Circumcision Procedure

Before the circumcision is performed, numbing medicine is used on the penis. The baby is then held down on a special board and the circumcision is performed using a specialized clamp. The babies usually cry more over being held down than they do from the actual procedure and should not be in pain once it is finished. The circumcision takes about one week to heal. Vaseline should be paced on the site each time the diaper is changed for about a week. Complications are rare, they include bleeding, infection, or very rarely injury to the penis itself.

There are different ways to numb the penis prior to the circumcision procedure. The two most popular ways are dorsal penile nerve block and topical lidocaine. Studies have shown each of these techniques to provide equivalent pain relief. The dorsal penile nerve block involves injection of local anesthetic, lidocaine, into the base of the penis. This numbs the nerve that provides sensation and gives pain relief for the circumcision. Topical lidocaine is a local anesthetic cream that can be placed over the end of the penis, it takes about 45 minutes to gain maximum benefit. After 45 minutes the topical lidocaine provides as much pain relief as the injectable. The advantage of the topical lidocaine is that it does not require an injection into the penis. The disadvantage is that it takes 45 minutes to become effective after the cream is placed.

There are different techniques that are used for newborn circumcision. The three most common are the Gomco clamp, the Mogen clamp, and the Plastibell. The Gomco is the most commonly used clamp in the US because that is how most people are trained. The Mogen clamp is quicker and has less bleeding but fewer people are trained on its use. The Plastibell involves leaving a plastic bell on the penis until it falls off after several days. This is now used infrequently mostly because parents don’t like the hassle of the plastic device on the penis.

After the circumcision the baby may be fussy or may sleep. They tend to be angry over being held down for the procedure but they should not be in pain. The end of the penis will be wrapped in a gauze that was Vaseline on it. The gauze will usually fall off on its own with diaper changes. If the gauze is still on the day after the procedure it can be removed by the parent. The penis should be cleaned with each diaper change with a diaper wipe. After it is cleaned Vaseline should be put on the tip of the penis to prevent it from sticking to the diaper. This should be done for about one week.

Some spotting of blood is normal on the diaper and is nothing to be concerned about. If the diaper is filling up with blood, this is not normal and the baby needs to be seen immediately. A scab will form around the rim of the penis. This scab takes about a week to heal and is normal. The scab may get a yellowish color and goopy when it gets wet, this is normal. It is important to keep it clean so don’t be afraid to wipe the area with diaper changes. Watch for signs of infection. If the penis turns very red, is hot to the touch, has pus or if the baby gets a fever, the baby should be evaluated right away. The baby may be bathed the day after the circumcision.

Complications from circumcision are very rare. Bleeding can occur but is usually easily controlled at the time of the procedure. Infection is possible but surprising a rare event. Injury to the penis itself is incredibly unusual. The local anesthetic, the cream or the injection, work very well. It is my opinion that in most cases circumcision is more difficult for the parent than it is for the baby.