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Circumcisions are frequently done by our practice in both the newborn nurseries and in the office. This often serves as a source of anxiety for many new parents. We have set up this page in order to help answer many of these questions in hope that this will help many new parents to understand the procedures, the normal post-procedure process and to alleviate many unnecessary concerns.
Circumcisions are often performed in both the nursery or in the outpatient offices of either pediatric urologists or pediatricians. Typically these procedures are performed before the child is 12lbs (which is usually about 2 months for a full-term infant). Once the child is past this size he may be too large to be strapped down the circumcstraint board and the risk of bleeding increases significantly. Once they are past this size they often have to wait until six months of age in order to undergo a circumcision under general anesthesia in the operating room.
Your child will receive a local numbing injection at the base of the penis similar to what a dentist does to numb a tooth for a dental procedure. This will provide him with about two hours of pain relief. You may also give him infant tylenol prior to and after the procedure.
There are two popular methods for performing circumcisions in infants. The PlastiBell and the GOMCO clamp are both popular methods for performing newborn circumcisions that have both been around for many years. These methods work equally well in experienced hands, however the ultimate decision on the type of circumcision should be left up to your provider as your child's anatomy and the provider's experience often necessitate the selection of one method over the other. BOTH procedures include cutting of the skin. Neither procedure is less painful than the other. When healed they produce an identical result.
This method uses a metal clamp that is tightened to the point that it compresses the skin edges together in order to fuse them together. The skin is then removed with a scalpel and the clamp needs to remain in place for 5-10 minutes before it is removed. When the clamp is removed there is often a vaseline gauze dressing on the penis.
Care: The vaseline gauze is to remain overnight and should be removed the next morning. However, it is okay if the gauze often falls off early. Once the gauze is off petroleum jelly (without fragrances or additives) should be applied directly to the penis (and a small coating on the front of the diaper) for two weeks time in order to keep the penis from sticking to the diaper. Additionally, many children have a large baby fat pad at the base of the penis that pushes the foreskin over a portion or all of the head of the penis like a "turtle neck". After 4 days of healing if the penis looks like a "turtle neck" and the entire head of the penis is not visible- the foreskin should be retracted when the vaseline is applied to the penis to prevent adhesions from forming.
Bathing: No soaking baths for 5 days. May use diaper wipes gently on the penis to clean.
This method uses a round plastic ring that is placed between the head of the penis and the foreskin. A string is tied tightly, compressing the foreskin between the string and the plastic ring and cutting off the blood to the foreskin that is past the string. Most of the foreskin is then removed with a scalpel, however a rim of foreskin is left to allow the ring to stay in place. This rim of skin then dies over the next several days and the ring typically falls off in 5-7 days.
Care: Initially there is no care for this method while the ring is in place. Once the ring falls off you should then apply vaseline to the penis with each diaper change for one week to prevent the penis from sticking to the diaper. Additionally, many children have a large baby fat pad at the base of the penis that pushes the foreskin over a portion or all of the head of the penis like a "turtle neck". After 4 days of healing if the penis looks like a "turtle neck" and the entire head of the penis is not visible- the foreskin should be retracted when the vaseline is applied to the penis to prevent adhesions from forming.
Bathing: Soaking baths may resume the day after the procedure. Newborns with their umbilical stumps should not have soaking baths until the purple stump falls off.