Despite how commonly it is performed, understand that newborn circumcision is surgery and thus has inherent risks, including infection. Any time foreign matter or objects come in contact with the penis before it heals, there is a risk of infection. Further, improper diapering can be very uncomfortable for the recently circumcised child. After circumcision, it’s important to take particular care when diapering your baby and follow the step-by-step guide from your urologist. Here are some common tips on how to diaper your baby, but bear in mind that your doctor may have other instructions particular to your child’s needs.

Prepare the Area:

• Before you get started, wash your hands thoroughly. An anti-bacterial soap is not necessary. Just be sure to wash your hands well, including under your nails.
• Keep all your supplies at hand, including a clean diaper, warm water, baby soap, a washcloth, petroleum jelly, and gauze.

Gently Clean Your Baby:

• Gently wipe the genital area with a soft washcloth dipped in warm water and a little baby soap. This will remove urine and feces from the circumcision area.
• Dry the area with a second, clean washcloth. Pat the area dry, don’t rub.
• Do not use wipes containing alcohol or fragrance, as these can irritate the skin and cause significant pain.

Apply Petroleum Jelly:

• If indicated by your provider, apply a good amount of petroleum jelly (Aquaphor, Vaseline, etc.) to the inside of the diaper and/or on a piece of sterile gauze. This prevents the wound from sticking to the diaper, which can cause pain and slow the healing process.
• Your doctor may provide instructions on applying petroleum jelly directly to the penis.

Sterile Gauze (if recommended):

• If your healthcare provider recommends using sterile gauze, place it gently over the circumcision area to protect it. The gauze might also be pre-treated with petroleum jelly.
• Always use clean, sterile gauze as directed.

Secure the Diaper:

• Whenever you change the diaper, check the circumcision site for any signs of infection, like excessive redness, swelling, foul-smelling discharge, or persistent bleeding. If you notice any of these, contact your pediatrician right away.
• Always use a fresh diaper, even if the old one looks clean.
• Fasten the diaper loosely – securely enough to not slip off but still allow air to flow to the area.

Follow-Up Care and Appointments

• Avoid submerging the child’s body in water for the first 24 to 48 hours after the circumcision. Sponge or washcloth bathing is acceptable. After the second day, a normal routine
• Changing your baby’s diaper often throughout the day is good practice to prevent infections and ensure the circumcision area remains clean. This is especially important for the first few days after circumcision.
• Keep any follow-up appointments with your pediatrician or urologist to ensure the circumcision is healing properly.

The Bottom Line

Remember that circumcision is a surgical procedure and requires proper care, even with something as simple as a diaper. Diapering your child the right way can speed up recovery and avoid pain and discomfort for your child. For any other questions, please contact your TNCC circumcision specialist.

While we always look to educate parents about the benefits and risks of circumcision, we encounter plenty of parents who have performed extra research on whether they should have their newborn circumcised. On the one hand, doing this research uncovers many opinions and experiences. On the other, there is plenty of misinformation floating around that should not factor into such an important decision. One of the more hotly debated topics involving circumcision revolves around penile sensitivity and, ultimately, sexual enjoyment later in life. There are conflicting opinions and even studies about whether removing the foreskin affects the individual’s ability to enjoy sex or sexual activity later in life. These studies have tried to compare sensitivity and pleasure between those who have and those who haven’t had a circumcision.

Quality Studies Show Little to No Difference

While it is highly subjective and challenging to measure someone’s relative sensitivity and pleasure during sexual relations, many studies over the years have tried to give us the answer. Most high-quality studies have shown that most of the sexual sensation men experience comes from the glands (or head) as well as the underside of the penis. In other words, the foreskin itself, while containing nerve endings, does not strongly factor into a pleasurable sexual experience.

On the other hand, less rigorous studies have shown that circumcision may reduce sensation during sexual relations in the future. Of course, as part of our jobs, it is incumbent upon any pediatric urologist performing newborn circumcisions to understand this topic and formulate their own opinions. Based on the data and the quality of studies that we have, we believe that a well-performed newborn circumcision does not appreciably change penile sensation later in life.

What About Surgical Injury?

