Tuesday, February 23, 2010

The Most Common Issues After the Bris

There have been a number of times when I have been called to a home where the baby of the house is six months, ten months, even a year old or more. The little guy was circumcised when he was eight days old, but now he does not look circumcised.

And most of the time I was not the mohel - the family heard about me and did not want to bring their mohel back to look at it. (There have been cases where I have been called back when I was the mohel - I trust and hope it is because people feel comfortable contacting me, knowing the care I put into each baby's bris.)

Usually the issue only became apparent in the last few months. "At first it was fine. But lately, we've been having this issue."

Mind you, this happens with circumcisions done by doctors and mohels alike, and is usually due to the parent being unaware that this may happen, more than any oversight in the circumcision or a less than adequate job.

99.8% of the time the bris is fine and no touch-up surgery is required. However, there is something that does need to be done that will bother your baby in the minute it takes to do it, but does not have a healing process and will not cause any bleeding.

Again, this can usully be avoided with proper education.

Because a baby spends so much time on his back, and because his diaper smushes his penis together, and because many babies develop baby fat which is primarily deposited in the groin area, a percentage of babies develop one of a few symptoms that either A. make the shaft and glans of the penis disappear into the scrotum, or B. make it that you can't see the outer rim of the glans, which should appear distinct from the shaft.

If the bris is done correctly, what you should see is described in the second half of this post.

How to Keep it That Way

After the baby heals - say, about a week after the cessation of any ointment application, it is imperative that you make sure the outer edge of the glans remains distinct from the shaft.

All this requires is a gentle pushing of the skin below the glans at every diaper change - and particularly when the baby is in the bath.

Do not do this for at least a week after the actual bris, because any pressure on the penis during the first week of healing could reopen a wound and cause bleeding.

Sometimes not an issue at all

With some babies and with some circumcisions this is never an issue.

With others, no matter how the circumcision is performed, this can be an issue which, if unmonitored, can continue to cause concern for two years of the baby's life. In all this time, the baby is fine! But you, the parent, want to know why things look the way they do, and really want to understand what you are seeing.

Be on top of it, take charge, know what you are looking at and what you need to see. When you are in the know, you will know how to handle the situation such that the asthetic looks of the circumcision will never be a cause for alarm.

Disappearing penis

While less common than the "almost uncircumcised" look, the disappearing penis is essentially when the shaft and glans disappears into the scrotum when the baby is lying on his back. A gentle push on the 3 o'clock and 9 o'clock sides of the scrotum surrounding the shaft - or on the belly just above the "dark hole" will usually cause the shaft to pop out of its hiding place.

What can you do about it?

Firstly - follow above instructions to avoid it happening.

Secondly - if it's too late and the shaft disappears, there are two options.

A. Continue as above every time the diaper is open. Either it will clear up on its own through this counter-attack, or it will clear up on its own when the baby is walking - and particularly when he is out of diapers. Remember, the more time he spends on his back and the more baby fat he accumulates in his legs will both contribute to the disappearing penis look.

B. If it does not go away, corrective surgery is extremely effective. In most cases, however, you will not have to go this route. Consult with an honest pediatric surgeon who does not jump to do unnecessary surgeries, and you will get an honest opinion. Usually it is "wait it out. It will be fine."

Any questions - feel free to call me or email me.

[I am not looking to cause alarm - merely to educate about what is out there. I firmly believe that with proper monitoring, a properly done circumcision will look and turn out absolutely fine. Before you look at the following links, remember these cases are relatively uncommon. Nonetheless they are not so rare as for you to be unaware...
See more on this subject here and here...]

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