcision have changed over time. What remains the same is that the best long-term outcomes are a result of understanding the facts behind your options, and the impact of circumcision on your son’s health. This begins by understanding the pros and cons of circumcision, and why circumcision is best performed up to 44 weeks after conception.
My services include consultations in a zero-pressure environment, and surgical circumcisions if you so choose. I look forward to hearing from you, and becoming your primary circumcision resource.
WHY 44 WEEKS?
Circumcisions are best performed at 41-44 weeks after conception, not 48-hours after birth.
Timing is everything.
The old belief that boys should be circumcised within 48 hours of delivery is not in the best interest of the infant or the mother. The birth is already a traumatic moment for both of you, and the few days following it are better spent bonding, healing, and working on breastfeeding.
Growth equals healing.
Babies tend to lose weight the first week after birth as they are adjusting to being out in the world and learning to feed. After the first week they begin to put on weight, to grow, and this means they are better able to heal from a procedure like a circumcision. (Jewish doctors historically waited eight days to perform a circumcision for this reason.)
Premature babies need time.
Babies born well before 38-40 weeks of gestation and weighing less than 6 pounds are not ready for circumcision. They need more time to grow and gain strength and resilience. We can still accomplish circumcision with only a local anesthetic up to 44 weeks after conception.
Services
Your circumcision consultant and physician in the Richmond area.
Circumcision is never a requirement, but it remains an option that parents of newborn boys are asked to consider – sometimes urgently. I provide an opportunity for discussion of this option with attention to pertinent health, cultural, and religious factors. After your questions have been answered, I will, if you choose, perform your son’s circumcision utilizing careful techniques developed over my three decades of experience with the procedure and its potential complications.
Consultation
During the consultation we will discuss any concerns or questions you still have beyond the FAQ featured here. Usually, the consultation is conducted in a telephone conversation at no charge, sparing you the expense and inconvenience of another trip out of your home with your new son. Then I will provide recommendations geared toward the best long-term outcomes for your son, in an honest, fact-based approach that leaves the decision up to you. If future corrective or invasive surgery might be required based on our consultation, I will explain the condition and make recommendations to help you plan such procedures.
Circumcisions
If, after our discussion, you conclude that circumcision is the best course for you and your son, I will perform the procedure in an outpatient procedure suite at MedRVA’s Stony Point Surgery Center. You will be in the room, and you may have your Rabbi or religious officiate accompany you, if desired. Please ensure you reserve at least two hours to be with me the day of the procedure. This provides us time to process any remaining paperwork, to discuss any remaining questions, and to allow the local anesthetic to take effect to provide your son the most comfort during the procedure. For questions about the procedure see my FAQ section.
DR. WINSLOW
An experienced circumcision physician in Virginia.
A leading practitioner, voted "Top Doc" in the practice of newborn urology in the Richmond area, my vast experience in the field of circumcisions is a result of over three decades of corrective surgery for newborn boys who were circumcised poorly or who were born with urological health issues.
Now my practice makes full use of that experience to provide services that help parents make healthy, well-informed decisions about circumcision for their newly-born sons. In an effort to contribute to the long-term health of baby boys, I now direct my surgical skills to providing only first-time circumcisions for infants between 41-44 weeks gestational age (or 1-3 weeks old if born at term).
History/CV
A leading practitioner, voted "Top Doc" in the practice of newborn urology in the Richmond area, my vast experience in the field of circumcisions is a result of over three decades of corrective surgery for newborn boys who were circumcised poorly or who were born with urological health issues.
Now my practice makes full use of that experience to provide services that help parents make healthy, well-informed decisions about circumcision for their newly-born sons. In an effort to contribute to the long-term health of baby boys, I now direct my surgical skills to providing only first-time circumcisions for infants between 41-44 weeks gestational age (or 1-3 weeks old if born at term.)
History/CV
Rates
Please note that I do not participate with any medical insurance company.
*If you elect to have the circumcision for your son, I will apply the $150 consultation fee toward the circumcision fee. I accept cash, checks and credit cards.
INSURANCE REIMBURSEMENT
Although the quoted fees are due at the time of your appointment, these costs are sometimes still covered by insurance.
1. Payment in full is due at the time of your appointment.
2. You will be provided an itemized receipt to file with your insurance company.
3. Your insurance company will send you a reimbursement check for the portion covered.
Payments in full are due at the time of your appointment. At registration, MedRva will assess their fee for use of the facility. (I have no control over their fee. This facility participates in many insurance plans and may offer you the opportunity to use your insurance for this portion.)
When the nurse brings you back to the procedure room to meet me, I will accept your payment for the procedure itself. You may pay by check or credit card. I will provide you an itemized receipt to use if you decide to pursue reimbursement for ‘out-of-network’ expenses.
FAQ
An experienced specialist in newborn circumcisions focused on long-term health.
While there may be cultural, religious or personal beliefs, the pros and cons from a medical perspective include:
PROS
- Better lifelong hygiene
- Reduces risk of infant urinary tract infections
- Reduces risk of STDs in later life
- Reduces risk of inflammatory skin conditions and penile skin cancer
- Eliminates risk of phimosis (foreskin doesn’t retract)
- Eliminates risk of paraphimosis (strangulation of head of penis by retracted foreskin)
CONS
- Some immediate bleeding
- Discomfort/pain immediately following the procedure
- Yeast infections during healing
- Scarring from surgery (late and rare)
While your OB-GYN can perform the circumcision, their specialty is women’s reproduction and health. They do not focus on the anatomy of the infant penis or the disorders that can afflict boys. For both the OB-GYN and the general pediatrician, their training and experience does not prepare them for surgery on this small scale. It falls by definition within the specialty of pediatric urology.