With that said, however, injury to the penis, while rare, can indeed change feeling and sensation. Improper clamp placement and surgical technique, amongst other concerns, can cause problems. And this is where one of the most critical decisions will be made – who will perform the procedure? Ultimately, while circumcision is a relatively straightforward procedure that can be performed in different settings and by various medical and even nonmedical practitioners, it’s essential to choose an experienced pediatric urologic surgeon to ensure the highest level of training. Each of the pediatric urologic surgeons at The Newborn Circumcision Center is fellowship-trained and board-certified, adhering to the very highest standards of medical care.

To learn more and speak to our staff members about the circumcision process and to schedule a consultation with one of our urologists, we encourage you to call our office at (678) 208-6288 or take our newborn circumcision questionnaire to request an appointment and learn more. To give yourself the appropriate amount of time, feel free to give us a call several weeks in advance of the due date, or even as soon as you find out the sex of your child, you find out you’re having a boy. We will be happy to have an honest conversation about the pros and cons of circumcision to help you make the right decision for yourself and your family.

A vitamin K shot shortly after birth in newborns has become commonplace to prevent a serious condition known as vitamin K deficiency bleeding or VKDB. Though rare, VKDB can be devastating, causing significant and life-threatening bleeding. When the bleeding occurs in the brain, the child’s life may be at risk, and the possibility of longer-term health problems and neurological deficits increases dramatically.

VKDB can be classified into early, which occurs within the first week after birth, and late, which presents between 2 and 12 weeks after birth. The late form of VKDB is typically more severe as this is when the bleeding is most likely to occur in the brain. VKDB can occur in children up to six months of age, but this is very rare.

The Details of Vitamin K in Newborns

Vitamin K is crucial to forming blood clots, which in turn stops bleeding. Prothrombin, the protein that promotes clotting, and three other pro-clotting proteins depend on vitamin K. As an aside, Vitamin K also plays a significant role in producing healthy bone tissue, but this is less of a concern during the neonatal phase.

Newly born children have naturally low vitamin K levels stored in the liver because this nutrient does not cross the placental barrier as easily as other vitamins and minerals. Further, unlike adults, the neonatal gut does not have the appropriate function to produce or absorb vitamin K reliably until six months old. Lastly, breast milk is naturally very low in vitamin K, so babies that are breastfed or formula-fed may have a higher risk of vitamin K deficiency.

This combination of factors means it will take some time after birth for the child to build up vitamin K levels—this does not happen reliably until the child is six months old.

Are Vitamin K Shots Safe?

Vitamin K shots have been shown to be very safe and, as such, are a standard course of action in newborn care. As with any childcare decision, parents have the right to refuse a vitamin K shot or give their child oral vitamin K.

Vitamin K and Newborn Circumcision

Newborn circumcision is performed within the first ten days of the child’s life and often within the first 48 hours. As such, newborns who have not received their vitamin K shot are at a higher risk of bleeding during this time. Any surgical procedure or puncture of the skin will have a higher risk of uncontrolled bleeding and potentially cause devastating effects for the child. As a result, the newborn circumcision center does not perform circumcisions on babies without their vitamin K shot.

What About Oral Vitamin K?

Orally administered vitamin K has been studied and is significantly less effective against VKDB. Even after three oral vitamin K doses, research shows a ten times greater risk of bleeding versus just one vitamin K shot. This is because the infant’s intestines cannot reliably absorb vitamin K until the child is about six months old.

Learn more about newborn circumcision by scheduling an appointment with one of our newborn circumcision experts.

At first glance, the idea of removing the foreskin from a baby’s penis soon after they are born can seem incredibly painful. Some cultural and religious customs require it, but for most other patients, circumcision of their newborn is an elective procedure that has benefits but also concerns that parents should address with their pediatric urologic surgeon and circumcision specialist.

One of the most common questions we are asked, and rightly so, is whether the infant feels pain during circumcision:

The short answer, of course, is that any time skin or tissue is removed, there is nerve involvement, which will cause discomfort or pain if no anesthetic is used. That said, circumcision is not as painful as it might seem, mainly because of the speed of the procedure and the resilience of infants during this time. Any discomfort may be exacerbated by a fussy infant – a very normal occurrence as they get used to life outside the womb. Further, just like older patients, babies will have different tolerances for pain, and some may even let out what seems to be a painful scream simply because they are being handled by someone other than their mother or are uncomfortable for different reasons.

