Newborn Circumcision – Forest Lane Pediatrics of Plano and Dallas
Male circumcision is a common procedure, generally performed during the newborn period. To summarize, the American Academy of Pediatrics’ Circumcision Policy Statement (Copyright © 2012 AAP) reports that the preventive health benefits of elective circumcision of male newborns outweigh the risks.
Those benefits include prevention of:
- Urinary tract infections
- Penile cancer, and
- Transmission of some sexually transmitted infections, including HIV
- Complications are infrequent; most are minor, and severe complications are rare
- Newborn circumcision has considerably lower complication rates than when performed later in life
Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, cultural beliefs and practices. The American College of Obstetricians and Gynecologists has endorsed this statement.
Pediatricians from Forest Lane Pediatrics of Plano and Dallas perform neonatal circumcisions in the hospital and in their office. The doctors use the Mogen® and Gomco® clamps as part of their neonatal circumcision technique. Following a sterile cleanse of the area, a dorsal penile nerve block (DPNB) is done. DPNB is effective in reducing neonatal circumcision pain.
Your obstetrician may use other techniques including a Plastibell®. Plastibell® circumcision is a simple technique for neonatal circumcision. A clear plastic bell-shaped ring with a handle fits over the head of the penis. The ring is then covered over by the foreskin. A suture is tied firmly around the foreskin, compressing the skin against the groove in the Plastibell®. The excess skin extending beyond the ring is trimmed. Then the handle is removed. In 3 to 7 days the Plastibell ring will fall off. The circumferential wound will heal in about a week.
Circumcision Wound Care
Typical appearance: Expect redness of head of the penis, white or yellow granulation tissue, and/or swelling for the first 7 days after circumcision. Notify your pediatrician if there is significant redness, secretions, crusting, or swelling beyond 7 days. Call immediately if there is foul-smelling discharge.
Lubrication: Regardless of the type of circumcision done, we recommend protecting the head of the penis with Vaseline (petroleum jelly) after the procedure. For Plastibell circumcisions apply the Vaseline directly to the head of the penis every diaper change. For Gomco circumcisions apply the Vaseline to clean gauze and cover the head of the penis with the Vaseline gauze every diaper change for 3 days. After 3 days it is no longer necessary to use the gauze and the Vaseline can be applied directly to the head of the penis. See below for guidance on long-term lubrication.
Short-term prevention of adhesions: (reattachment of the foreskin to the head of the penis): Monitor the foreskin and the head of the penis. Starting as early as 24 hours after the circumcision, the foreskin may start to cover any part of the head of the penis. If this occurs, use gentle pressure to separate the foreskin from the head of the penis. Apply lubricant to the area that was attached and now has been separated for at least 2 weeks.
If the Plastibell technique was used to circumcise your son, there will be a plastic ring attached to the head of the penis by a string. The string will fall off with the bell within 5-10 days typically. The Plastibell should be mobile on the penis and the penis should not come through the top of the Plastibell. If the penis is protruding through the top hole of the Plastibell and is stuck, your son should be seen immediately.
Long-term prevention/treatment of adhesions:
Due to the large pre-pubic fat pad (the puffy area between the penis and the belly) that exists on most infants, it is common for the skin on the shaft of the penis to become adhered to the head of the penis. Check at least once a day to make sure that the groove around the base of the head of the penis is visible and clean. Boys with more fat are more prone to have adhesions develop.
Many parents make it part of their diaper changing and/or bathing routine to check for adhesions. Use gentle pressure to separate the foreskin from the head of the penis whenever necessary. Apply lubricant to the groove at the base of the head of the penis, or wherever there have been adhesions, for as long as necessary to keep the foreskin free from the head of the penis.
Other benefits to lubrication:
A 2008 study (Urol J. 2008;5:233-6) showed that applying lubricant with every diaper change for the first 6 months following circumcision promotes good healing and lowers both the risk for infection and the risk for meatal stenosis (narrowing of the hole where urine comes out because that area is rubbing directly on the diaper).
Please contact our office if you have any further questions about circumcision care.