What is circumcision?
How do I handle the circumcised penis in the newborn?
When should I even do the circumcision?Â
These are some of the questions that often create anxiety for first time mums of male newborns especially in this part of the world where circumcision is the rule rather than the exception. As usual, your Paediatricians are the best to ask even though we are not the one who routinely do the procedure!!
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In this post , Dr Rotimi Adesanya, a Family Physician – usually the gurus in doing many of the circumcisions address most of the concerns mums have about circumcision. This was the excerpt from our online Facebook group forum where the topic was extensively discussed. Read and be informed!
As always, you can #AskThePaediatricians via comments any questions you may have!
What is circumcision?
Circumcision is one of the world’s most widely-performed procedures. Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain tribes in Africa and other parts of the world.
Male circumcision is the surgical removal of the foreskin; the foreskin is opened and then separated from the glans after inspection.
Circumcision= circumfence + excision.
It is from Latin word circumcidere, meaning “to cut around” . We will focus more on the newborn and infants. Circumcision should not be performed without a qualified health professional and a sanitary environment.
It can be done in the theatre, in the consulting room or at home.
It is done by all categories of qualified health workers GP, Family Physician, Paediatricians, Obstetrician and Gynecologists, Surgeons, Midwives, Nurses and Community health extension workers (Chews).
Newborn circumcision is often done in the hospital nursery, usually 7- 8 days after birth.
Biblically, Leviticus 12:3 says, “On the eighth day, the flesh of (a male child’s) foreskin shall be circumcised.”
This is also supported by medical science, which notes that there is more vitamin K and prothrombin present in the blood by day 8, which means less pain, less bleeding, and a better healing process.
Based on my last explanation, It is not advisable to have routine newborn circumcision done before the baby is eight days old.
Health benefits of circumcision
Circumcision aids personal hygiene, as it makes it simpler to wash the penis.
Though the risk of urinary tract infection in males is low, it is more common in uncircumcised males. Circumcision therefore prevents urinary tract infection.
Prevention of sexually transmitted infections:Â Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV.
Prevention of penile problems:Â Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or the head of the penis.
Although cancer of the penis is rare, it is less common in circumcised men.
 The Circumcision Process
There are two main methods used in circumcision:Â Plastibell or the Traditional Surgical Methodogical support
The Plastibel Method
The picture below is what we call Plastibel.
The Plastibell comes in six sizes to fit over the glans of various baby boys’ penises at birth. The most common size used is 1.2cm in diameter, followed by 1.3cm. Larger sizes of 1.5 and 1.7cm are used infrequently.
- The doctor looks at your child penis and estimate the appropriate size.
- The fore skin is separated, a small cut is made and then the plastic is put on the glans and and tied.
- The foreskin is then cut and clean up.
- No gauze and no dressing is applied.
You just wear your baby diaper after the procedure!
The Traditional/Surgical Method
- It involves separation of the foreskin and cutting the extra flesh.
- In some cases, doctors need to put stitches to prevent bleeding.
- Thereafter, a dressing is placed on the glans.
- The dressing will be removed after some days unlike the plastibel which does not require dressing and falls on its own 3-5 days after the procedure.
Post Circumcision Care
- Pain relief: circumcision causes pain; and for newborns, this pain may interfere with mother-infant interaction or cause other behavioural changes. Paracetamol drops or syrup should be given twice daily for two to three days.
- Surgical type circumcision should be done under local anesthesia.
- For surgical circumcision, a light dressing such as gauze with petroleum jelly will have been placed over the head of the penis.
- The next time the baby urinates, this dressing usually will come off. Some pediatricians recommend keeping a clean dressing on until the penis is fully healed, while others advise leaving it off.
- The important thing is to keep the area as clean as possible. If particles of stool get on the penis, wipe it gently with soap and water during diaper changes.
- Please DO NOT APPLY Engine OIL! It is an hydrocarbon and can give the baby dermatitis! Pure olive oil can be used!
- For the plastibell method, you don’t need to do anything in terms of dressing or otherwise!
- The plastibell covers the raw area,take your baby bath normally.
- Just wait for the plastic to drop usually in 5 days but may take up to a week.
- Normal routine care of the baby – should be continued.
- Once the plastic drop, the circumcision is healed just bath the baby and the penis area normally.