Pain Management

Most importantly, speak to your circumcision specialist about pain management. There is the option for the child to be administered a topical local anesthetic or an injected nerve block, both of which are very safe. This will improve discomfort dramatically and help your little one through the process. For the next few days, if you see your newborn having discomfort, your urologist will also give you guidance on administering Tylenol / acetaminophen to provide him with and come to make them more comfortable.

Post Circumcision Care

After the circumcision, how you care for the wound also makes a difference in how comfortable your child will be. Be vigilant about preparing the penis during diaper changes. Using plenty of petroleum jelly (Vaseline or Aquaphor) helps prevent the circumcised penis from sticking to the diaper and causing additional pain.

Proper bathing and hygiene habits like removing any fecal matter should it touch the newly circumcised penis can reduce the likelihood of infection.

Whenever handling a wound, be sure to wash your hands thoroughly to minimize the risk of passing on any bacteria.

The Bottom Line

Once you’ve decided on a circumcision, feel free to use us as a resource for questions, including allaying any fears about whether the circumcision will be painful for your child. While all children are different and have different pain and discomfort thresholds, newborn circumcision pain can be managed very effectively both during and after the procedure. Post-procedure care ensures that infection and other potentially painful postoperative complications are minimized or avoided.

Contact The Newborn Circumcision Center to learn more about your options.

As you have likely found in your research, circumcision is the surgical removal of the foreskin from the penis, but not all circumcisions are the same. Most commonly, circumcisions vary in how much of the foreskin is removed. This variability creates a decision some parents must make – between partial and complete circumcision – often when cultural or religious norms do not guide them. Both options are acceptable, but each has unique benefits and risks but with similar postoperative care.

Partial Circumcision

There is quite a bit of variability in what is considered a partial circumcision. However, the one constant is that only a portion of the foreskin is removed, meaning that some skin still covers the head of the penis, known as the glands. In any case, there is significantly less foreskin than before the procedure. Typically, the degree to which the foreskin is removed is a conversation between the urologist here at TNCC and the parents. Ultimately, the choice of how much foreskin to leave depends on parental preference and any medical limitations that may arise.

Partial circumcision is chosen for various reasons, but most often to walk a fine line between retaining some of the protective, aesthetic and sensory benefits of the foreskin while achieving some of the medical and hygienic benefits of a complete circumcision.

Benefits of a Partial Circumcision:

• Aesthetic:  Some parents opt for partial circumcision to maintain a specific appearance of the penis or to “match” the fsther’s circumcision.
• Cultural Preferences: Partial circumcision may adhere to some cultural practices.
• Possibly Recovery Benefits: By removing less foreskin, the procedure is somewhat less invasive, potentially leading to quicker recovery.

However, while partial circumcision may offer medical benefits, such as a reduced risk of urinary tract infections and a lower risk of sexually transmitted diseases, benefits may not be as predictable as with a complete circumcision. Partial circumcision also comes with a unique set of considerations, in addition to any circumcision’s risks, including:

• Uneven removal or healing of skin
• Removing too much or too little skin
• Fewer or less predictable protective effects than a complete circumcision

We do not believe the

Complete Circumcision

Complete circumcision is what most people think of when they consider a circumcision. This involves removing the entire foreskin, fully exposing the head of the penis. This is the more common form of circumcision for medical, cultural, and religious reasons. A complete circumcision is often recommended over a partial option for its more consistent medical benefits.

Benefits of Complete Circumcision

• Medical Benefits: Complete circumcisions reduce the risks of urinary tract infections, penile cancer, and transmission of some sexually transmitted diseases, including HIV and herpes.
• Hygiene: With the foreskin entirely removed, it can be easier to clean the penis, reducing the risk of infections and certain conditions like balanitis (inflammation of the glans).
• Cultural or Religious Norms: Often, complete circumcision is necessary to fulfill cultural or religious obligations and norms.

