Thank God, most brisses I do look pretty nice after the bandage comes off. Even when there is some swelling and things don't look "amazing" immediately, time usually corrects things and within a week or two swelling goes down and the look "fills in" and "evens out."
In some cases, a few months down the road I'll get either a phone call, email, or chance encounter when the question of "why is his penis disappearing into the shaft?" comes up.
I've blogged about this before. Suffice it to say, my initial reaction is always, "Does your baby have a lot of baby fat?" 100% of the time the answer is, "Yes! His legs are nice big pulkies" (or some similar euphemism for 'quite large').
THIS is the reason behind the "look" which was not apparent when I finished with my care of the baby post bris. With the exception of some newborns who are born larger, most newborns are born between 6-8 pounds, perfectly apportioned with no significant baby fat.
But once they've been around for 2-6 months, and their bodies have discovered food, it deposits most of the baby fat quite significantly into the legs and groin area. Compound that with the constriction of the diaper, plus a lot of time on the back, and a chubby baby may very well have a tip of the penis (the glans) finding itself squashed with nowhere to go but to sink into the shaft, or, worse, to have the skin of the shaft climb up and adhere itself to the rim of the glans giving the penis a partially circumcised look. Parents will understandably be concerned.
This is why I try to remind everyone of what "may" happen in the event your baby becomes chubby.[Of course, some people never experience this at all.] Therefore - nip it in the bud! Be vigilant! Make sure the glans is always separate and distinct every time you open your baby's diaper. Sometimes the diaper is as much at fault as the baby fat. Neither of these are a "fault," per se, as both are really par for the course. But if parents are aware and know to keep the glans separate from the shaft, most of these "problems" will never come up.
Call if you have a question. I am always happy to come and take a look to tell you what you are seeing. And remember it is better to call earlier, when baby is 2-3 months old, than later, such as from 6-12 months old. In either case you can be shown what to do to train the skin the right direction. But the more it drags on, the more uncomfortable it can be for the baby.
Showing posts with label disappearing penis. Show all posts
Showing posts with label disappearing penis. Show all posts
Sunday, September 2, 2012
Monday, August 8, 2011
The Fusion Challenge
This is a topic which seems to come up every now and then, but since I've dealt with it twice in the past week, I write about it again. [Here is the original posting on this subject]
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
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...]
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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