- It’s OK to wash the penis as it heals. Once the penis heals, wash it with soap and water during normal bathing.
If you observe any of the following after circumcision, please go to the hospital
- Normal urination doesn’t resume within 12 hours of the circumcision
- There’s persistent bleeding
- There’s foul-smelling drainage from the tip of the penis
- The plastic ring remains in place one week after the circumcision.
Problems after circumcision are not common. Common complications
- The most common complications associated with circumcision are bleeding and infection.
- Circumcision may also result in foreskin problems, as the foreskin might be cut too short or too long.
- The foreskin might also fail to heal properly.
- When this happens, the remaining foreskin might re-attach to the end of the penis, requiring minor repair.
If you observe any of the following after circumcision, please go to the hospital
Circumcision cannot be performed on males with the following conditions:
- Abnormal penis including where the urethra (urinary) opening is not on the penis tip (hypospadias or epispadias)
- Chordee, or the downward curvature of the penis,
- Buried penis is a condition in which the penis is concealed because it is surrounded by fat in the pubic region
- Sick or unstable babies
- Bleeding disorders or a family history of such.
- Baby with severe neonatal jaundice.
Babies with the above conditions should be seen by the Specialist – Urologist before circumcision!
Hopefully for mums and dads reading, your questions as regards circumcision has been answered. Should you still need any clarifications or questions, feel free to ask in comments or email: ask@askthepaediatricians.com!
I like that you mentioned that cancer of the penis is less common in circumcised men. My wife and I are expecting to have a son in just a few months, and we were curious about circumcision. Thanks for the information–we’re definitely going to have it done when he is born.
Good to hear that Oscar. Thank you for reading!
After circumcision should I cleaning the penis with spirit or water. If yes where should the cleaning be?.
No! It depends on the method of circumcision your baby has and none requires cleaning with methylated spirit.
For plastibel, simply do nothing and the plastic will fall off and then bath like the rest of the body.
For traditional method, simply follow the instructions given by the surgeons usually apply the antibiotic cream if given one.
I never knew that no gauze or dressing is applied after the procedure. I think that is pretty amazing considering that you are dealing with extremely sensitive parts of the body. I want my boy to be as clean as possible so I’ll have to consider getting him circumcised.
Great idea Sam. For the plastibel method, nothing is applied and once the plastic drops, that is all!
Please am on the third day after my baby circumcision.the bandage around d penis,seems firm and has not fallen off.despite my application of penicillin and olive oil.what do I do
You may need to take the child back to the clinic where the circumcision was done so the health care workers can assist you further.
Thank you…. I went back and the bandage was removed and presently it has healed well and my baby is ok
Good to hear Joy! Well done!
dear Doctor,i just did my baby circumcision today “plastibell”,and every one as said use olive oil or petroleum jelly or penicillin which have done neither because i am a first time boy mum and scared dat i dont inflict infection on my child.i dont know if am doing the right thing.Also my son is 2weeks +2days old,i observe that when he pees,his penis all the time i have i seen it as never risen,just flat down,no erection when he wee. i told the doctor,they ask me to monitor until one month, like i said i am a first time boy mum,please help
You did not need to apply anything for plastibel circumcision….simply follow the instructions of your doctor. As regards erection, the kids do not need to have erection each time they pass urine. I think you should stop worrying. All the best
Dear Doctor, I am a first time boy mum also, my baby circumcision (plastic bell) was down yesterday and we were asked to use olive oil to clean d area at every diaper change and nothing more. Today, I noticed d area is whitish as if d area is infected, please what should I do? And how do I clean the area at every diaper change?
Really?? After the plastibel drops, you do not need to use anything to clean or rub on the area….you bath the area just same way you bath the rest of the baby’s body and apply the regular body cream or vaseline you use on the baby. There is no extra treatment required. I am not sure what is the whitish thing you are referring to or why it is ….you may want to show your doctor.
Ma, my baby is four months and the foreskin on his penis has re-attached, I took him back to the hospital and the doctor said is normal, but i don’t like the way it looks, pls what will i do?
Kindly take him to see a Paediatric Surgeon or Urologist for the revision of the circumscision. It can be fixed.
