Circumcision Immediate Aftercare
By Dr. Brown
Your son has just been circumcised and there are a few things to do. Please read this information sheet as it will answer most of your questions and alert you to potential problems.
As the circumcision heals, you will probably see a red "bloody" scab; more likely you will see a white to yellow to gray "wet scab" - this is not pus - it is a normal healing process. Do not mistakenly wipe it off - it will take the penis longer to heal if you remove it!
DO keep the penis and diaper area clean as you usually would, using soap and water or any brand of diaper wipes. For bathing, if the umbilical cord remains attached, sponge bathing is suggested. If the cord is off and dried already, an underwater bath is fine if it is more than 24 hours after the circumcision.
DO use a lubricating jelly called White Petrolatum (Vaseline) or A & D ointment on the tip of the penis to completely lubricate the tip so it will not stick to the diaper. You can apply the Vaseline on gauze (sterile or not) or directly on the penis. The gauze serves to keep on the ointment on the tip of the penis and keep poop off the tip of the penis. Keeping this area sterile is very tough and he will urinate and stool all over it soon enough, so do not sweat the small stuff. Infection of the tip after a circumcision is very, very rare.
Lubricate for 5-7 days, until the area is dry and crusty. You should no longer see the "pus" looking material when it has adequately healed. At this point you can stop using the Vaseline.
DO NOT use Paste ointments like Desitin. They dry and do not lubricate well. Never use anesthetic creams (EMLA) after circumcision for pain relief. They are dangerous and really are not needed. You should not need Acetaminophen for pain relief. Most crying is for hunger or stool in the diaper or milk related problems.
What to expect over the next few days:
Feeding and behavior. Please feed as usual, but do not be surprised if your son eats less on the first day after circumcision. He may sleep more or less than usual. Generally by two cycles of eating and sleeping, he will be back to his usual behavior, but certainly by 24 hours afterwards. Recovery seems delayed if your son was stimulated a lot by being passed from person to person a lot in the last day. Less stimulation seems better.
Swelling of the penis and normal secretions. It is normal for the area just under the glans (mucous membrane) to be swollen and pink for several days. The most swelling is under the tip. This area underneath is also where it may ooze blood (1-3 drops).
After 24 hours or so, the tip (glans) begins to secrete a yellow substance that may remind you of pus, but it is not pus and it is normal. It looks like dried egg yolk. This is NORMAL This secretion may also be on the mucous membrane area. Wipe as usual, but do not scrub the discharge off.
Bleeding. The first several diaper changes after the circumcision may show mild oozing of bright red blood where the incision was made. One to three drops is the usual total volume, unless the sticky discharge is pulled off on the diaper if there was not enough lubricant the last diaper change.
Color. The skin on the glans is always a different color than the shaft of the penis. It is normal for the glans to be beefy red, eventually healing to a purple/red/blue color.
Urination. The amount an infant urinates depends on oral intake of fluids. Therefore if he drinks less, he is likely to urinate less and less often. The circumcision should not directly cause urination problems. A pink or salmon colored urine usually is uric acid crystals that have precipitated out of the urine because mild dehydration. Rarely is it bleeding. Uric acid crystals are very benign and go away when he drinks better over the next few days. What to expect over the next few weeks and months. As the swelling continues to diminish, the yellow secretion also recedes.
Adhesions. Adhesions of the mucous membrane onto the glans may and most often do occur. Frequently (at bath time), be sure to retract the foreskin gently until you meet resistance. Do not cause trauma! Your pediatrician can also help you to show you how to do this. DO NOT BEGIN PUSHING THE MUCOUS MEMBRANE DOWN OFF THE GLANS UNTIL AT LEAST THREE WEEKS AFTER THE CIRCUMCISION IS DONE. Once the circumcision has healed, you will need to start doing some retracting of the foreskin. DO this not by pulling on the foreskin, instead you can push along either side of the penis which will gently retract the foreskin. Talk to the doctor about this
Reasons for concern:
If you notice any of the following signs, call your pediatrician: foul odor, persistent oozing of blood or yellow, white or green substances from the penis, body temperature too low (below 97.5 rectal) or too high (above 100.0). If there are concerns that something else may be wrong, it is always better to call and check with your doctor.
