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| |    Circumcision: An Overview by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Circumcision is a minor surgical procedure to remove the foreskin from the penis. The foreskin is a flap of skin that covers the tip of the penis at birth. The decision whether to have your baby circumcised is often influenced by cultural, religious, and personal factors, and the parents' assessment of the medical risks and benefits. Before the circumcision Generally the baby isn't fed for an hour before circumcision. This is to prevent spitting up, since the baby will be lying on his back for the procedure. Circumcision The usual procedure takes about 3-5 minutes. In medical (non-ritual) circumcisions, the baby is secured onto molded plastic board with Velcro straps so that he can't move much. The penis is washed with antiseptic solution. Surgically, circumcision involves creating a thin ring of crushed tissue at the base of the foreskin where the incision is then made. The crushing of the tissue prevents bleeding. There are different sorts of instruments for protecting the tip of the penis during the procedure. Most practitioners have one technique with which they are most comfortable. Pain There are moments of the circumcision that appear to be painful, and studies have looked at newborn pain responses (like faster heart rate and crying) and found that the procedure causes these signs of stress. Numerous techniques have been developed to provide anesthesia for circumcision. Post-operative pain can be managed with infant acetaminophen (Tylenol), cuddling and allowing the baby to suck. Some babies seem sleepy or "out of it" for a day after the procedure. Possible Complications Circumcision is a very safe procedure, and serious complications are rare. When bleeding occurs it is usually during the procedure when the doctor is still there, and is easily treated. Very rarely a major complication can occur due to surgical mishap. Care of the baby after circumcision At the end of the procedure the doctor will probably wrap the tip of the penis with petroleum jelly (Vaseline) coated gauze to prevent any scab from sticking to the diaper. When you change your baby's diaper, use a fresh piece of petroleum jelly gauze or a dab of petroleum jelly. The tip of the penis will look red and swollen for a few days to a week afterwards. A white or yellow rim may appear where the foreskin was cut. This scab is called eschar, (ess-car) and is part of the healing process. It will fall off when it is ready to, and doesn't need to be pulled away. Until fully healed (one to two weeks) the tip of your baby's penis can be washed with plain water by dripping it over from a soaking washcloth, then patting dry. Once it looks healed, you can discontinue the petroleum jelly, and as long as the umbilical cord has fallen off, start giving your baby tub baths. Warning signs to watch for It is rare to have a complication of circumcision. A small amount of blood in the diaper is normal for the first two days. If the cut area bleeds actively, put pressure across the tip of the penis with your finger and thumb, and call your doctor. Any bleeding beyond two to three days isn't normal and should be evaluated by a physician. Redness and swelling are the norm for the first 4-5 days after circumcision. Infection is uncommon, but if the shaft of the penis is swollen, you see lots of pus, or your baby seems sick or has a fever, call his doctor.
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