Complications from circumcision are rare, and in the newborn, typically occur to times per 1,000 procedures Most common complications include bleeding, particularly if there is an underlying coagulopathy For minor bleeding, treatment includes manual pressure and a compression dressing Circumferential dressings need to be monitored for penile ischemia or urinary retention If bleeding continues and a specific bleeding vessel can be identified, treatment includes topical administration of lidocaine with epinephrine and/or sutures If bleeding is generalized and persistent, the infant should be evaluated for a coagulopathy with complete blood count, and coagulation studies Wound infection is another infrequent complication of circumcision It is typically localized, with evidence of local redness, irritation, or drainage If localized, treatment includes topical antibiotic ointment, although caregivers should be educated on generalized symptoms of fever, irritability, or lethargy If present, infants with generalized symptoms should be evaluated for sepsis with blood, urine, and CSF cultures and parenteral antibiotics Surgical complications of the procedure can include injury to the urethra or glans If injury is suspected, urgent pediatric urology consultation should be obtained If the circumcision has not been completed, any prepuce or redundant skin should be left intact as this tissue may be used in the repair Similarly, if there is evidence of hypospadias, circumcision should be deferred and referred to pediatric urology, for repair Urethrocutaneous fistulas can also result from circumcision, although these can be corrected as an outpatient procedure several months after the initial procedures If the glans is injured or amputated during the procedure, the severed tissue should be wrapped in saline-soaked gauze, placed indirectly on ice An emergent pediatric urology consult should be obtained, as there have been reports of successful reattachment if it is performed within an hour of injury Additional glans injury can occur if the Plastibell ring, which normally sits over the glans for several days until the skin sloughs and ring falls off, is displaced If the ring cannot be removed easily, it may need to be removed used ring cutters, particularly in the setting of constriction or ischemia Vaginal Discharge Newborn females may present with either a milky white or blood-tinged vaginal discharge Both can be attributed to withdrawal from maternal hormones, and need nothing more than conservative management, observance, and reassurance to the parents Occasionally, a girl with prolapsed urethra will present with “blood in the diaper.” The prolapsed urethra is recognizable as an annular, beefy red or purple mass between the labia