Please check your baby’s diaper every hour for the next 24 hours to look for any abnormal bleeding. Leave the gauze in place and remove it after 24 hours. If it has fallen off, do not panic-just replace it with a fresh 3x3 gauze with some Vaseline on it and put it over the penis. Close the diaper. For the following four days, put a small amount of Vaseline on your finger and rub it over the incision site placing a thin layer of ointment over the entire head of the penis. No gauze bandages are required after the first 24 hours, just ointment.

It is important to push the skin down off the head of the penis if it has moved up a little to ensure it heals properly just behind the back rim of the head. Do not do any pushing on the skin for the first two days because it will be swollen from the surgery. If you are unsure of the appearance of your son’s penis, bring him to see Dr. Crouse, and he will adjust the skin for you if he thinks it is required.

General care following the circumcision:

It is normal for your son to be a little irritable for the first 24 hours following the circumcision.

Most babies like to nurse in a quiet environment following the circumcision. A baby who cries for more than a few minutes is usually from air swallowed during the circumcision and needs to be burped.

Most babies sleep quite well following the circumcision. The best sleeping position for your baby is on his side, supported by a blanket roll.

Healing is promoted by keeping the area clean and dry. Warm water and a cotton-ball or wash cloth are preferred for cleaning the area around the penis. Avoid moistened towelettes, alcohol, powders and lotion since these may cause irritation.

Disposable diapers are strongly recommended for the first week since they tend to be less irritating, and they help keep the area dryer and cleaner.

It is better both before and for about three days following the circumcision to restrict the handling of your baby to just a few people. Also, avoid unnecessary travel as car seats can be irritating to the new circumcision.

Healing:

Healing is usually rapid and occurs in several stages. Remember that a circumcision is like any other cut. There are many factors that influence healing; but most importantly, every child heals differently.

First, the cut edge seals and the bleeding ceases within minutes, hours, or even over the course of an entire day. The area just behind the glans (especially the underside) will become swollen. This inflammation will subside within a week or two. In the first two days, there may be an off-white or yellowish, patchy appearance of the glans. These  patches are a type of scab and are associated with normal healing.

After a few days the area where the skin was cut look green and yellow. This is NOT pus. It is healing tissue. It can look this color for up to two weeks after the circumcision.

You will also notice that the glans appears red and glossy, sometimes purple. This is because the skin covering the glans of an uncircumcised penis is mucous membrane (like the skin inside your cheek). Once exposed, the mucous membrane will toughen (or keratinize), and in time take on a normal appearance. It takes about a month for the penis to take on a normal, healed appearance.

Appearance:

A common concern for parents is aesthetics. Remember that penises come in all shapes and sizes. While most penises “look normal” within days of the circumcision, some do not take on a “completely normal appearance” until after the penis starts to grow. Furthermore, although the penis may appear smaller after the circumcision, it is not! This appearance is mostly due to relaxation of skin surrounding the penis, which prior to circumcision holds the penis more erect.

After a few days to a week, some parents notice swelling of the mucosal tissue behind or under the head of the penis and believe it looks “like a blister”. This type of swelling is normal. It is not a blister and will gradually subside.

On occasion, a poor aesthetic result occurs when too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. The latter is sometimes caused by the presence of a hydrocele or penile erections. In nearly all of these cases, the penis will heal properly and in time take on a normal appearance. If you are concerned in any way about the appearance of your son’s penis, please consult with Dr. Crouse immediately.