Pediatric circumcision

What is a pediatric circumcision?

A circumcision is a surgical procedure used to remove the normal foreskin covering the head of the penis. The current position of the American Academy of Pediatrics is that the benefits of circumcision outweigh the potential risks and this makes it a reasonable procedure to perform when desired by parents.

What are the benefits of a pediatric circumcision?

Benefits include a decreased rate of urinary tract infections, possibly decreased rates of penile cancer and decreased transmission of certain sexually transmitted diseases (STI), including HIV.

What are the risks of a pediatric circumcision?

Risks of the surgery include:

• Bleeding

• Infection

• Injury to the penis or urethra

What can I expect with a pediatric circumcision?

A variety of methods are available to perform a circumcision and your surgeon will describe the method they use.

• Local anesthetic - Children less than 12 weeks of age and/or less than 13 lbs. can have their circumcision completed in clinic. A local anesthetic is used, the foreskin is removed, and typically a bandage is applied (rarely a need for sutures occurs).

• General anesthesia - In children over 6 months of age, the procedure is done with general anesthesia in the operating room, the foreskin is removed and a series of sutures is used to reattach the shaft skin. 

Appearance after a pediatric circumcision

During the first few weeks after a circumcision, the penis may look very swollen and raw. This is the normal response of these tissues (areas of skin) to surgery. It looks much worse than it feels, and boys are usually very comfortable.

There may be bruising around the head of the penis and at the base where the nerve block (numbing medication) was placed. Many parents ask about the red or purple appearance of the head of the penis after circumcision.

This is quite normal as the skin is very thin and has a very good blood supply. There may be some crusting/scab formation as the penis heals. If the skin of the shaft of the penis swells and covers the head of the penis, it can be pushed back gently by pressing on the skin around the base of the penis.

Pain control after a pediatric circumcision

You will need to purchase acetaminophen (Tylenol®) to have available when you take your son home. All boys are given acetaminophen (Tylenol) in our clinic prior to the start of the procedure.

The nurses will give you instructions on his next dose and time. You can continue this for up to 48 hours as needed. After that, most boys are very comfortable or may only require an occasional dose of Tylenol. Children under the age of 6 months CANNOT have Motrin (Ibuprofen).

Things to watch for after a pediatric circumcision

After the circumcision, the penis will be red, irritated, and swollen for several days. Infection is very rare but would appear as increasing redness that spreads to the base of the penis and scrotum. It could also present as drainage from the incision.

• If you are worried about an infection, please call our office.

• If you child has a temperature over 100.4F, please take you child to the pediatrician’s office to be examined.

Prior to leaving, the nurse will check for bleeding.

• If there is bleeding at home, larger than a quarter size in his diaper, or if there are drops of blood coming from his penis, snug up the diaper and with the hand between the legs to apply gentle pressure with the palm of the hand to the penis against the abdomen for 15-20 minutes and cuddle. This should help stop the bleeding.

• If the bleeding does not stop, please continue applying pressure and call the clinic or our on-call number for emergencies.

Penile adhesions/secondary phimosis can occur, but rarely. The remaining foreskin will get swollen and possibly cover the head of the penis. Push down this skin and apply Vaseline® for 2-3 weeks with every diaper change. If you cannot push down his skin, call us!

Follow-up after a pediatric circumcision

In most cases follow-up is not needed. If you have any questions about how your child’s penis is healing, please call us, we may need to set up an appointment. If it seems to be healing well, there is no need to arrange a follow-up appointment.

Contacting the office after a pediatric circumcision

If you have general questions about your son’s circumcision, please call our office nurse line. If you reach a voicemail, be sure to leave a number(s) where you may be contacted. Your call will be returned within one business day.

• For urgent calls, such as excessive bleeding: During clinic business hours, please call our nurse line. Please do not leave a voicemail for urgent calls.

• Before or after business hours please contact the Emergency on-call number provided at your appointment.