This leaflet is intended as a general guide to preparing for your child's circumcision and to proper after-care. It covers boys from about 1 year old up to puberty. There are separate guidance leaflets for infants under 1 year as well as for teenagers and adults.
If your doctor has given you specific advice regarding preparation for your circumcision or its after-care then you should follow his instructions rather than this article.
Your son's circumcision may be covered by religious requirements or medical necessity in which case it may be necessary to deviate from the guidance herein.
There are two major methods of performing circumcision for a boy prior to puberty. One uses a plastic bell or clamp which remains on the boy's penis for a week or so and works by depriving the foreskin of its blood supply. In the other method the foreskin is pulled forward, temporarily clamped in front of the glans and then cut off with a scalpel. The two methods require slightly different after-care.
You should ask your doctor which method was used and follow the appropriate after-care section below.
If your son has not been circumcised by 1 year old it is then preferable to wait until he reaches around 8 years (but in any case at least 5 years old) so that you can discuss with him what is to be done and why.
Explanation of what is to happen is very important to avoid undue worry and, especially in younger boys, the thought of being emasculated. The boy needs to understand that he is being circumcised to give him a benefit and not as any form of punishment.
You should choose a circumciser who has considerable experience of performing the operation on children. If you need assistance in finding a suitable circumciser, the Gilgal Society may be able to suggest one from the lists it maintains.
Some doctors' lists fill up months ahead. If timing is important to you, e.g. to fit in with your son's school holidays, then be sure to make your initial contact with the doctor well in advance. You can always fix a date for several months ahead, even if the doctor offers earlier dates. Do not schedule a circumcision immediately before major examinations as the boy cannot get up and walk around to relieve any pressure on his penis.
Be sure to tell the doctor if your son is allergic to any anaesthetic or antibiotic; if he suffers from diabetes; is on any prescribed medication; or if he has recently had any other medical treatment.
If possible ask the doctor for a sedative that you can give the child in advance of going to the surgery so that he is relaxed and can then be circumcised under local anaesthetic. Clearly, the older a boy is the easier it is for him to understand what is required and to co-operate by lying still.
A general anaesthetic carries risks many times those of the surgery itself and should be avoided if possible, but one may be necessary to allow the doctor to safely operate on an uncooperative or very nervous child.
The penis of a young boy is too small for the doctor to be able to distinguish between 'high' or 'low' placement of the scar line, or even a 'tight' or 'loose' circumcision. You should, however, be satisfied that the doctor will remove enough skin to ensure that the glans is permanently bared. It is also desirable that he remove the frenulum to prevent any possible future problem of frenulum breve. If the glans is not completely bared there is a risk of the foreskin adhering to the glans as it heals, thus forming unsightly and possibly painful 'skin bridges'. Placement and tightness can be more easily controlled as the boy grows with the onset of puberty.
It is not possible to be absolute about the results from different methods, but in general terms: the Plastibell or equivalent will provide a 'low' but slightly 'loose' circumcision; the Gomco Clamp will provide a 'low' circumcision with a range of possible tightness from 'loose' to 'tight'; the Forceps Guided method will provide a 'high' but 'loose' circumcision.
Ask any other questions you may have about the proposed circumcision. This is your last chance to opt out or to choose a different doctor if you are not entirely happy to proceed.
Hygiene
You should ensure that, on the morning of the operation, your son takes a good bath or shower and pays particular attention to his genitals. He should retract his foreskin as far as he can and clean well under it.
Immediately before the time of the operation he should be encouraged to empty his bowels and bladder.
Food
Unless he is to have a general anaesthetic, ensure that he eats a light meal before setting out. Having surgery on an empty stomach can cause fainting. Take some chocolate and a sweet drink (like Coke) to replenish his sugar levels after the operation.
Emergency Contact
Ask the doctor for his emergency contact number in case there are any problems.
Food
The boy should be given a sweet drink and some food after the operation, whilst waiting for his penis to be checked.
