Newborn Circumcision Care
Depending on the care provider, his/her training, and the technique used, care instructions given to parents after newborn circumcision can vary and at times may be confusing. Regardless of the instructions given, the parent or guardian needs to understand that post-circumcision care should not be complicated or scary. The penis with its rich blood supply is unlikely to get infected or damaged by the family when manipulated, cleaned, or inspected.
Cleaning and Ointment
Cleaning a newborn circumcision site is done primarily for hygiene reasons. In other words, infection is very rare after a circumcision even though your baby is routinely urinating and stooling on the site. Most care providers recommend gentle wiping with warm water and baby soap for general cleaning purposes only, not as a requirement for improving healing or infection prevention. The decision to clean a newborn circumcision is left to the parents, and if hygiene and routine cleaning are desired then keep it simple and gentle. Bathing is permitted and encouraged for general hygiene, but submersion under water (bathtub) should be less than 5 minutes, and afterward the penis should be allowed to ‘air out’ and become dry before returning to the diaper or applying ointment. Some care providers discourage submersion under water for several days after circumcision, which is reasonable but probably not critical. Common sense is encouraged.
An ointment is very commonly recommended after circumcision especially if a clamp (Gomco, Mogen) is used. Infants with a plastic ring device (Plastibell) in place probably do not benefit from ointment to the site until the ring comes off. Some even recommend generous amounts of petroleum jelly (Vasoline) or antibiotic ointment (Bacitracin, Neosporin). A circumcision will heal like any other sore, injury, or cut elsewhere on the body. If too much ointment is placed on the site, it prevents air access and normal scabbing and may delay the healing process. Antibiotic ointment is usually unnecessary since infection is rare and it may cause a secondary yeast infection that causes its own problems. The advantage of ointment is 1) to prevent sticking to the diaper, 2) to prevent any stinging or discomfort associated with urine or stool contact to the open site, and 3) avoids irritation to the newly exposed meatus (pee hole)–see OUTCOMES section. In general, limiting the ointment amount and frequency of use while allowing air to the circumcision site will probably provide the best results.
Bleeding is to be expected with a circumcision since it is a ‘procedure’ involving human skin. Of course, bleeding should be minimal and temporary. If bleeding is steady, progressive or persistent you should immediately consult your child’s care provider. The best way to stop most bleeding is to apply pressure. After circumcision, one of the best ways to apply pressure to the site is to apply a “pressure diaper.” This involves placing the penis up on the abdomen, applying a small amount of vaseline (petroleum ointment) and then placing on top of the penis a thick packing (like 2 folded wash clothes) while TIGHTLY securing the diaper on top of the packing. This will cause the diaper to press on the packing which presses the penis against the abdomen for excellent pressure. It is typically recommended that the tight diaper remains in place for 30-60 minutes before reinspecting. This may need to be repeated if bleeding or oozing continues. In the very rare event bleeding is excessive, if your baby has a bleeding disorder, or if your baby is lethargic/pale you may need to quickly go to the closest emergency room for evaluation.
Open Wound, Skin Separation, Redness or Swelling
An open wound or skin separation at the site may occur. This is relatively common especially if the Gomco or Mogen clamps are used (no plastic ring). Because of the excellent blood supply in a newborn/infant penis, an open wound should not get infected and will most likely heal quickly and not require treatment by a care provider. The healing process of any skin separation is typically very fast and occurs within a few days. Applying ointment has pros and cons for this problem. The pro is it prevents sticking of the penis and wound to the diaper and it may provide some comfort when urine or stool contacts the tissue. The con is that it probably slows healing, and since infection is very unlikely it may not be as helpful as exposure to air and drying when possible. Antibiotic ointment (Neosporin) is rarely necessary and, if used more than once, may cause skin irritation and a yeast infection.
Redness and swelling at the site are to be expected. Since the likelihood for infection is extremely rare, this swelling and redness probably represent normal healing. If significant redness and swelling occurs at the site but does not seem to be spreading, then normal cleaning and air should be provided. If antibiotic ointment is used it should be stopped since this redness and swelling may be an indication of a secondary yeast infection. If the redness and swelling spread down onto the base of the penis and onto the abdomen then a rare skin infection (cellulitis) may have developed and needs medical attention. Fever and a bad odor are also indications an infection may be present. Again, do not worry about infection since it is very rare and typically becomes very obvious to the parent.
Ring or Plastibell-like circumcisions do not require any specific care while the ring is on. This is an advantage of the technique. Still, inspection is necessary to make sure the redness or swelling does not spread beyond the penis onto the abdomen. If very foul smelling, fever, or spreading redness occurs then consultation with your care provider is encouraged. Also, the glans (head) of the penis should stay under the plastic ring or protrude slightly into the center. However, if the glans (head) sticks significantly through the ring, it is a relatively urgent concern because of a possible ‘tourniquet effect’ on the penis that should be addressed by your child’s care provider. Once the ring falls off, no specific care is needed if your inspection reveals a satisfactory outcome.
Clamp or Cutting Circumcision
Clamp or cutting circumcisions (Gomco, Mogen, Religious) are commonly associated with more care instructions by care providers. However, these types of circumcisions do not require aggressive treatment, since infection is also rare. The issues related to these types of circumcision usually relate to the open sore or site management discussed above. And since this is less common with the plastic ring (Plastibell), parents may feel that specific treatment and care is necessary when it is usually not required. Keep it simple, unless significant swelling and redness develop.