Circumcision Patient Education Handout - AALFA …...4465 White Bear Parkway White Bear Lake, MN 55110 651.653.0062 Fax: 651.653.0288 © Pfenninger and Fowler’s Procedures for Primary

4465 White Bear Parkway

White Bear Lake, MN 55110 651.653.0062 Fax: 651.653.0288

© Pfenninger and Fowler’s Procedures for Primary Care, 2nd Edition, p. 1989-1990. Copyright © 2003, Mosby, Inc. All rights reserved. AALFA Laboratory Procedure, Process and Safety Manual Given to Patient at 36wks Printed:

Circumcision Patient Education Handout

What is Circumcision?

Circumcision is the surgical removal of the portion of the foreskin that normally covers the tip of the penis. It usually takes 5 to 10 minutes. The infant does experience some pain during the operation, but a simple nerve block can minimize this pain. Healing takes 5 to 7 days.

Is Circumcision Necessary?

Although circumcision is commonly performed on male infants in the United States, it is an entirely elective procedure. There is no law or requirement that a baby boy must be circumcised. Parents must carefully consider the risks and benefits before deciding to have their baby circumcised. The American Academy of Pediatrics (AAP) issued a statement in 1999 concluding that there is existing scientific evidence demonstrating potential medical benefits of newborn male circumcision. However, the AAP determined that the data is insufficient to recommend routine neonatal circumcision.

The existing scientific evidence of potential medical benefits includes the fact that circumcision can decrease the chance of getting cancer of the penis. There is also some evidence that the risk of urinary tract infections and some sexually transmitted diseases may be lower in circumcised males. Their partners may also have a lower risk of abnormal Pap smears, but more research is needed in this area before a recommendation can be made.

If my son is not circumcised, how will I care for my son’s penis?

In the first few months, your baby’s uncircumcised penis is simply cleaned and bathed with soap and water like the rest of the diaper area. Initially, the foreskin is connected to the glans (head) of the penis, so do not try to pull back the foreskin. It is not necessary to cleanse the penis with Q-Tips or antiseptics, but watch your baby urinate occasionally to make sure that the hole in the foreskin is large enough to permit a normal urine stream. If the stream is consistently no more that a trickle or if your baby seems to have some discomfort while urinating, consult his clinician. The American Academy of Pediatrics (1-847-434-4000, or www.aap.org) has a helpful brochure in taking care of a baby with an uncircumcised penis.

Your clinician will tell you when the foreskin has separated and can be retracted safely. This will not be for several years. After this separation occurs, retract the foreskin occasionally to cleanse the tip of the penis underneath. Once your son is bathing himself, you will need to teach him how to do this himself.

Are there times when an infant should not be circumcised?

Circumcision should not be performed if there is any abnormality of the penis. This is especially true when the urinary opening is at some point on the penis other than the tip. The tissue of the foreskin is often used for surgical correction of penile defects. Removing the foreskin could make such a repair much more difficult or even impossible. If there is a family history of bleeding problems, circumcision should not be performed until laboratory tests show that the baby’s blood clotting is normal.




NEWBORN CIRCUMCISION-cont’d

What are the risks of Circumcision?

Overall, complications from circumcision are rare. As with any surgical procedure, bleeding and infection are possible. On rare occasions, damage to the tip or shaft of the penis may occur.

When is circumcision done?

Newborn circumcision is usually performed a day or two after delivery and must be performed before 6 to 8 weeks of age, depending on your clinician’s preference and the condition of the baby. If the baby is ill in any way, circumcision is delayed until he is well. Note that some insurance plans will cover circumcision if it is performed on a newborn, but they will not cover it once the baby has been released from the hospital. Others will not cover circumcision for babies over 8 weeks of age.

What does the penis look like after circumcision?

After circumcision, the tip of the penis is red and moist, and it often becomes covered with a yellowish mucus-like substance. This is part of the normal process of healing and may last for a week. Petroleum jelly gauze is applied to the penis to prevent it from sticking to the diaper. This gauze is removed when it becomes soiled.

Is there anything special that should be done after we go home?

Acetaminophen (1.25ml of infant drops 160mg/5ml) may be given for any apparent pain or irritability. Rarely is any pain medicine needed beyond 24 hours.

Take care to keep the circumcision area as clean as possible. Use a soft wash cloth and warm water for cleaning. (Diaper wipes may irritate the healing area.) At each diaper change for the first week, gently pull back the penile shaft skin and apply petroleum jelly to the groove between the back of the tip of the penis and the shaft skin. Also apply petroleum jelly to the front of the diaper until healing is complete to prevent the penis from sticking to the diaper.

If your doctor used the Plastibell technique, you do not need to use Petroleum Jelly. The Plastibell protects the penis tip. The foreskin remaining beyond the string will turn black, dry out and fall off along with the Plastibell within 1 week.

Very rarely, a narrowing of the urinary opening will occur. The opening may begin to look like a pinhole, and the urinary stream will become very strong and may squirt out at an angle. This rarely occurs before age 1 year. It can be corrected in the office, so tell your clinician if you find that this narrowing has developed.

A website that may be of interest

www.aap.org/visit/circumcision.htm (circumcision information)

If you have any further questions regarding circumcision or anything related to the procedure, please discuss them with your clinician. This is a decision which you, the parent, should discuss completely before deciding to have the procedure done.




Preparing for your infant son’s circumcision:

1. Make sure your baby is well fed before the appointment time.

2. Give 1.25ml of infant Tylenol™ drops.

3. Bring along a light blanket to swaddle him during the circumcision.

Documents

Circumcision Patient Education Handout - AALFA …...4465 White Bear Parkway White Bear Lake, MN 55110 651.653.0062 Fax: 651.653.0288 © Pfenninger and Fowler’s Procedures for Primary