After Circumcision Care
It is common for parents to have concerns and questions after their baby boy’s circumcision. Below is detailed information on caring for your baby post-circumcision and we are available for calls or emails with any concerns that need Dr McAuliff’s attention.
How to care for your son in the first 24 hours following the circumcision:
- It’s best to keep your boy swaddled, snugly (especially his legs). If he kicks around too much, he may become uncomfortable. Swaddling is not necessary after the first day but feel free to continue if he finds it comforting.
- Your boy will go home with a square of white gauze with petroleum jelly placed over the head of your son’s penis. Please leave this in place an only remove it after 24 hours. If it falls off early, simply replace it with fresh 3×3 gauze with petroleum jelly on it, place it over the head of the penis and close the diaper.
- It is important to check your baby’s diaper for abnormal bleeding every hour for the first 24 hours
- It is fine to leave the gauze in place if soiled with urine, however, if it is soiled with stool, remove it gently and replace with fresh gauze and petroleum jelly after rinsing his bum with warm water.
- We will wrap your son’s penis with a long piece of gauze. This should be left in place for 24 hours as well, however, if it falls off early, don’t be concerned, just leave it off. When it is time to remove it after 24 hours, you may find it is dry or stuck on the penis and you may have to pull a bit harder than you would expect. There may be a little blood when you do this but it is normal. Simply apply direct pressure on the head of the penis as we taught you in the clinic. If needed, use a bit of warm water to wet the dressing to help remove it.
- No gauze bandages are required after the first 24 hours, just petroleum jelly.
This image shows initial application of the gauze with Vaseline. Replace it if it falls of in the first 24 hours. The image also shows the long gauze and bandage around the penis that will be removed in 24 hours, or if it falls off earlier you may leave it off.
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General care following the circumcision:
- For a few weeks following circumcision, apply a generous amount of Vaseline to create a thick layer over the entire head of the penis.
- To ensure proper healing, it is important to push the skin down off the head of the penis if it has moved up a little. It needs to be just behind the back rim of the head. For the first couple days after surgery, do not apply any pressure to the skin as it will still be swollen from surgery. It is important to keep the mucosa from adhering (see image) and/or a skin bridge forming when the mucosa and/or skin respectively attaches to the head of the penis. If you are unsure of the appearance of your son’s penis, bring him to see our doctor, and we will adjust the skin for you if required.
- We find that most babies enjoy nursing in a quiet room after their circumcision. If your baby cries for more than a few minutes, it is likely just from swallowing air during the procedure and he just needs to be burped.
- Babies tend to sleep soundly for several hours after circumcision. It is best to keep your boy on his side, supporting him with a rolled blanket.
- Promote healing by keeping the area as clean and dry as possible. Apply warm water with a cotton ball or soft wash cloth when needed to clean around the penis. Moist towelettes, alcohol, powder, and lotion can cause irritation so please refrain from using these items. Please wait to give your son a bath until after the doctor has given you the OK, generally after 3-4 days.
- Disposable diapers tend to keep the area dry, clean, and can be less irritating, therefore are strongly recommended for the first week.
- For the 3-4 days immediately following his circumcision, limit the handling of your baby to just a few people and avoid unnecessary travel as car seats can cause irritation.
Here you see a part of the mucosa attaching to the head of the penis. This is an example of mucosal adhesion that requires a simple adjustment by our doctor.
Healing Post Circumcision
A circumcision is similar to any other cut and healing tends to happen quickly over several stages. While there are many factors to take into account when healing, it is important to note that each child heals differently.
The initial healing of the cut edge occurs as bleeding stops within minutes but can take the entire day. The area behind the glans will become swollen – especially the underside. This will dissipate after the first week or two. You may notice an off-white or yellowish, patchy appearance of the glans. This is a normal sign of healing and are indicative of a type of scab.
A few days later, the area around the cut may look green and yellow. This is NOT pus and is nothing to be concerned about. This is just tissue that is healing and may take up to two weeks to completely heal.
The glans will start to appear red, glossy, and sometimes purple because the skin covering the glans is a mucous membrane (similar to the skin inside your cheek). Over time, the exposed mucous membrane will toughen (keratinize), later taking on a normal appearance which takes about a month for complete healing.
You will notice yellow patches on the head of the penis as it heals. This is a normal part of healing.
The head of the penis can often be purple, blue or red after circumcision. This is normal.
Circumcision Scar? – Appearance of the Penis
It is common for parents to be concerned with how their boy looks after circumcision. Most of the time, penises will “look normal” after a few days post-procedure, however, some do not look completely normal until after the penis starts to grow. Additionally, while the penis may look smaller after circumcision, it is not. This appearance stems from the relaxation of the skin around the penis after circumcision. Prior to the procedure, this skin would hold the penis more erect.
