What is circumcision?
Circumcision is an operation to remove loose foreskin covering the head of the penis. This may be done for medical,social or religious reasons. The General Medical Council recognizes that male circumcision can be done for religious and cultural reasons.
What is the best age for circumcision?
We recommend your son’s circumcision is done when he is as young as possible, best done soon after first week of life. Circumcision however can be performed at any age.
Where will circumcision be performed?
Circumcision is best performed in a clean environment with sterile instruments by a trained and experienced surgical practitioner. Community Health Centre provides all of the above i.e. Purpose built operation theatre Sterile single use instruments Highly Qualified and Experienced Surgeon It is also registered with the Care Quality Commission
Introduction of the Surgeon
Circumcision will be performed by Dr K.G.Rauf. He graduated from renowned King Edward Medical College, Lahore in 1982. He did his post-graduate surgical training in UK. He is a Fellow of the Royal College of Surgeons of England (1988) and Certified in Plastic Surgery by The British Association of Plastic Surgeons and the Royal College of Surgeons of England (1992). He has been working at the University Hospitals of Leicester as Plastic Surgeon since 2002. Dr Rauf is also able to converse (other than English), in Urdu, Hindi, & Punjabi.
Before surgery Consent
Both parents and/or carers with parental responsibility must give consent before the procedure. Consent means you want to have your son circumcised, and that the procedure and potential risks have been explained to you which you are prepared to accept.
Circumcision will be done under local anaesthesia by “Plastibell” method (commonly known as a “ring” method).
How will local anaesthetic be given?
Local anaesthetic will be injected by a very fine needle under the skin close to the base of the penis. The injection site can swell and can leave a bruised appearance which will settle in 2-3 weeks time.
What is Plastibell method?
This is one of the safest methods of circumcision
After local anaesthesia the foreskin is retracted back to expose glans (tip of penis)
Plastibell device (plastic ring with handle) of appropriate size is placed over the glans
Foreskin is redraped over the plastibell
Plastibell thread is tied with tight surgical knots to press foreskin against the plastibell
Foreskin is removed, leaving a narrow rim of skin beyond the thread thus completing circumcision. The narrow rim of skin beyond the thread goes white initially and then turns black (similar to colour changes in umbilical cord after application of clamp)
Will the child feel pain during the procedure?
No. The local anesthetic blocks the nerves carrying pain sensations and the child therefore does not feel any pain during the procedure.
Will the child cry during the procedure? Why?
Children can cry during the procedure because of the following reasons:-.
1. Separation from parents. (Parents of children older than one year will be allowed to stay and hug/cuddle the child during the procedure.)
2. Local anesthetic blocks pain sensations only. The sensations of touch and stretch which are not painful remain intact. The child can cry because of these “painless” sensations during the procedure.
3. Child’s legs are held in one position during the procedure which can irritate the child thus making him cry.
How long will it take to heal?
Healing takes 4- 10 days in children upto 1 year of age. It takes longer, upto 2-3 weeks, in older children..
The narrow rim of skin left behind (after removing foreskin) beyond the thread tied over the plastibell turns initially white and later black (like skin beyond umbilical cord clamp after birth). The plastic ring, the thread and the black rim of skin separate spontaneously. A yellow line is visible where the separation takes place. This yellow line disappears within 1-3 days.
Some redness and swelling of the penile shaft can last for upto 2-3 weeks after separation of the plastic ring. Please contact the clinic if it lasts longer.
What to do after circumcision? Any special care required for my child?
NO special care is required after “Plastibell” circumcision.
Wash the circumcision site and surrounding skin, especially the perineum, with baby soap and running tap water at each nappy change. DO NOT use wipes for cleaning.
Child can also be put in bath tub. Use of salt water in bath tub (one teaspoon of table salt for every litre of water) helps in healing. It is also best to wash with running water and baby soap before and after putting child in bath tub.
What are the risks and potential complications following circumcision?
Plastibell method is one of the safest method with extremely low risk of complications. Following are the potential complications/risks:
| Bleeding | less than 1% risk |
|---|---|
| Infection | less than 1% risk |
| Urinary obstruction | less than 1% risk |
| Need for revisional surgery | less than 1% risk |
What do I do in case of bleeding?
Bleeding. Serious bleeding can only take place if the ligature/ thread tie over the plastibell slips. This is extremely rare. There is however possibility of minor temporary oozing of minimal amount of fresh blood in early period after circumcision if child had dense adhesions between glans and foreskin. Separation of these adhesions can leave slightly raw surface over glans which can cause a slight ooze of fresh blood.
What to do. Immediately cover penis with clean gauze/cotton cloth or thick tissue paper thoroughly soaked in cold water and apply gentle pressure (equal to pressure required for holding a spoon) continuously for 5-10 minutes. Remove gauze etc after 5-10 minutes and observe. No need to do anything if bleeding has stopped. Cover again/apply pressure and ring the contact number given by the clinic immediately if bleeding persists.
What to do in case of infection?
Again it is rare to have infection after Plastibell circumcision. Some degree of redness and swelling is part of normal healing process and does not mean infection. If swelling and redness is more than what is explained and child develops fever then it is best to contact the clinic and ask for review by a doctor.
Child is unable to pass urine after circumcision
The commonest cause for inability to pass urine after circumcision is the meatus (external opening of urethra) getting pressed against the plastibell. The plastibell is fairly mobile and can be lifted slightly to move it away from the meatus (opening at the end of penis for passing urine) to relieve the obstruction. Contact the clinic if this maneuver fails to relieve the obstruction.
Some concerns expressed by parents after circumcision
Answer Every child is different. The amount of skin left behind varies and is tailored to the amount of skin anticipated to be required by the child during future growth.
Answer excess skin is often left behind when the child has a condition where the major part of the shaft of the penis is hidden in the fat over pubis. This skin will be required by the child during future growth. Parents are required to retract the skin back and expose the whole of glans twice daily for three months following a conservative circumcision.