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Aftercare Instructions
After the Bris, your son will need time to heal and recover from his circumcision. It's very important to follow these instructions so that he heals correctly and comfortably, and to minimize the risk of infection. During the first few days, your main goal is to keep the area as clean as possible until it completely heals.
In the unlikely case of bleeding, apply firm direct pressure using a sterile gauze to any area of continued oozing of blood for a period of 10-15 minutes. Do NOT examine the wound while applying the pressure. In the extremely unlikely situation that you find a diaper that is not stained but soaked with blood, go immediately to the closest emergency room, or call 911. Call me as well in this situation.
- There is a strip of Vaseline gauze surrounding the penis. Leave this in place until it falls off. It may come off with the next diaper change, or it may stay in place until the next day. If it is still there after 48 hours, gently remove it.
- Wash the genitals gently after each large bowel movement, using either a soft cotton cloth, cotton balls, or a sponge with a few drops of non-detergent soap in warm water, rinse, then gently dry. It is absolutely OK to wet and touch the penis. Do NOT use alcohol-based wipes on the circumcision wound but water wipes are okay!
- Apply a grape-sized amount of Vaseline ointment to the center of a sterile gauze, and then gently place it onto the penis for a total of ten days of care. Replace it with each diaper change The penis may remain in any position and your baby may sleep on his back or side. Do NOT tie anything around the penis!
- If the gauze sticks to the penis, simply soak your baby's bottom in a basin of warm water. Your baby may be fully bathed 10 days after the circumcision, if the cord is off; i.e., when you have finished with the 10 days of dressing changes you may bathe your baby.
- Be alert to signs of infection, such as increases in redness, pain or swelling. Your baby may be irritable for 3-4 days and will heal in 12-14 days with residual swelling up to three weeks after the circumcision.
- If your baby is irritable you may give him an additional dose of Infant Tylenol four hours after the circumcision.
- Please feel free to call me at any time with further questions or problems, and try not to worry - your baby will heal just fine!
After the First Day
One to two days following the circumcision there may be an off white or yellowish, patchy appearance of the head of the penis (also called the glans) or just below it. These patches are a type of scab and are associated with normal healing. The glans may also appear to be deep red or purplish and have a shiny or glossy appearance. The rim of the head of the penis (also called the corona) will eventually have a deeper purplish or reddish color than the rest of the head.
Retracting the Foreskin
The penis has a base and a tip (head) at the end. The foreskin is the skin that covered the head and was mostly removed in the circumcision. The head of the penis has a ridge all the way around between it and the shaft. When the circumcision has healed properly, the entire ridge of the penis will be exposed.
After the circumcision, the remaining foreskin may stick to the head of the penis. This isn't usually a problem, but sometimes a procedure is needed to detach the stuck foreskin. You can help prevent adhesions from forming by retracting (pulling back) the foreskin so the ridge between the head of the penis and the base (shaft) is seen. Be sure to wait 5 days before beginning this process.
- If the foreskin is covering any part of the head, gently pull it back until you see the ridge all the way around.
- Apply petroleum jelly liberally to the tip, upper shaft and any raw/healing areas. Do this with every diaper change.
- If the penis is hidden by the fat pad (layer of fat at the base) push down on it to help expose the penis.
- Stop doing retractions and applying petroleum jelly after about 6 weeks.
After the First Week
The yellow crusting and glossiness typically resolve after a week or two. Until that time the Vaseline and gauze should continue with diaper changes. Pediatricians typically recommend that babies be sponge bathed until the umbilical cord falls off. This typically occurs at about 2 weeks of age but may be after only one week or as late as one month. Once the cord is off and the penis doesn't have the yellow crusting or the red glossy appearance, you may immerse your baby to bathe him. Until that time, be sure to clean off any stool that may have deposited on the penis.