Within a few days or a week, you may notice the mucosal tissue swelling behind the head of the penis. Some say that it “looks like a blister” but this is not a blister, it’s normal and will gradually dissipate. Scarring resulting from infant circumcision is rare, regardless of any swelling during the first week.
If too little or two much skin is removed, there could be a poor aesthetic result. It’s more likely to happen if the cut edge of the skin attached too high or too low along the shaft of the penis which can happen in the presence of a hydrocele or penile erections. In nearly all these cases, the penis will heal properly, taking on a normal appearance over time. 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
Some parents voice their concerns about a band on the underside of the penis, thinking that it may need 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).
This band is normal and is no reason for concern.
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Frequent Concerns After Baby Circumcision
What should I expect my son to be like after circumcision?
It is normal for your baby to sleep 6-8 hours after circumcision and may miss a feeding. Some may become irritable for several minutes to hours after the procedure. Most babies will return to relatively normal behavior within a day or two.
The gauze is very sticky and hard to pull off.
It may take a little bit of effort to remove the gauze bandage. A warm water soak and some Vaseline may make this easier, just know that you may have to pull a bit more firmly than you expect in order to remove it. Don’t forget the direct pressure method we instructed you on if you see any bleeding. See detail below.
The gauze around the penis fell off before 24 hours.
This is nothing to worry about. Just be sure that there is gauze and Vaseline on the penis until the first 24 hours are up. Then just apply Vaseline at the incision site as instructed for every diaper change.
There is stool on the gauze around the penis or on the penis after the gauze is removed.
Not to worry, just try to clean it as best as you can using warm water. Then place a fresh white gauze with Vaseline over the penis until the 24 hours are up.
When you take off the gauze, there is some bleeding.
Light bleeding is normal and to be expected. Take some gauze with Vaseline on it and squeeze the bleeding area of the penis with your fingers for 3-5 minutes. Repeat if necessary. Call Dr. McAuliff directly if bleeding persists despite pressure.
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.
Let us know if you have concerns and we can have you bring your boy back into our Richardson clinic to make any needed adjustment.
Will my boy’s penis carry a scar from circumcision?
We use a circumcision method which makes visible scarring on the mature penis very rare. Swelling and discoloration is normal in the week after surgery and the penis will look more normal over time.
Does it hurt when the baby urinates?
It may hurt a little the first day, but after a day it should not be painful.
When can bathe my son again?
Dr McAuliff will instruct you at a follow up appointment when it is safe for your son to get a full-immersion bath again.
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 nearly all cases, you can control bleeding by applying direct pressure. How often complications occur in post-procedure infants depends on the skill and experience of the physician and other factors.
Remember, early treatment (if any is needed) is always best. Even though complications are rare, please consult with Dr. McAuliff if you have any questions about the appearance of the penis.
Bleeding Post-Circumcision
It is important to check your baby’s diaper every hour for the first 24 hours to see if there is any bleeding. You can peer in from the edges so as not to disturb a sleeping baby. If you don’t see any discoloration of the diaper, he is likely doing just fine and not bleeding abnormally. It is normal to see a little red from bleeding on the gauze. Only remove the gauze and check for active bleeding if you notice it is soaked with fresh blood. Treatment for active bleeding is the same as if you cut the tip of your finger:
- Apply pressure to the penis for no less than 3-5 minutes. Grasp the penis between your thumb and two fingers with a piece of gauze with Vaseline (prevents sticking).
- If there is continued bleeding after applying pressure, repeat step one.
- After you have successfully stopped the bleeding, apply fresh gauze with Vaseline onto the head and close the diaper. Check the gauze and diaper again after 10 minutes for any signs of continued bleeding.
You may need to try the pressure technique twice, for 3-5 minutes at a time, before calling Dr. McAuliff 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 Dr. McAuliff.
Concealed Penis
The penis may tend to retract inward if the penile shaft length is similar to the diameter or if there is a fair amount of pubic fat. This is normal and is only a concern during the first month or two since a healing circumcision can adhere to the surrounding skin, creating a “concealed penis”.
If this sounds like your son, a thin layer of Vaseline around the entire glans once a day is all it takes to greatly reduce the chance of concealed penis, until the glans is mostly healed in 1-2 months. Simply place gentle downward pressure on either side of the base of the penis to expose the glans.
Consult Dr. McAuliff if the you cannot fully expose the penis or if you notice connecting skin bridges from the shaft to the head of the penis.
Infection
Infection is possible, albeit rare. 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.
Sticking Bandage:
We send your son home with a long gauze strip (1/2 x 8 inches) around his penis. This only needs to be in place for the first 24 hours and, if it falls off early, do not worry, just leave it off. You can use the square gauze given to you at our office, place a bit of Vaseline on it, and wrap it around the penis for the remainder of the 24 hour period. Remove the gauze strip after 24 hours if it hasn’t already fallen off.
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.
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