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Circumcision - Injury Prepuce

  • Posted on- Apr 04, 2018
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Circumcision is a common procedure in which the skin covering the tip of the penis is surgically removed. It's usually performed on a newborn boy before he leaves the hospital, and often within the first 2 days of his birth.

Boys are born with a hood of skin, called the foreskin, covering the head of the penis. In circumcision, the foreskin is removed to expose the head of the penis. It's a quick procedure that causes very little bleeding and stitches aren't needed.

Older boys can be circumcised, but the procedure is a bit more demanding. After the circumcision, a protective bandage may be placed over the wound, which generally heals on its own within a week to 10 days.

Most parents make the decision about circumcision based on cultural, religious, or personal reasons (such as whether other male family members have been circumcised.

Preparing for the Circumcision

Once the parent decides that their baby will be circumcised, discuss it with the doctor who'll perform the procedure. Many circumcisions on newborns are done by obstetricians, but pediatricians, family practitioners, urologists, neonatologists, and pediatric surgeons also can do them.

However, circumcision is delayed for babies with certain medical conditions. The child's examining pediatrician or neonatologist will decide if the newborn should wait to be circumcised.

Circumcisions are often performed in the hospital's nursery treatment room. Some parents choose to be in the treatment room during the circumcision, while others prefer to wait for the baby to be returned to the nursery.

What Happens During Circumcision?

A baby is typically awake for circumcision. He is usually positioned in a molded plastic seat that helps hold him safely in place. The penis and surrounding skin are cleansed with antiseptic before the procedure begins.

Pain-Control Measures

A local anesthesia is used to numb the area of the penis where the incision will be made. This may include a numbing cream or medicine that is injected into the penis using a tiny needle. Because of the numbing cream, the patient will feel very little as the needle goes through the skin.

To further reduce stress and discomfort, the nurse may give the baby a "sucrose pacifier" (a pacifier dipped in sugar water), which has been shown to reduce newborn distress. Sometimes acetaminophen is given to help with pain. Babies may also feel better when swaddled.

Circumcision Methods

In newborns, circumcision can be performed in several ways. The most common techniques protect the head of the penis with special devices while the foreskin is removed. The doctor will determine which method is appropriate.

In newborns, the three most common circumcision techniques are:

1. The Gomco Clamp

A special instrument called a probe is used to separate the foreskin from the head of the penis (they are usually joined by a thin membrane). Next, a bell-shaped device is fitted over the head of the penis and under the foreskin (an incision may be made in the foreskin to allow this). The foreskin is then pulled up and over the bell and a clamp is tightened around it to reduce blood flow to the area. A scalpel is used to cut and remove the foreskin.

2. The Mogen Clamp

Again, the foreskin is separated from the head of the penis with a probe. The foreskin is then pulled out in front of the head and inserted through a metal clamp with a slot in it. The clamp is held in place while the foreskin is cut with a scalpel and remains for a few minutes after this to make sure that bleeding has been controlled.

3. The Plastibell Technique

This method is similar to the Gomco clamp technique. After separation with a probe, the plastic bell is placed under the foreskin and over the head of the penis. A piece of suture is tied directly around the foreskin, which cuts off the blood supply to the foreskin. A scalpel may then be used to cut off the extra foreskin, but the plastic ring is left on. About 6 to 12 days later it falls off on its own.

After the Circumcision

After a circumcision, doctors will apply petroleum ointment over the wound and wrap the baby's penis in gauze to keep the wound from sticking to his diaper (unless the doctors have used the Plastibell method, which requires no dressing).

There is very little bleeding after circumcision, no matter which technique is used. Though one may see a little bit of blood oozing from the edge of the incision or on the diaper when the first dressing is taken off, this will generally stop on its own.

The patient's penis may be sore for a few days after the procedure, so be gentle when bathing him. Never use astringent and special bath products. Most doctors recommend keeping the area clean with warm water. If poop gets on the penis, soapy water can be used to gently wipe it away.

If there is a dressing on the incision, apply a new one (with petroleum jelly) whenever you change a diaper for the first day or two. Even after the dressing is no longer needed, you should put a dab of petroleum jelly on the penis or on the front of the diaper for 3 to 5 days. This can help avoid discomfort from rubbing and sticking to the diaper.

It usually takes between 7 to 10 days for a circumcised penis to heal from the procedure. Until it does, the tip might be raw or yellowish. Call your doctor right away if notice any of the following:

  • bleeding that continues or blood on the diaper (more than quarter-sized)
  • redness or swelling around the tip of the penis that gets worse
  • fever
  • signs of infection, such as the presence of pus-filled blisters
  • not urinating within 12 hours after the circumcision

Benefits of Circumcision

In the first year of life, a circumcised infant is less likely to get a urinary tract infection. It may be easier to keep a circumcised penis clean and uninfected, though boys who don't have circumcisions can be taught to properly clean beneath the foreskin once it becomes retractable (usually by puberty).

Later in life, studies show that circumcised men may also be at lower risk for developing cancer of the penis (although the disease is rare). Circumcision may lower the risk of contracting HIV and other sexually transmitted diseases (STDs) from an infected female partner.

Risks and Complications associated with Circumcision

A circumcision is considered a safe procedure with minimal if any, risks. Most of the time, there are no complications.

In rare instances, complications can include:

  • Infection: Infection is rare because doctors use sterile techniques to perform the procedure. Most circumcision-related infections are mild and easily treatable with antibiotics. Signs of infection include worsening redness, pus, pain, and swelling around the incision, or fever. If you notice any of these signs, call the doctor.
  • Bleeding at the site: This is more likely when the child has a bleeding disorder, which is why it's important to let the doctor know about any family history of bleeding or clotting problems. Very rarely, a small blood vessel may be nicked during the procedure. In most cases, this bleeding will stop on its own, but occasionally stitches are required.
  • Risks associated with anesthesia: Local anesthesia is very safe, but it can sometimes cause bruising, bleeding, or skin irritation. Rarely, it can cause irregular heart rhythms, breathing problems, an allergic reaction, and, very seldom, death. These complications are not common, and usually, involve patients who have other medical problems.
  • Incomplete removal of the foreskin: Sometimes too much skin is left behind. This becomes less apparent as the child ages. Occasionally, if the excess skin is uneven, a corrective procedure may be required at a later date.
  • Damage to the penis: In rare cases, the head of the penis can be injured during a circumcision. However, precautions doctors take almost always prevent this from happening.

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