Preparation and After-care for
Your Infant's Circumcision

 

Introduction

This leaflet is intended as a general guide to preparing for your infant's circumcision and to proper after-care. It covers infants up to about 1 year old. There are separate guidance leaflets for older children as well as for teenagers and adults.

If your doctor has given you specific advice regarding 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 you may need to deviate from the guidance herein.

There are two major methods of performing circumcision for an infant.
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, 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. In either case no stitching is normally required for an infant circumcision.

Planning an Infant Circumcision

Do not leave the decision to circumcise your new infant son until after he is born. Parents should discuss this operation well in advance of the birth so that the mother doesn't have to worry about it whilst recovering from the birth.

It is preferable not to circumcise the baby until he is at least a week old and well established, having at least regained birth weight. The delay also allows any genital abnormality to be properly assessed since some are contra-indications for circumcision.

A premature baby should not be circumcised until he has reached the point at which he would have been born had he gone to full term.

It is also best if the circumcision can be performed before the boy is 3 months old, and certainly before six months.

You should choose a circumciser who has considerable experience of performing the operation on infants. In general this will be a doctor, but Jewish Mohelim (who may not be doctors) are very well trained and experienced in infant circumcision. Your local Mohel may be willing to circumcise a non-Jewish baby. If you need assistance in finding a suitable circumciser, the Gilgal Society may be able to suggest one from the lists it maintains.

Circumcision in the doctor's office rather than the hospital nursery ensures that it is not performed in a rush by the most junior doctor; but in a manner more conducive to the comfort of the baby. Parents can also more easily be present, which can be calming for the baby. There is also a slightly lower risk of post-operative infection.

Anaesthesia

Be sure to discuss anaesthesia with your chosen circumciser. There is generally no justification for circumcising a baby without anaesthetic. Although a baby does not anticipate pain, nor react to it in the same way as an older child or adult, he does feel any pain. A suitable local anaesthetic should always be used. General anaesthetics should be avoided for infants because they pose very significant risks. (Mohelim who are not also doctors cannot use anaesthetics but their method of circumcision is very quick and causes minimal discomfort to the baby.)

Choosing an Outcome

The penis of an infant 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 he 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'.

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 and Mogen Clamp methods 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.

Preparation

Hygiene

You should bath the baby as normal in the morning. Wash around his genitals but do not attempt to retract his foreskin unless it is already quite loose.

Immediately before the time of the operation you should change the baby's nappy/diaper for a clean one. Have another clean one ready for use afterwards if necessary.

Food

The baby should have his normal feeds up to one hour before circumcision.

After-care -- General

Emergency Contact

Ask the doctor for his emergency contact number in case there are any problems.

Swelling

After the operation 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.

Food

The baby should be suckled or given his bottle immediately after the operation. He should be cuddled and reassured as much as possible.

Nappy/Diaper

The baby's nappy/diaper should be changed as soon as possible each time it becomes damp or soiled.

Pain Relief

The anaesthetic will last for a couple of hours after which the baby should not feel any pain. If he does not settle then you can use an infant pain relief (eg Infant Calpol) or consult the doctor.

After-care -- Plastibell or Equivalent

Very little special care is needed when this method is used.

The baby should be given a daily bath as usual, but add some salt or Epsom Salts 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 as they can actually delay healing.

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 and glans each time the baby is changed will prevent the two fusing together and forming 'skin bridges'.

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, like the umbilical cord stump.

There may be a little pink or red staining of the nappy for a few hours after the circumcision and again when the ring separates. There should not be any significant or sustained bleeding -- should this occur contact the doctor immediately or take the baby to the Hospital Emergency Department.

The bell will fall off naturally after about a week, leaving a fully healed circumcision. Do not attempt to pull it off, even if it seems loose.

Notify the doctor immediately if:

After-care -- Gomco or Forceps Guided

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 Emergency Department.

Stitches

If stitches have been used, these will fall out by themselves within 7-10 days and no special action needs to be taken about them.

Dressings

Your baby 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

Once the first dressing is off, the baby should be given a daily bath as usual, but add some salt or Epsom Salts 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 as they can actually delay healing.

Adhesion

The glans may be a little raw from separation of adhesions. The cut edges should be pushed back off the glans and a little petroleum jelly (Vaseline) smeared on the wound and glans each time the baby is changed to prevent the two fusing together and forming 'skin bridges'.

Possible Problems

Notify the doctor immediately if:

When the Boy Becomes Older

When your son grows older he may notice the difference between his circumcised penis and the uncircumcised penises of his friends. You should prepare him for this by explaining that he has been circumcised and why you chose to have it done for him.

The Gilgal Society has a leaflet (All about being circumcised) which may be useful in explaining things to a 7-10 year old.



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April 2012
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