Choosing Between Partial and Complete Circumcision

Choosing between partial and complete circumcision should be based on discussions with the TNCC team and trusted medical providers, personal or family beliefs, and cultural practices. These discussions should not be rushed, and we suggest they are had well before the birth.

Considerations for Decision-Making

We can help you parse important information for your decision, including:

• Pre-operative needs and requirements
• Addressing any medical concerns or questions
• Post-operative benefits and risks
• Long-term benefits and possible consequences

Partial and complete circumcisions are both safe in the hands of a qualified and experienced circumcision specialist. However, partial circumcisions come with a relatively high rate of complications, so we do not perform them. The decision to circumcise should be made in consultation with your trusted medical professionals and aligned with your values, beliefs, and health goals.

When patients are not circumcised, the foreskin covers the entire glans, or head, of the penis. Usually, when pulling back on the foreskin, it should retract quickly, showing the entirety of the glans. This should be the case for both children and adults when the penis is in its flaccid or erect state. Phimosis is a condition in which the foreskin is tight, or the skin wraps tightly around the penile shaft, almost like a rubber band has been placed around it. In addition to potentially causing balanitis, an infection under the foreskin, phimosis can also be caused by balanitis and the swelling that often accompanies these infections.

What Are the Types of Phimosis?

There are essentially two types of phimosis, both of which are treated similarly but have slightly different presentations. Partial phimosis occurs when the foreskin retracts when the penis is flaccid but does not retract when the penis is erect. Complete phimosis means that the foreskin cannot be pulled back either in the flaccid or erect state.

The Different Grades of Phimosis

There are also five grades of phimosis, which help the urologist understand the severity of the disease and the best way to treat it:

• Grade 1 is a foreskin that can be retracted fully, but there is a ring of tissue squeezing on the penile shaft, much like having a rubber band around the penis.
• Grade 2 allows for partial retraction and, as such, partial exposure of the glans of the penis.
• Grade 3 is a lower level of partial retraction at which only the urethral opening or meatus is visible.
• Grade 4 does not allow any retraction of the foreskin.
• Grade 5 is any grade of phimosis with co-occurring balanitis.

What Are the Consequences of Phimosis, and Why Should It Be Treated?

In their young years, phimosis can cause several concerns. As you can imagine, a tight foreskin can be rather uncomfortable in mild circumstances and painful in others. Some of the common symptoms include:

• Dark red or blue glans or head of the penis
• Difficulty or pain when urinating
• Slowed urinary stream
• Pain when pulling back the foreskin
• Bulging of the foreskin when urinating
• Infections under the foreskin

Adults with this condition often present to a urologist for diagnosis and treatment. Adults will typically experience the widest variety of symptoms beyond discomfort as they will frequently experience sexual dysfunction as well – phimosis may cause:

• Pain during intercourse
• A lower level of enjoyment and sensation
• Premature ejaculation
• Recurrent infections or balanitis
• Less than ideal cosmesis

What Is Paraphimosis

Paraphimosis occurs when the foreskin is pulled back but becomes stuck behind the glans or head of the penis. Depending on the severity, this condition can put enough pressure behind the glands of the penis to impede blood flow which can cause swelling, pain, and tissue death. This is an emergency that needs immediate surgical care to relieve the pressure. Do not delay in getting the child/patient to an emergency room.

Does Newborn Circumcision Help?

Newborn circumcision, while an elective procedure, is the definitive preventative measure for phimosis. By removing the foreskin, there is, of course, no opportunity for phimosis or tightness in that region to occur. How this factors into a parent’s decision to circumcise their child is based on their personal beliefs and desires. However, it’s essential for us as medical professionals to offer all the benefits and risks of newborn circumcision.

While mild cases can often be treated with home care under the supervision of a qualified urologist, phimosis can worsen over time. Adolescents and adults with phimosis looking for treatment should speak to their pediatric or adult urologist to understand more about older child and adult circumcision, which is quite different from newborn circumcision.

For this and other questions about circumcision, please speak to your pediatric urologic surgeon or contact The Newborn Circumcision Center for more information and an appointment with one of our team.