We understand that parents will sometimes have concerns and questions in the days after a baby boy’s circumcision. Please see the detail below for information on how to care for your baby post-circumcision, and do not hesitate to contact us with any concerns that you feel require Dr. McAuliff’s attention.
How to care for your son in the first 24 hours following the circumcision:
- Keep your son snugly swaddled (especially his legs). The more he kicks his legs, the less comfortable he may be. After the first day you no longer need to swaddle him, but can continue to do so if he finds it comforting.
There will be a square white gauze with Vaseline placed over the head of your son’s penis. Leave the gauze in place and remove it only after 24 hours. If it has fallen off, just replace it with a new piece of gauze with some Vaseline on it and put it over the penis then close the diaper.
- Please check your baby’s diaper every hour for the first 24 hours to look for any abnormal bleeding.
- If the white gauze over the penis is soiled with urine don’t worry just leave it alone. If it is soiled with stool, remove the gauze gently and rinse his bottom with warm water and replace the gauze with Vaseline on it.
- There will also be a long piece of gauze wrapped around your son’s penis. Leave this gauze in place for 24 hours as well. If it falls off earlier, don’t worry just leave it off. If it is dry or stuck when you are trying to remove it after 24 hours, you may need to wet it to make it easier to remove and you may need to pull slightly harder and expect that there may be a little bleeding when you do this. This is normal and you may need to apply some direct pressure on the head of the penis as we taught you in the clinic. You may use some warm water to wet the dressing to help remove it. If there is some bleeding, maintain firm pressure for 3-5 minutes.
- No gauze bandages are required after the first 24 hours, just ointment.
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General care following the circumcision:
- For the following weeks after circumcision, put a generous amount of Vaseline on your finger and rub it over the incision site placing a thick layer of ointment over the entire head of the penis.
It is important to push the skin down off the head of the penis if it has moved up a little to ensure it heals properly just behind the back rim of the head. Do not do any pushing on the skin for the first two days because it will be swollen from the surgery. It is important to avoid mucosal adherence (see image) and/or skin bridging which results from the mucosa and/or skin respectively attaching to the head of the penis. If you are unsure of the appearance of your son’s penis, call our office to ask if you need to make an appointment for him to see the doctor.
- Most babies like to nurse in a quiet environment following the circumcision. A baby who cries for more than a few minutes is usually suffering from air swallowed during the circumcision and needs to be burped.
- Most babies sleep quite well following the circumcision. The best sleeping position for your baby is on his side, supported by a blanket roll.
- Healing is promoted by keeping the area clean and dry. Warm water and a cotton-ball or washcloth are preferred for cleaning the area around the penis. Avoid moistened towelettes, alcohol, powders, and lotion since these may cause irritation. Don’t give your son a bath before the doctor has said that it is ok to do so (generally after 3 – 4 days).
- Disposable diapers are strongly recommended for the first week since they tend to be less irritating, and they help keep the area dryer and cleaner.
- It is better both before and for about three days following the circumcision to restrict the handling of your baby to just a few people. Also, avoid unnecessary travel as car seats can be irritating to the new circumcision.
Healing Post Circumcision
Healing is usually rapid and occurs in several stages. Remember that a circumcision is like any other cut. There are many factors that influence healing; but most importantly, every child heals differently.
First, the cut edge seals and bleeding ceases within minutes, hours, or even over the course of an entire day. The area just behind the glans (especially the underside) will become swollen. This inflammation will subside within a week or two. In the first two days, 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.
After a few days the area where the skin was cut look green and yellow. This is NOT pus. It is healing tissue. It can look this color for up to two weeks after the circumcision.
You will also notice that the glans appears red and glossy sometimes purple. This is because the skin covering the glans of an uncircumcised penis is mucous membrane (like the skin inside your cheek). Once exposed, the mucous membrane will toughen (or keratinize), and, in time, take on a normal appearance. It takes about a month for the penis to take on a normal, healed appearance.
Circumcision Scar? – Appearance of the Penis
A common concern for parents is aesthetics. Remember that penises come in all shapes and sizes. While most penises “look normal” within days of the circumcision, some do not take on a “completely normal appearance” until after the penis starts to grow. Furthermore, although the penis may appear smaller after circumcision, it is not! This appearance is mostly due to the relaxation of skin surrounding the penis, which prior to circumcision holds the penis more erect.