For information on pros and cons of circumcision see our link Pros and Cons of Circumcision
Your son has just been circumcised and there are a few things to do. Please read this information sheet as it will answer most of your questions and alert you to potential problems.
As the circumcision heals, you will probably see a red "bloody" scab; more likely you will see a white to yellow to gray "wet scab" - this is not pus - it is a normal healing process. Do not mistakenly wipe it off - it will take the penis longer to heal if you remove it!
DO keep the penis and diaper area clean as you usually would, using soap and water or any brand of diaper wipes. For bathing, if the umbilical cord remains attached, sponge bathing is suggested. If the cord is off and dried already, an underwater bath is fine if it is more than 24 hours after the circumcision.
DO use a lubricating jelly called White Petrolatum (Vaseline) or A & D ointment on the tip of the penis to completely lubricate the tip so it will not stick to the diaper. You can apply the Vaseline on gauze (sterile or not) or directly on the penis. The gauze serves to keep on the ointment on the tip of the penis and keep poop off the tip of the penis. Keeping this area sterile is very tough and he will urinate and stool all over it soon enough, so do not sweat the small stuff. Infection of the tip after a circumcision is very, very rare.
Lubricate for 5-7 days, until the area is dry and crusty. You should no longer see the "pus" looking material when it has adequately healed. At this point you can stop using the Vaseline.
DO NOT use Paste ointments like Desitin. They dry and do not lubricate well. Never use anesthetic creams (EMLA) after circumcision for pain relief. They are dangerous and really are not needed. You should not need Acetaminophen for pain relief. Most crying is for hunger or stool in the diaper or milk related problems.
What to expect over the next few days:
Feeding and behavior. Please feed as usual, but do not be surprised if your son eats less on the first day after circumcision. He may sleep more or less than usual. Generally by two cycles of eating and sleeping, he will be back to his usual behavior, but certainly by 24 hours afterwards. Recovery seems delayed if your son was stimulated a lot by being passed from person to person a lot in the last day. Less stimulation seems better.
Swelling of the penis and normal secretions. It is normal for the area just under the glans (mucous membrane) to be swollen and pink for several days. The most swelling is under the tip. This area underneath is also where it may ooze blood (1-3 drops).
After 24 hours or so, the tip (glans) begins to secrete a yellow substance that may remind you of pus, but it is not pus and it is normal. It looks like dried egg yolk. This is NORMAL This secretion may also be on the mucous membrane area. Wipe as usual, but do not scrub the discharge off.
Bleeding. The first several diaper changes after the circumcision may show mild oozing of bright red blood where the incision was made. One to three drops is the usual total volume, unless the sticky discharge is pulled off on the diaper if there was not enough lubricant the last diaper change.
Color. The skin on the glans is always a different color than the shaft of the penis. It is normal for the glans to be beefy red, eventually healing to a purple/red/blue color.
Urination. The amount an infant urinates depends on oral intake of fluids. Therefore if he drinks less, he is likely to urinate less and less often. The circumcision should not directly cause urination problems. A pink or salmon colored urine usually is uric acid crystals that have precipitated out of the urine because mild dehydration. Rarely is it bleeding. Uric acid crystals are very benign and go away when he drinks better over the next few days. What to expect over the next few weeks and months. As the swelling continues to diminish, the yellow secretion also recedes.
Adhesions. Adhesions of the mucous membrane onto the glans may and most often do occur. Frequently (at bath time), be sure to retract the foreskin gently until you meet resistance. Do not cause trauma! Your pediatrician can also help you to show you how to do this. DO NOT BEGIN PUSHING THE MUCOUS MEMBRANE DOWN OFF THE GLANS UNTIL AT LEAST THREE WEEKS AFTER THE CIRCUMCISION IS DONE. Once the circumcision has healed, you will need to start doing some retracting of the foreskin. DO this not by pulling on the foreskin, instead you can push along either side of the penis which will gently retract the foreskin. Talk to the doctor about this
Reasons for concern:
If you notice any of the following signs, call your pediatrician: foul odor, persistent oozing of blood or yellow, white or green substances from the penis, body temperature too low (below 97.5 rectal) or too high (above 100.0). If there are concerns that something else may be wrong, it is always better to call and check with your doctor.
For information on pros and cons of circumcision see our link Pros and Cons of Circumcision