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, be confusing. Regardless of the instructions given, the parent or guardian needs to understand that circumcision care should not be complicated or scary. The penis, with its rich blood supply, is unlikely to get infected or be damaged by the family when manipulated, cleaned or inspected.
Cleaning a newborn circumcision site is done primarily for hygiene reasons. 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. This is only for general cleaning purposes and should not be viewed as a requirement for improving healing or infection prevention. The decision to clean a newborn circumcision is left to the parents. If hygiene and routine cleaning are desired then keep it simple and gentle.
Bathing is permitted and encouraged for general hygiene. However, submersion under water (bathtub) should be less than 5 minutes. 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 for circumcision care 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 scabbing from occurring in a normal fashion and may delay healing. 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 to 1) prevent sticking to the diaper, 2) prevent any stinging or discomfort associated with urine or stool contact to the open site and 3) avoid irritation to the newly exposed meatus (pee hole)—see Outcomes. In general, limiting the ointment amount and frequency while allowing air to the circumcision site will probably give the best results.
Bleeding is to be expected with circumcision since it is a ‘procedure’ involving human skin. Of course, bleeding should be minimal and temporary. If the bleeding is steady, progressive or persistent then immediate consultation with your child’s care provider should occur. 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 inspection. 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 then you may need to quickly go to the closest emergency room for evaluation.
Open Wound, Skin Separation, Redness or Swelling
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. It 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 pros are it prevents sticking of the penis and wound to the diaper and it may provide some relief of discomfort when urine or stool contacts the tissue. The con is that it probably slows healing. 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, 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 airing should be provided.
In the event that an antibiotic ointment is being used it should be stopped, since redness and swelling could also be an indication of a secondary yeast infection. Should the redness and swelling spread down onto the base of the penis and onto the abdomen, a rare skin infection (cellulitis) may have developed, which will need 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 this technique. Still, inspection is necessary to make sure the redness or swelling does not spread beyond the penis onto the abdomen. If a foul smell, fever, or spreading redness occurs, consult with your care provider. Also, the glans (head) of the penis should stay under the plastic ring or protrude slightly into the center. If the glans (head) sticks significantly through the ring (pictured), this is a relatively urgent concern because of a possible ‘tourniquet effect’ on the penis. It should immediately 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 from providers. These types of circumcisions do not require aggressive treatment since infection is also rare. Issues with 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 circumcision care is necessary when it is usually not required. Keep it simple, unless significant swelling and redness develop.
We are not providing medical advice; if you need advice, please consult with your child’s physician or care provider regarding personal concerns, risks, and outcomes.