AFTER CARE

1. In the unlikely case of bleeding…apply firm direct pressure using a sterile gauze to any area of continued oozing of blood for a period of 10-15 minutes. Do NOT examine the wound while applying the pressure. (In the extremely unlikely situation that you find a diaper that is not stained but soaked with blood go immediately to the closest emergency room, or call 911) Call me as well in this situation.

2. Wash the genitals gently after each large bowel movement, using either a soft cotton cloth, cotton balls, or a sponge with a few drops of nondetergent soap in warm water, rinse, then gently dry. Continue to wash for a period of 10 days. (it is absolutely OK to wet & touch the penis) Do NOT use abrasive cleaning wipes on the circumcision wound!

3. Apply a grape sized amount of Vaseline ointment to the center of a sterile gauze, and then gently place it onto the penis for a total of ten days of care. Replace it with each diaper change The penis may remain in any position and the baby may sleep on his back or side. Do NOT tie anything around the penis!

4. If the gauze sticks to the penis, simply soak the baby's bottom in a basin of warm water. The baby may be fully bathed 10 days after the circumcision, if the cord is off. ( i.e. when you have finished with the 10 days of dressing changes you may bath the baby.)

5. Be alert to the signs of infection, such as increases in redness, pain or swelling. The baby may be irritable for 3-4 days and will heal in 12-14 days with residual swelling up to three weeks (3 wks) after the circumcision.

6. If the baby is irritable you may dispense one single dose (0.4 ml or 1/3 of the eyedropper) of Infant Tylenol or Tempra drops 4 hours after the circumcision. Again, this is a one time dose of Tylenol or Tempra.

7. NOTE: The glans or head of the penis will be beefy red in color; the area immediately below the glans will be quite swollen for several days. Small yellowish-white firm plaques, moist crusts or a whitish filmy material may occur near the wound or head of the penis, Days 3-10. This formation is normal and will eventually disappear.

8. Please feel free to call me at any time with further questions or problems and try not to worry, the baby will heal just fine!

 

HEALING PROCESS

1. Healing is usually rapid and can be viewed in several stages. It should be remembered that this is like any other cut and that there are many factors that influence healing; but most importantly every child heals differently.

First, the cut edge seals and bleeding ceases within minutes. Within minutes or hours, the area just under the glans or head of the penis (especially the underside) will become swollen. This inflammation goes down within a week or two. One to two days following the circumcision there may be an off white or yellowish, patchy appearance of the glans. These patches are a type of scab and are associated with normal healing.

You will also notice that the head is red and shiny. This is because the skin covering the head of an uncircumcised penis is mucous membrane (like the inside of your cheek). Once exposed, the mucous membrane will change and become skin like the rest of the penis. The head of the penis should take on a "normal" appearance within a week to 10 days time. Any minor residual swelling will go away within a few weeks.

To avoid having the head stick to the diaper, with each diaper change cover the head with gauze coated in Vaseline. Do this until the head is no longer red and shiny.

2. Circumcision is associated with few and infrequent complications, though as with any surgical procedure there are occasional problems.

An uncommon complication is bleeding. In most cases bleeding is controlled by direct pressure. Take a gauze with some Vaseline on it and gently press against the bleeding area. Hold gentle pressure for ten minutes. Then release the pressure and watch the gauze for any sign that there is continued bleeding. Check the gauze every five to ten minutes for at least one hour. If you are not sure that the bleeding has stopped call me.
(In the extremely unlikely situation that you find a diaper that is not stained but soaked with blood go immediately to the closest emergency room, or call 911).

There are reported cases of infection, although these are rare. Common signs of infection include a pus discharge (not the dry yellowish patches mentioned above), a foul smell, excessive swelling or redness, local warmth, fever or rash in the penile area. With development of any of these signs please call me immediately and I give you further instructions.

Some infections, which do not cause a fever but only mild symptoms, can usually be treated with a topical antibiotic ointment.

3. Final appearance of the penis is dictated by many factors and is the greatest cause for concern amongst parents. It should be remembered that everyone's anatomy is different and penises come in all shapes and sizes. The result of one circumcision cannot be identical to the next. Remember that there is wide variation in the appearance of penises. Your baby’s penis may not look like his father’s or his brother’s. Even twins can have very different anatomy.

While most penises begin to look healed within days of the procedure, some will continue to change until after the penis begins to grow. Furthermore, the penis may look smaller after the circumcision, since the foreskin (which is now gone) usually extends beyond the tip of the penis. Also, in chubby babies, the fat pad surrounding the penis may hide much of the shaft until the baby fat disappears.

There are some babies who are circumcised as newborns who have circumcision revision at some point during childhood. This is often a cosmetic issue and is mostly an elective procedure. It is uncommon but does occasionally happen.

4. After a few days, if the edge of the skin has moved up onto or above the ridge that divides the head from the shaft of the penis, gently pull it down with each diaper change until it separates easily from the ridge. Be very gentle at first and don’t force it until the healing seems complete. After the head is not longer red and moist, you can exert more pull to peel it off the head. He will probably be mad at you, but this does not cause significant pain. If it won’t separate, your pediatrician can pull it down. You can also call me about this.

If the foreskin remnant is allowed to stick to the head, it may grow attached with an adhesion that will have to be divided with surgery in the future.

5. Feel free to call at any time with concerns. If your concern is not urgent you may also communicate via e-mail.