During the first week after an average 40-week birth, newborns tend to lose weight. After that first week they begin to gain weight and grow again, allowing them to heal faster. Their coagulation mechanisms mature, reducing the risk of bleeding after the procedure. They can also be comforted by parents, and yet they are young enough to be unaware of undergoing a procedure. It also avoids the greater risk and expense of general anesthesia.
Circumcision is more often a matter of choice. Sometimes culture or family tradition mandates that a baby boy be circumcised. Sometimes there is a physical condition or deformity of the penis that requires surgery or circumcision. If future corrective or invasive surgery might be required based on our consultation, I will explain the condition and make recommendations to help you plan such procedures. There are several short-term and long-term benefits from a medical standpoint, enumerated under PROS AND CONS.
The prevalence of circumcision varies depending on where you are in the country and due to cultural and religious factors. According to a 2013 study by the CDC (Center for Disease Control), “from 1979 through 2010, the national rate of newborn circumcision declined 10% overall, from 64.5% to 58.3%.” The good news is that parents are now educating themselves about the PROS and CONS of circumcision and considering their son’s particular situation before making a choice. I encourage you to do the same during our consultation.
In a circumcision, the cylinder of redundant skin that extends out over the head of the penis is removed. It is a surgical procedure. A clamp compresses the circle of skin where the redundant foreskin originates, and the excess is trimmed away. (Think of a too-long shirtsleeve with the cuff extending out over the end of your hand.) I begin administering the local anesthetic while you comfort your baby. You may caress him, speak to him in your soft voice that is now recognizable to him, and induce him to suck on a pacifier. During the procedure, I will explain to you what I am doing, and demonstrate for you the proper care you’ll administer at home.
I administer a local anesthesia injection that stings slightly, but it quickly produces complete numbness for the procedure. During the procedure, some babies cry because their legs are restrained. Parents can console their baby by caressing him, speaking to him in a soft voice that he recognizes, and by inducing him to suck on a sweetened pacifier. The circumcision site may be tender to touch for a few days. I provide instructions about Tylenol at the end of the procedure.
Newborns between 41–44 weeks heal faster than at any other stage in their lives. They quickly return to a state of comfort by the next day, but the skin itself — the compressed circumcision line — is fragile for about five days. I provide post-circumcision recommendations for cleaning and care, which will help promote better healing.
Absolutely. I welcome a Rabbi or religious officiate whose presence is pertinent to the procedure. I also ask family members to attend if they will be doing diaper changes. Mom, dad, or even grandparents can attend, but please limit company to those who will be helping you care for your son after the procedure.
An uncircumcised male can enjoy normal health. Worldwide throughout history there have been untold millions of newborn boys left uncircumcised. Medically, however, the following problems more commonly afflict uncircumcised boys:
- An 80-fold increase in urinary tract infections in infants under one year.
- Increased risk for foreskin infections (balanitis) that can spread to the bloodstream.
- Scarring of the foreskin that might progress to phimosis — an inability of the foreskin to be retracted to expose the head of the penis.
- Of greater concern is the potential catastrophe of paraphimosis, in which the scarred foreskin is retracted behind the head of the penis and not returned to its normal position. The resulting constriction can result in strangulation and death of that important structure.
During our consultation, if I discover and define a congenital (developed before birth) deformity, I might recommend against circumcision, as the foreskin might be utilized in the reconstructive surgery.
This is a common question to which there is no definite answer because no experimental study has fully addressed the question. Studies have been conducted to rate the experience of grown men who were not circumcised as babies and who then underwent circumcision because of a disorder of the foreskin. Some of these men reported reduced appreciation of sexual activity after circumcision. These men, however, suffered from a variety of penile disorders before the surgery. Studies that have attempted to compare grown men both circumcised and intact have been inconclusive due to the inability to quantify how one man feels pleasure compared to another.
I limit my circumcision window to 44 weeks after conception. Beyond that age, boys are too active to permit an expert circumcision without a general anesthesia. If you decide to have your son circumcised later, I recommend that you wait until he can safely tolerate elective general anesthesia, usually after 6 months of age.
My consultations are a zero-pressure opportunity for you to decide what is right for you. There is a fee for that consultation, but if you decide not to have the surgery, I will provide guidance to help you keep your son’s intact penis clean and healthy.
At the time of the procedure, I will show you how to care for your son after you return home. I’ll also provide a post-circumcision care hand-out. By complying with these instructions, you will reduce the possibility of recurrent adhesions, infection, and scarring.
Contact
Contact me for newborn circumcision consultations, or surgery.
The decision to have your son circumcised can be made to feel less daunting with the professional advice of an experienced circumcision physician in a no-pressure environment. If you have questions beyond those answered in the FAQ section I hope you will consider me as your primary circumcision resource.
Please contact me, or enter your contact info and I will reach out to you.
Phone: (804) 220-1679
E-mail: boyd@DrWinslow44.com
HIPAA PATIENT CONFIDENTIALITY: If you send an email please do not include personal identifying information such as birth date or personal medical information. I am unable to diagnose a condition from email or other written communications. Upon receipt of your general inquiry email, I will arrange a time to speak via phone or to schedule a private consultation.