My son’s case is same…..the foreskin reattatch to one side of the penis after d circumcision and when I took him back to the hospital, the circumcision was repeated and when it healed again, same thing happened, d foreskin still reattach to one side of d penis. He’s growing with it now, 1yr8months old. Can I still take him to a pediatric surgeon or it’s late?
Kindly see a Paediatric surgeon or urologist for further management.
Good evening ma, my baby is a month plus and l did plastic bell circumcision is up 9days now but d ring hasn’t fall off what do l do,
That is a long time, go back to the hospital
Good evening doc. My son was circumcised on the eight day when the plastic bell fell in five days time I noticed the tip of the penis wasn’t straight so I told his doc he said it will straighten out with time and under d penis tip I noticed a tiny opening which pus like stuff occasionally came out from. So I felt maybe they injured him in the process and maybe repaired it. I recently saw a doc I showed him but there was no discharge according to him and he said not all penis tip is straight. That though they didn’t do a perfect job but its fine. Pls should I be worried? Baby is nine months old now and I’ve been keeping d place clean.
I think you can let a Paediatric surgeon or urologist have a look and advise you appropriately. The specialist is the best person to give a second opinion.
Hi Doc, thank you for this article.
You mentioned that we shouldn’t use engine oil after circumcision.
Please why not? And what are the dangers involved?
It is not appropriate and cause horrible complications including wounds. Follow your doctor’s advice as regards post circumcision care for the traditional form of circumcision
Good evening ma. My son is sixteen months old and he is not circumcised yet because his paediatrician asked us to wait until he is one year old, I want to know if plastibel can be done for him since he is sixteen months old now. Thank you
Hi Maureen. I am not sure the reason your paediatrician asked you to wait. I want to believe there must be a medical reason because we will usually not ask you to wait if there is no medical issues for example hypospadias. In such instance, it is better to see your paediatrician before doing the circumcision. He or she may want to refer you to a surgeon for the circumcision if there is a medical issue. This is very important that you see a specialist first before going ahead with the circumcision.
Good evening doctor.
I circumscribed my baby on Thursday, and till Saturday only some of the gauze has removed, some are still stuck under on the penis.I was told to apply olive oil and penicillin. But its still stuck.
What do I do..Thank you
You can take the child back to the hospital where the circumcision was done so they can sort it out for you! For answers requiring immediate or faster responses, please post on our Facebok Group wall.
Hi Doc please small stool entered the plastibel ring after circumcision. What do I do please. .
Just clean it out gently
My son’s circumcision has been done twice because the first time, it didn’t heal properly. Even the second time, it still doesn’t look neat. One can’t differentiate the ring and the cap from the body. It just doesn’t look neat. I would have loved to attach the pictures, but it’s not possible. I don’t know where it all went wrong. Is it possible to correct this error? I really need help. He’s two years old now. For the two times his circumcision was done, it took about two weeks each for the penis to heal. I feel like my son doesn’t heal fast. Please I need help. Who can I see to correct this? I want to make everything right now that he’s still little.
You should see the Paediatric surgeon or urologist for your baby’s circumcision; these are the experts and also the ones who can correct any error if still present.
That is not jedijedi. It is a sign of poor feeding – inadequate breastfeeding. All you need to do is to breastfeed your baby exclusively and on demand and ensure your baby empties one breast before switching to the next. Alternate the breasts when feeding.
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Hi Doc, pls can my baby be circumcised even without the navel falling off.
Yes as long as your doctor is happy to do it.
Hello Ma’am, my boy was circumcised 10 days after birth because he was being treated for jaundice. He’s 25 days old & the site is healed. Am worried when he pees,the urine flows sideways instead of flowing straight. The penis hole is on the tip of the penis but it pointing sideways. I noticed the plastic ring was tied by the side during circumcision. Could that be the cause? Is it normal? Can it be redone so that the urine flows straight? Help a worried mom.
Thanks as I await your response.
This has nothing to do with the circumcision. You should take the baby to see a Paediatric surgeon for further evaluation and advice. Was the baby passing straight urine before the circumcision?
Good evening ma, my baby is a month plus and l did plastic bell circumcision is up 9days now but d ring hasn’t fall off what do l do,
That is a long time, you need to go back to the hospital where the procedure was done. It is most likely they use a wrong size one and may need to take it out by themselves