Circumcision and Foreskin Care

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If your child has an abnormality with the penis (penile anomaly), needs care after circumcision, or if you are having trouble deciding on whether to circumcise, a pediatric urologist with Norton Children’s Urology, affiliated with the UofL School of Medicine, can evaluate your child and provide guidance and recommendations.

Our pediatric urologists can determine if a penile anomaly requires circumcision for treatment and can provide you with care guidance. They also can correct a circumcision that was not performed by a urologist or did not heal properly.

Evaluation and Timing

Urologists recommend that a child be evaluated to determine the best method of care for a penile anomaly. At Norton Children’s Urology, we want to evaluate babies before 4 weeks of age. During the evaluation, your child will have a physical exam, and the pediatric urologist will be able to provide you with a recommendation, as well as answer any questions you may have.

After evaluation, if you elect to circumcise your child or the procedure is deemed medically necessary, a newborn circumcision will be scheduled as soon as possible.

If your child is older than 4 to 6 weeks or if there is a congenital penile anomaly, a newborn circumcision may not be able to be completed, even if necessary. A pediatric urologist will work with you to guide treatment plans.

How Is Circumcision Performed?

If the evaluation determines a circumcision is needed or you decide to have your child circumcised, an appointment will be scheduled with a urologist. Circumcision is a common and safe procedure to remove the foreskin from the head, or glans, of the penis.

Newborn circumcision typically requires only a topical and/or local anesthetic, but is still considered a surgery. Our providers work to keep the child as comfortable as possible. Most babies are held still or placed into a circumcision brace during the procedure. After the child receives the local anesthetic to numb the area, the procedure can begin. Once numbed, local anesthetic is injected around the penis to ensure the child does not feel pain during the procedure. The pediatric urologist uses a temporary clamp device, called a Gomco or Mogen. This helps stop bleeding so the foreskin can be cut and removed. A dressing of gauze with petroleum jelly or antibiotic ointment is then applied.

How to Care for a Child After Circumcision

It is normal for the baby’s penis to be red, swollen or bruised after the dressing is removed. As the baby heals, the skin may begin to look red, yellow and possibly crusty. It is normal to see some drops of blood in the baby’s diaper at the surgical site.

Should your child’s penis bleed, gently apply pressure to the area for 5 to 10 minutes, until bleeding stops. If you cannot stop the bleeding within 10 minutes, call the number given to you by your pediatric urology team.

When the dressing falls off or you remove it when the pediatric urologist says you can, it does not need to be replaced. The dressing can be removed by soaking your baby in a bath of water only. Soap should not be used for two to three days after the circumcision, as it can cause discomfort.

Using petroleum jelly on the inside of the diaper can help the child’s penis not stick to the diaper. If the diaper sticks, soak the child in bath water until the diaper can be gently removed.

Call the number provided by your child’s pediatric urologist if you have questions or concerns, including if:

  • You notice any signs of infection, such as worsening redness and/or foul-smelling drainage near the incision site and increased swelling.
  • Bleeding does not stop after 10 minutes of gentle pressure applied to the incision.
  • Your child has a fever of 101. 5 degrees by mouth or 102.5 degrees using a rectal thermometer.

Foreskin and Uncircumcised Penis Care

If you opt not to have your child circumcised or your child does not require one, here is how to take care of foreskin.

The foreskin is firmly attached to the glans (head) of the penis. Over time, the foreskin begins to separate from the glans. During this process, you may notice a white, cheesy material called smegma between the layers of skin. You also may see “white pearls” develop under the fused layers of foreskin and the glans. This is normal.

Once the foreskin separates from the glans, it can be pulled back (retracted) from the penis toward the belly, exposing the head of the penis. This can happen as early as age 5, but many children do not experience this until their teen years. Do not forcibly retract the child’s foreskin, as this can cause pain and bleeding, leading to scarring and skin adhesions.

As long as the foreskin is not retracting, only the outside of the penis needs to be washed. As the child is bathed with soap and water, wash the outer layers of the penis the same way. Should the child’s foreskin retract, wash that exposed area of the glans with water only — soap can irritate the skin.

After bathing, pull the foreskin over the glans. As the child ages and the natural separation and retraction of the foreskin occurs, teach your child how to clean underneath when they bathe as part of their daily routine. Additionally, once the foreskin can be retracted, it should be retracted prior to urinating and then replaced once the bladder has been emptied.

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