When to pull back skin after circumcision

Boys are born with a piece of skin that covers the head (or glans) of the penis. This is called the foreskin. A circumcision is when the foreskin is surgically removed.

Most of the time, a circumcision is done during the first 10 days after a baby is born (often within the first 48 hours). It will take place in the hospital or, for some religious ritual circumcisions, at home. If you decide to have your son circumcised, your pediatrician, family doctor or OBGYN will do the surgery before you bring your baby home. The doctor can tell you about the surgery and the possible risks.

If circumcision is done after the first 10 days, it can be harder and may need general anesthesia (medicine to make the baby sleepy and not feel as much pain). Sometimes doctors decide to do the surgery at a later date or not do it at all. Some reasons a circumcision might be done at a later date may be:

1. Premature babies or those who have special medical concerns may not be circumcised until they're ready to leave the hospital or will need circumcised in the future.
2. Babies who are born with physical abnormalities of the penis that need to be corrected surgically often aren't circumcised at all because the foreskin may need to be used as part of a reconstructive surgery.

the surgery 

One of the hardest parts of the decision to circumcise is understanding that it can be painful. The two main types of local anesthetic used to make it less painful for a baby are:

1. A topical cream (a cream put on the penis) that needs about 20 to 40 minutes to take its full effect
2. An injectable anesthetic that requires less time to take effect and may provide a slightly longer period of anesthesia

Sometimes acetaminophen is also given with the anesthetic. This helps lessen pain during the surgery and for several hours after. Giving a pacifier and swaddling a baby also can help lessen stress and pain.

caring for a circumcised penis

After your baby has a circumcision, you will need to keep the area clean. Gently clean with warm water — do not use diaper wipes. Soapy water can be used if needed.

If there is a dressing on the surgery site, put a new one on (with petroleum jelly) every time you change a diaper for the first day or two. Even after the dressing is no longer needed, put a dab of petroleum jelly on the penis or on the front of the diaper for 3 to 5 days. This can help your baby avoid pain from rubbing and sticking to the diaper.

Most of the time it takes between 7 to 10 days for a penis to heal. At first the tip of the penis may appear slightly swollen and red and you may notice a small amount of blood on the diaper. You may also notice a slight yellow discharge or crust after a couple of days. This is a normal part of healing.

If you notice any of the following problems, call your doctor right away:

• Bleeding that is not stopping
• More than a quarter-size amount of blood on the diaper
• Redness getting worse or not going away after 7 to 10 days
• Fever
• Other signs of infection, such as swelling or discharge getting worse, or pus-filled blisters
• Not peeing normally within 12 hours after the circumcision

However, with quick intervention, almost all circumcision-related problems are easily treated.

caring for an uncircumcised penis

In the first several years your son's foreskin will separate from the tip of the penis. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months or years. Once this happens, the foreskin can be pulled back away from the tip of the penis. This is called foreskin retraction.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding and tears in the skin.

smegma

When the foreskin separates from the head of the penis, skin cells are shed. These skin cells may look like white, pearl-like lumps under the foreskin. These are called smegma. Smegma is normal and nothing to worry about.

cleaning

If your son's foreskin separates before he reaches puberty, an occasional retraction with cleansing beneath will do. Once your son starts puberty, he should clean beneath his foreskin as part of his daily routine, just like washing his hair and brushing his teeth. Teach your son to clean his foreskin in the following way:
Step 1: Gently pull the foreskin back away from the end of the penis.

Step 2: Rinse underneath the foreskin with soap and warm water.

Step 3: Pull the foreskin back over the penis care for an uncircumcised penis

re-circumcision

When a child is circumcised, sometimes extra skin from the penis attaches to the head of the penis and attaches itself. This can occur because too much skin was left behind during the original circumcision (incomplete circumcision/extra foreskin). The extra skin can also be uneven with more skin on one side versus the other side. Often, a redo is done because the extra skin may lead to irritation or infection. Fortunately, this is a very minor surgery and correcting the circumcision does not take a long time.

same day circumcision

Our pediatric urologists perform same-day circumcisions for patients in the clinic.  Ask your provider if your child is a good fit for the same-day clinic circumcision program. 

questions or concerns? 

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