Before the Circumcision

Baby’s Health:

• Please discuss your baby’s readiness for circumcision with his family physician or pediatrician. I will rely on their experience and physical exam to advise you of any potential issues.

• I will also go through a brief screening questionnaire when we speak on the phone prior to the circumcision.

The Day Of:

Please have your son dressed in an outfit that allows easy access, such as a sleeper or onesie.

Try to avoid feeding him for approximately one hour before, so that he is able to soothe easily during and after the procedure.

Placing EMLA cream or giving Tylenol prior to the circumcision are options available for pain control, and I am happy to provide guidance to interested parents.

Immediately following the Circumcison

After the circumcision, a special gauze bandage will be put over the penis which slows bleeding, lowers risk of infection, and prevents the wound adhering to the bandage. A diaper will be placed back on, and the baby gets dressed.

Five to ten minutes later, I will re-examine the circumcision site and do the first diaper change, going over all instructions with the parents, as well as what to expect in the coming days (which is summarized below).

Ongoing care

Normal Healing Process:

The purpose of this brief summary is to give parents an idea of what to expect to see as the penis heals after the circumcision.

• There will likely be redness and mild swelling to the area immediately after the circumcision. Most of the swelling is likely be on the underside of the penis. As noted above, the swelling should stabilize or improve by day two. The redness will likely persist for up to two weeks.

• Many parents become concerned about a yellowish film that develops in the days after the bris. This is normal granulation tissue, which is formed as the soft tissue of the penis heals itself. It should not be removed, and will fade away slowly on its own.

• If your baby is more fussy than usual, most babies will respond well to some combination of feeding, rocking and burping if needed. If this isn’t enough, he can be given 40 mg of Tylenol every 4 hours as needed.

Diaper change

• Apply a new dressing over the penis at every diaper change for three days after the circumcision.

• Diapers can be changed every 3-4 hours, or after every stool, whichever comes first.

• To apply the new dressing, simply gently remove the old one (it will often have fallen off already), and then place an opened 2 x 2 gauze, covered with a film of Polysporin, directly on and around the penis, and close the diaper on top.

• If the gauze is stuck to the penis, do not pull it off with force, as this is likely to cause bleeding. Soak the gauze in warm water first so that it peels off easily.

Cleaning:

• The penis should be cleaned by very gently running or squeezing warm water over it for the first three days after the circumcision.

• From the fourth day on, your son may be bathed, making sure to clean the penis very gently.

• Should stool come in direct contact with the procedure site, simply run warm water gently over the area, in combination with gentle dabbing with a cloth until the area is clean (followed by Polysporin dressing as above).

• Do not use baby wipes directly on the penis for the first three days after the circumcision.

• Do not apply barrier creams, such as Sudocrem, directly onto the penis, although they can be applied to the buttocks as usual.

Bleeding:

• A small amount of intermittent blood on the diaper, or spotting, is normal for the first day or so after the circumcision.

• If at any point there is active/ongoing bleeding, simply apply firm and non-stop pressure to the area with two fingers on either side of the penis, and gauze in between, for 3-4 minutes.

• If this is not effective, or if at any point there is a large amount of blood, notify myself or your baby’s physician immediately.

Infection:

• Wound infection from a circumcision is very rare. It’s part of the normal healing process to have swelling to the area for the first two to three days, as well as yellow, sticky granulation tissue.

• If there is significant redness and swelling that is increasing after two days, or there is redness and warmth to the area associated with liquidy, pus-like discharge, contact myself or your physician to address this.

Please note, I will also be available at any time before or following the circumcision to answer any questions and address any concerns. Please do not hesitate to contact me.