Physician Contributor
April 24, 2021
In the US, many thousands of neonatal (routine) circumcisions are performed every year and the vast majority (99.6%) are performed without complication. Odds are good that you will not have a problem with your son's circumcision if it is done by a trained medical provider. Odds are also good that your son will not have a problem with his circumcision as he grows up. It is still good to know what can go wrong and how to address it if it happens.
The most important piece of medical advice that I can give is that parents should follow the instructions of your baby's medical provider. Not every provider will give the same advice after circumcision but there are a few basics. First is that you have to know what is urgent and what is non-urgent. Bleeding, failure to urinate, signs of infection (redness/swelling/pus) are urgent problems which need medical attention right away. A little tenderness with diaper changes is normal but severe pain or a severely irritable baby is not. A couple small dots or spots of blood on the initial dressing or on the diaper with the initial urinations are normal but active bleeding is not normal. Healing tissues (wet scabs) can look yellowish and kind of gross but they are normal. Severe redness, or swelling, or actual draining pus are all not normal. When in doubt, contact the provider who performed the procedure. It is always a good idea to know how to access the emergency contact number for circumcision providers because though rare emergencies do occur!
The first and scariest urgent problem with circumcision is hemorrhage after the procedure. Active bleeding, oozing, or blood clots at the site of the circumcision or filling up the diaper requires immediate attention! Parents should immediately contact the provider who performed the circumcision or head straight to an emergency room. Severe bleeding can usually be stopped temporarily with local pressure directly on the site of bleeding. This works with many circumcisions but may not after "Plasti-Bell" type circumcisions where the bleeding may be under a plastic ring. Holding pressure can be a very short-term fix until you get medical treatment for your baby. Bleeding can usually be stopped pretty easily in an emergency room but sometimes it requires a specialist such as a (pediatric) surgeon or urologist. In rare and unfortunate cases severe bleeding after circumcision is how we first diagnose a bleeding disorder in a young male.
Another urgent complication after circumcision is infection. Severe infection after neonatal circumcision is rare. The high vascularity of the tissues provides for rapid healing and usually the prevention of infection -- even inside of a relatively dirty diaper! Some circumcision providers have parents apply prophylactic antibiotic ointments after circumcision and some don't. Antibiotic ointments might (but do not always) prevent infection short term but they can also sometimes cause nasty allergic reactions in the diaper area so they are debatable in their usefulness. Excessive redness or swelling of the penis especially if it spreading out from the circumcision site down the penis or onto the body is very worrisome and needs immediate evaluation by a pediatric or surgical provider. Neonates don't do all that well at containing bacterial infections in one location so local skin infections can turn into blood infections which may spread to other organs. Any fever after circumcision in the neonatal period (especially in first 28 days of life) is a crisis that needs emergency evaluation.
Other urgencies after circumcision are pretty rare. If a baby does not urinate normally after circumcision that could mean there was a severe complication that obstructed or damaged the urethra. This should be something that is exceedingly rare but would need very urgent medical evaluation. With Plasti-Bell circumcisions the head of the penis can sometimes slip through the plastic ring, get trapped and swell. This does not usually cause immediate severe injury or blockage of urination. It does need to be addressed with the circumcision provider somewhat urgently since it will remain in that penis-constricting position until someone figures out the best way to remove it.
There are a number of non-urgent complications from circumcision and rather than go into all of them I recommend reading this comprehensive list of urgent and non-urgent (common and rare) circumcision complications at Stanford's Newborn medicine website:
As a provider who has performed too many circumcisions to count in a long career, I have seen most of the things that can go wrong. Fortunately severe problems are very uncommon. Unfortunately, no one is happy when there is any complication no matter how small. Parents should be very proactive about making sure that their baby gets good medical care and a part of that is demanding good "informed consent" prior to circumcision. If a circumcision provider is not willing so spend some time with a parent talking about the procedure, it's risks and benefits, and what to do if a problem occurs then I wouldn't let them preform the procedure on my own baby.
Many anti-circumcision folks try to scare parents into choosing to forgo neonatal circumcision (while they harass providers who perform circumcisions or parents who choose circumcision). I think it is fine for any parent to choose or refuse circumcision for their son but I hope they base that decision on facts not on nonsense. Facilitating that knowledge is always my goal when I write for circumcisionchoice.com.
