Newborn infant boys who have been circumcised require management of the circumcision wound. For the first two to three days, gauze with petroleum jelly (Vaseline) should be applied directly to the entire surface of the penis. After this, for the next three to four days Vaseline alone should be applied to prevent the wound from adhering to the diaper. Any excessive bleeding, abnormal redness or discharge of pus from the penis should prompt an office visit. Please know that a yellow scab appears on the penis after circumcision for a few days. This is normal.
Older circumcised boys will often get irritation and redness at the urethral meatus which is the opening of the urethra (the small hole at the end of the penis) called meatitis. You should treat this with Neosporin antibiotic ointment applied several times per day. Chronic meatitis (redness and irritation of the penis opening) can cause the opening of the penis to be scarred and too small, a condition called meatal stenosis. Severe meatal stenosis requires referral to Urology for a procedure to reopen the urethral meatus.
Another problem with circumcised boys is adhesion of the skin to the head of the penis at the area of the circumcision. This can be checked at the time of a routine examination.
Uncircumcised boys can have problems with inflammation of the foreskin. If this occurs, a routine office visit should be made. This may need treatment.
Regarding normal uncircumcised boys, at the time of birth, the foreskin is attached to the underlying head of the penis (the glans). If your child remains uncircumcised, you should not try to forcibly retract the foreskin. Again, it is naturally attached and will not retract without tearing the attachments. To try to retract the foreskin of a young infant boy is unneeded, unnatural and painful for the young boy. By the time your boy is three to four years old, the foreskin can usually be retracted. When the foreskin can be easily retracted, you should do this during each bath and clean it for hygiene purposes. Boys who are nearing adolescence should be able to retract their foreskin so that erections will not be painful and future intercourse will be possible. Phimosis is the medical name for the condition in which the foreskin cannot be retracted in older boys. Unfortunately, circumcision is needed in these cases.
Pain and/or swelling of the testis occurring at anytime during a boy’s life is not normal. Testicular torsion, which is a twisting of the testis is possible. The twisting can shut of the blood supply to the testicle. The testicle can die as result of this. This should prompt an immediate call to the physician or a trip to the ER.
Adolescent boys with a burning sensation on urination or discharge of pus from the penis, need an examination. Infection is possible. Sores or blisters on the penis or groin area also require an examination. Sexual activity prior to marriage during the teenage years is fraught with complications and is discouraged.
Any bulges in the groin area in both boys and girls should raise your concern about a possible hernia. A hernia is caused by a defect or small opening in the muscular abdominal wall which allows for a portion of the intestine to protrude through it, producing a bulge which is usually found in the groin area. In boys the bulge is usually seen in the scrotum. Typically, the intestine will move easily back and forth through this opening and the bulge produced by the hernia will often appear when the intra-abdominal pressure is increased such as with crying. The bulge will often disappear when the abdomen is relaxed. The danger of a hernia is that the intestine can protrude through the opening in the abdominal wall and somehow become twisted or swollen so that it is unable to return to its proper position within the abdominal cavity. When this happens, the hernia is said to be incarcerated and the bulge of a hernia becomes firm, and often red and painful. This results in intestinal obstruction and vomiting. An incarcerated hernia is a surgical emergency and the physician should be notified immediately.