Swelling
Immediately after circumcision your son's whole penis may be swollen and look very bruised. This is a normal effect of both the injected anaesthetic and the handling it necessarily receives during the operation. These will gradually reduce over the next week or two.
Urination
Do not be surprised if his urine tends to spray instead of forming a neat stream for the first few days. This is a natural result of the swelling and will correct itself as the swelling subsides. He may find it more convenient to sit rather than stand during this time.
Underwear
If your son normally wears boxers he may find that they give insufficient support immediately post-operative. You may wish to consider buying him some briefs which will hold his penis in position and thus reduce the frictional stimulation which it would otherwise receive if allowed to swing freely.
Pain Relief
A local anaesthetic will normally continue to be effective for a couple of hours after the operation. Your son should not be in pain after this but may experience significant discomfort for a few days. If this happens then he should be given appropriate pain relief for his age. Be sure to read the instructions regarding dose and frequency.
Do NOT use Asprin based pain relief as this thins the blood and makes bleeding more likely. Paracetamol based medicines are to be preferred.
Sports, etc
Your son should not compete in contact sports such as football and rugby, nor in running and cycling, for a week after circumcision. He should also avoid swimming as the chlorine in the water may sting the wound and delay healing.
Time off School
There is no absolute need for your son to take time off school after circumcision, but he may find it very hard to concentrate on work for the first few days and so may find it useful to take a week off.
Very little special care is needed when this method is used. The boy can bath or shower as usual. If the doctor has given you some antiseptic powder then use it as directed, otherwise do not put any antiseptics on the wound or in the bath water.
The nature of the plastic bell should ensure that the circumcision cannot come into contact with the glans, which may be a little raw from separation of adhesions. If it should look as if there is some contact then a little petroleum jelly (Vaseline) smeared on the wound will prevent the two fusing together and forming 'skin bridges'.
The bell will fall off naturally after about a week, leaving a fully healed circumcision. The boy should be discouraged from attempting to speed up the release of the bell by pulling at it, even when almost off. It may be necessary to prevent a young child having access to his penis during healing by the use of suitable clothing.
A dark brown or black area around the plastic ring is perfectly natural and will disappear after the ring has fallen off. The skin under the string may also become soft and yellow.
There may be a little pink or red staining of the underpants for a few hours after the circumcision and again when the ring separates.
Notify the doctor immediately if:
Bleeding
If there should be excessive bleeding:- using the thumb and index finger, make a ring around the top of the penis and squeeze tightly for FIVE MINUTES. If the bleeding does not stop contact the doctor immediately for advice or go to the nearest hospital casualty department.
Stitches
The stitches will fall out by themselves within 7-10 days and no special action needs to be taken about them.
Dressings
Your son may have only a light dressing over the wound itself or the doctor may have applied a bandage to the whole penis. In either case, if the dressing falls off early do not worry. There is no need for another dressing to be applied, but you can use a light one if you wish.
If the first dressing has not already fallen off within 24 hours it must be removed by soaking in a warm bath. Gently release the dressing, stopping whenever you start to feel any resistance to its removal let the water soak off the clotted blood and then continue.
Bathing
Until healing is complete it is preferable that the boy takes baths rather than showers.
Once the first dressing is off, the boy should bath as usual, but with some salt added to the bath water to promote healing. If the doctor has given you some antiseptic powder then use it as directed, otherwise do not put any antiseptics on the wound or in the bath water.
Adhesion
The glans may be a little raw from separation of adhesions. A little petroleum jelly (Vaseline) smeared on the wound and glans morning and night, and after bathing, will prevent the two fusing together and forming 'skin bridges'.
Possible Problems
Notify the doctor immediately if:
You and your son may have further questions that this leaflet doesn't answer. The Gilgal Society has many other leaflets to assist, including one (All about being circumcised) which may be useful in explaining things to a 7-10 year old.
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