Uncircumcised penis
The foreskin is attached to the head of the penis at birth and will usually naturally pull away over the first few years of life. A white substance may be seen as the foreskin pulls back. This is smegma and normal, not a sign of infection.
As long as the foreskin doesn’t easily retract, only the outside skin needs to be cleaned.
If the foreskin retracts a little, clean only the exposed area with water. Don’t use soap on this area - this can irritate the skin. After cleaning always replace the foreskin back over the head of the penis.
As your child gets older and the foreskin has completely separated and retracts easily, begin to teach him to clean underneath it as he bathes.
If the foreskin does not naturally pull away from the head of the penis an this causes painful erections, bring your child in for an evaluation of the situation.
Circumcision types and care
There are two main types of circumcision, one that leaves a plastic ring (Plastibell) on the head of the penis, and another that removes the foreskin and is left open with petrolatum jelly on gauze.
Care depends on the procedure done. After a baby's circumcision, it takes about a week to heal regardless of the method used.
After the healing has taken place, no special care is needed other than routine cleaning.
A word about adhesions...
Sometimes the penis will sink into the fat pad surrounding it, allowing the skin to reattach over time.
If your child's foreskin comes back over the head of the penis, push back on the fat pad to pull the skin off the head of the penis with diaper changes. Apply petrolatum jelly (Vaseline) to the area to prevent sticking.
If it does stick, it is called an adhesion. This usually doesn't cause any problems - remember that uncircumcised penises generally pull away from the foreskin over the pre-pubertal years. The adhesions of a circumcised penis will also naturally pull away over time. If they cause pain, they should be addressed.
A white substance called smegma sometimes is seen around the edges of the head of the penis. This looks like cottage cheese and is sometimes mistaken for pus. It is not pus and is a normal substance made by the penis. Gentle removal with a moist cloth is all that's needed if it's bothersome.
Procedure descriptions
The type of procedure done is dependent on the training and experience of the person performing the procedure. Risks and benefits overall are similar. The final "look" of the penis will be the same after the first week.
Both types use a local anesthetic called lidocaine to numb the area. This injection may sting initially (sugar and a pacifier are used to help pain control for the sting) and the injection may leave a bruise at the base of the penis. Babies can still feel the cold of the cleaning product we use to decrease risk of infection and they can still feel tugging, but the sharp pains of the procedure are lessened with the lidocaine. The foreskin is pulled away from the head of the penis (aka glans).
The remainder of the procedure done and aftercare depends on the type of circumcision.
Mogen Clamp:
After the Mogen Clamp it will look bright red and swollen initially, then less swollen. As it heals, yellow granulation tissue appears on the head of the penis. This is normal and NOT an infection.
We recommend putting petroleum jelly on the head of the penis during the healing process to keep it from sticking to the diaper. If stool gets to the area, simply rinse with water without rubbing the area much. Reapply petroleum jelly each diaper change. We suggest you do not use any creamy products or lotions on the healing penis, as they cause irritation.
- The foreskin is pulled up and the clamp is placed over the glans, to protect it from being cut.
- The clamp puts pressure on the tissues to prevent bleeding.
- The foreskin above the clamp is removed.
- No stitches are needed unless there is excessive bleeding, which is a rare complication.
- The head of the penis will look open and raw during the healing process. This is normal!
- Change the gauze pad with petrolatum jelly (Vaseline) with diaper changes since it will be soiled.
- Rinse the head of the penis with water if stool (poop, bowel movement, meconium) gets on it, but usually simply changing the gauze is sufficient.
- Continue to place Vaseline gauze on the head of the penis until it is healed. You will know when it is healed when there are no more red or yellow areas.
- If there are signs of infection, such as redness of the penis shaft, temperature over 100.4F, poor feeding or fussiness, your baby should be evalutated urgently.
Plastibell
- A plastic ring (Plastibell) is inserted between the head of the penis and the foreskin and tied off.
- The ring is left in place until it falls off naturally, generally 3-7 days later.
- The Plastibell is left alone until the bell falls off and routine cleaning with diaper changes is done.
- If the ring does not fall off within 14 days or if it slips down the shaft of the penis, bring your baby in to be evaluated. This is an emergency if it seems red, tender, or your baby has a temperature over 100.4F, is fussy or not feeding well.
