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VNA of Care New England
VNA of Care New England

Newborn Circumcision

Definition

Circumcision is the surgical removal of the foreskin. The foreskin is a flap of skin that covers the tip of the penis.
Circumcision
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Reasons for Procedure

The procedure may be done for cultural or religious reasons. It is often done on babies in the first few days of life.
There may be some health benefits for circumcision. Many health professionals believe these benefits are small. Circumcision may be associated with a decreased risk of:

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Infection
  • Bleeding
  • Reaction to drugs used for anesthesia
  • You may not be happy with the appearance of penis after circumcision
  • Decreased penile sensation
  • Damage to the tip of the penis
Factors that may increase the risk of complications include:
  • Bleeding disorders
  • Family history of bleeding disorders
  • Birth mothers taking blood thinners during pregnancy
  • Penile deformities whose foreskin may be needed to repair the deformity
  • Prematurity
  • Infections or serious jaundice at the time of the circumcision

What to Expect

Prior to Procedure

  • The doctor will carefully examine your baby. This is to make sure your baby is in good health. The penis will be examined for any abnormalities.
  • Blood and/or urine tests may be done.
  • Your baby may be given a pacifier to suck on. The pacifier will have some sugar water on it. This has been shown to decrease pain in infants.

Anesthesia

The type of anesthesia may depend on where the circumcision is done. Two common approaches include:
  • Cream—A cream may be applied to the penis. This cream will help to numb the area. It is often done about 60-90 minutes before the circumcision.
  • Nerve block—This is a medication injected near the penis. The medication will block the nerve that runs to the penis. This will make the entire penis numb. It may be used in a hospital setting.

Description of the Procedure

The baby will need to be very still during the circumcision. The baby may be carefully restrained on an infant board or someone will hold the baby. The anesthesia will be applied.
Once the area is numb the doctor will begin. The foreskin will be pulled away from the penis. Some parts of the foreskin may still be attached to the penis. The doctor will sweep these attachments away. The extra foreskin will then be cut away. It can be removed with a scalpel or special clamp.
Stitches may be needed. They will be used to sew the remaining bit of foreskin into place. Petroleum jelly or an antibiotic ointment will be smeared on the penis. A bandage may be applied. A Plastibell device, if used, will be left in place instead of a bandage. The Plastibell will fall off on its own.

How Long Will It Take?

About 15–30 minutes

Will It Hurt?

Anesthesia prevents pain during the procedure.

Post-procedure Care

Swelling and scabbing is normal, but the circumcision site should heal in about 10 days. The Plastibell should fall off on its own within this time frame.
Home care will include:
  • Changing the bandage and cleaning the area at every diaper change.
  • Applying petroleum jelly or an antibiotic ointment to the area to keep the diaper or bandage from sticking to the penis.

Call Your Doctor

It is important for you to monitor your baby's recovery after you leave the hospital. Alert your baby's doctor to any problems right away. If any of the following occur, call your baby's doctor:
  • You find a bloodstain larger than the size of a quarter on the baby's diaper
  • The Plastibell device has not fallen off within 10 days
  • The penis or the area of the incision appears red, swollen, hot to the touch, or is oozing a yellowish discharge
  • The baby develops a fever or appears to be in pain
  • The baby does not have a wet diaper within 6–8 hours of the procedure
  • The head of the penis appears blue or black
If you think you have an emergency, call for medical help right away.

RESOURCES

Family Doctor—American Academy of Family Physicians http://familydoctor.org

Nemour's Kid's Health http://kidshealth.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca

Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

References

American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/pregnancy-newborns/caring-for-newborns/infant-care/circumcision.html. Updated December 2010. Accessed August 21, 2014.

American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics.2012;130(3):585-586.

Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. Cochrane Database Syst Rev. 2004;18(4):CD004217.

Circumcision. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 9, 2013. Accessed August 21, 2014.

Leef KH. Evidence-based review of oral sucrose administration to decrease the pain response in newborn infants. Neonatal Network. 2006; 25(4):275-284.

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