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 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
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.
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.
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 never use anaesthetics but their method of circumcision is very quick and causes minimal discomfort to the boy.)
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 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 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.
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.
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 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.
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.
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:
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
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 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 each time the baby is changed will prevent the two fusing together and forming 'skin bridges'.
Possible Problems
Notify the doctor immediately if:
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 him done.
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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