After a few days to week, some parents notice swelling of the mucosal tissue behind or under the head of the penis and believe it looks “like a blister”. This type of swelling is normal. It is not a blister, and it will gradually subside. Scarring from infant circumcision is rare, even if there is swelling in the first week.
On occasion, a poor aesthetic result occurs when too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. The latter is sometimes caused by the presence of a hydrocele or penile erections. In nearly all these cases, the penis will heal properly, and, in time, take on a normal appearance. If you are concerned in anyway about the appearance of your son’s penis, please call to consult with Dr. McAuliff immediately.
The technique used by Dr. McAuliff is associated with excellent cosmetic outcomes. Scarring on the penis is very uncommon, but do share any concerns you have in the weeks after your boy’s procedure.
Frenulum – Band of skin underneath the penis
Sometimes parents come to us worried about a band on the bottom of the penis fearing that it needs to be cut. This band is called the frenulum which carries the frenular artery and is normal (see image). It is similar to the band under the tongue (the part that is cut in some babies with tongue-tie).
You may notice a band on the bottom of the penis after circumcision. This is normal and no reason for concern.
Frequent Concerns After Baby Circumcision
There is a piece of skin still attached to the head of the penis, or you can’t see the entire head of the penis.
Post-Circumcisions Issues and Treatments
Circumcision is associated with few and infrequent complications, although with any surgical procedure there are occasional problems. For example, bleeding.
In almost all cases bleeding is controlled by direct pressure. The frequency of complications after infant circumcision varies with the skill and experience of the physician amongst other factors.
Even though complications are rare, do not hesitate to call the office if you have any questions about the appearance of the penis. Remember, early treatment (if any is needed) is always best.
Please check your baby’s diaper for any bleeding every hour or so for the first 24 hours after circumcision. If the baby is sleeping, you can just look at the front edges of the diaper from the outside. If it is not discolored, he is likely not bleeding abnormally. When you open the diaper, it is normal for the covering gauze to be a little red from bleeding. You need to remove the gauze to check for active bleeding only if the whole gauze has become soaked with fresh, red blood. You treat active bleeding from the penis the same as you would for the tip of a finger:
- Apply pressure to the penis for 3-5 minutes; no less. Do this by grasping the penis between your thumbs and two fingers using a piece of gauze with some Vaseline to prevent sticking.
- After applying pressure, inspect the area for continued bleeding and repeat step one if necessary.
- Once the bleeding has stopped, apply a fresh gauze square with Vaseline and close the diaper. Recheck the diaper after 10 minutes for any signs of more blood on the gauze.
It is reasonable for you to try the pressure technique twice, for 3-5 minutes at a time, as most bleeding will stop with this.
If the penis is dripping any blood, and you cannot stop the bleeding with the pressure technique that we have demonstrated to you, call the office or, if it is after working hours, call Dr. McAuliff.
When the length of the penile shaft is no greater than its diameter or when there is a good amount of pubic fat, the penis will tend to retract inward. This is normal. This characteristic is only a concern for the first month or two since the healing circumcision can adhere to the surrounding skin resulting in a “concealed penis”.
If your son fits this profile, you can reduce the chance of concealed penis by applying a very thin layer of Vaseline to the entire glans, once a day, until the glans takes on a healed appearance (about 1-2 months). To expose a glans that has retracted inward, place gentle downward pressure on either side of the base of the penis.
Consult Dr. McAuliff if the penis cannot be fully exposed, or if any connecting skin bridges form between the shaft skin and the head of the penis.
Although rare, there have been reported cases of infection. Common signs of infection include: a pus like discharge, a foul smell, excessive swelling or redness, local warmth, a fever, or a rash anywhere in the area of the penis. With any of these signs, or if your son has not urinated in over 12 hours, consult Dr. McAuliff immediately.
There will be a long gauze strip (1/2×8 inches) wrapped around your son’s penis. This strip may fall off within the first 24 hours. If it falls off early, do not worry, this is normal, just leave it off. You can place a new piece of gauze (with some Vaseline on it) on the penis for the remainder of the 24-hour period. If after 24 hours the gauze strip is still in place, please remove it.
To remove the gauze strip:
- Apply Vaseline liberally and completely over the stuck surface.
- Close the diaper and allow 10-15 minutes for the bandage to soften.
- Gently peel away surfaces that are no longer stuck. Repeat the process as necessary. It is okay to do this a little at a time over the course of the day – it always comes off.