The following is information regarding circumcision. Please read the material carefully, as it will detail the pre and post circumcision care of your son. Once you have read the information, please feel free to contact me with any questions via text message or email.
Dr. Greenberg performs infant circumcision on babies between the ages of 5 days and 8 weeks who weigh at least 2.5kg (5.5lbs).
The uncircumcised penis, with the foreskin covering the glans (head of the penis). This is how it would appear looking from the side
The same penis as in Figure 1 but drawn as if the foreskin was transparent. Here, you can see the foreskin in relation to the glans. Notice the adhesions (indicated by arrows) between the inner side of the foreskin and the glans. These are present at birth in almost all babies and must be released before the actual circumcision.
This shows the foreskin stretched forward and through the central slit of the Mogen. Notice the outline of the glans (shaded, indicated by arrows) safely behind the Mogen. The cut is made along the front surface of the Mogen.
The same penis, following circumcision. Notice that the cut edge of the skin retracts to just behind the back rim of the glans (indicated by arrows). This is the site of the healing.
Some parents become anxious immediately before and during the procedure. This response is understandable. However, the baby will notice if a parent is behaving in a noticeable nervous or anxious manner and this in turn will cause the child to experience nervousness and anxiety. It is therefore essential that the parents remain calm while in the procedure, as it will make the procedure easier for your son.
Keep your son snugly swaddled. The less he moves his legs the less discomfort he will have.
Materials needed for aftercare are an antibiotic topical ointment and 4″×4″ sterile gauze pads. All materials needed for aftercare can be purchased in our pharmacy.
With each diaper change:
Squeeze some antibiotic topical ointment, an amount about the size of a Loonie, onto the centre of a sterile 4″×4″ gauze pad and set to the side.
Remove the dirty diaper, clean the baby, and place a clean diaper underneath the child.
Remove the existing 4″×4″ pad by gently peeling from bottom up. Expect to find some light blood stains with the first few changes. They should lighten with each subsequent change.
Inspect the area for fresh blood. If there is no new bleeding, place the new gauze pad over the penis so that the mound of ointment is applied directly over the tip of the penis and then close the diaper.
Expect your son to be a little irritable for about one day. Most babies like to nurse in a quiet environment following the circumcision. Babies who cry for more than a few minutes are usually suffering from air swallowed during the procedure and need 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 soft cloth are preferred for cleaning the area around the penis. Avoid pre-moistened towelletes, alcohol, powders, and lotions as they may cause irritation. Disposable diapers are strongly recommended for the first week as they tend to be less irritating and are much drier than cloth diapers. Avoid unnecessary travel as car seats can be irritating to the newly circumcised baby, and can delay healing. Do not bathe your baby for the first 3 days after the circumcision (this includes immersion baptism). Sponge baths are allowed (as is affusion baptism). Continue with the antibiotic topical ointment dressing for 3 days after the circumcision. Have your son examined by your Family Doctor or Paediatrician within 10 days of the circumcision.
IF THERE IS ACTIVE BLEEDING
Apply pressure to the penis for 3 minutes. Do this by grasping the penis between two or three fingers over the 4″×4″ gauze pad.
DO NOT REMOVE THE PAD as this may cause more bleeding.
Inspect the area for continued bleeding. Continued bleeding will be evident if the gauze pad continues to become redder with blood. If bleeding continues, apply another 4″×4″ gauze pad over the existing one and repeat step 1. When the bleeding stops, leave the pads on the penis and close the diaper.
Healing is usually rapid and can be viewed in several stages. It should be remembered that this is like any other cut and that there are many factors that influence healing. Every child heals differently.
First, the cut edge seals and bleeding ceases within minutes. Within hours, maybe a day, the area just behind the glans (especially the underside) will become swollen. This inflammation subsides within a week or two. One to two days following the circumcision 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. You will also notice that the glans is red and glossy. This is because the underside of the foreskin, which covers the glans of the uncircumcised penis, is a mucous membrane (like the inside of your cheek). Once exposed, the mucous membrane will toughen (a process called keratinisation), and in time will take on a normal appearance. The penis should take on a “normal” appearance within about one month’s time.
Circumcision is associated with few and infrequent complications, though as with any surgical procedure there are occasional problems.
The most common complication is bleeding. In most cases, bleeding is controlled by direct pressure as described in a preceding section.
There are reported cases of infection, although these are rare in this setting. Common signs of infection include a pus discharge, a foul smell, excessive swelling or redness, local warmth, fever or rash in the penile area. With development of any of these signs, please call me immediately and I will give you further instructions.
Some infections which do not cause a fever, but only mild symptoms, can usually be treated with a topical antibiotic ointment.
Final appearance of the penis is dictated by many factors. The final appearance of the penis is the greatest cause for concern amongst parents. It should be remembered that everyone’s anatomy is different and as such, penises come in all shapes and sizes. The result of one circumcision cannot be identical to the next. While most penises begin to look “normal” within days of the procedure, some do not take on a completely “normal” appearance until after the penis begins to grow.
Furthermore, the penis may look smaller after the circumcision. On occasion, a poor aesthetic result occurs when too little or too much foreskin 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 a penile erection or hydrocele. In nearly all cases, the penis will heal properly and in time take on a “normal” appearance.
Any concerns should be brought to Dr. Greenberg’s attention, as early treatment, if needed is always best. In case of emergency, Dr. Greenberg can be reached by cellular phone at 416-702-8990.
The best way to reach the doctor is by text message. Medically urgent messages after circumcision will be answered when the doctor as soon as possible them. Otherwise, the doctor may not answer until he is in the office.
Office phone: (416) 661-0004
Doctor’s cell phone: (416) 702-8990
Fax: (416) 661-0810
Email: mark@drgreenberg.ca
RateMDs: Dr. Mark Greenberg
For post-circumcision emergent calls, the doctor will always respond as soon as possible. Otherwise, he may not respond until he is in the office.
