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How circumcision is performed

How circumcision is performed


WARNING: The following information describes actual circumcision procedures. You may wish to skip some or all of this section.

How a circumcision is performed will mainly depend on the preferences of the surgeon performing the operation. It will also depend on the use of any anaesthetic, which can be related to the baby's age (for example a general anaesthetic will not be given routinely to a baby under 6 months of age).

A baby boy's foreskin is naturally adhered to the head (or 'glans') of their penis at birth. This gradually separates on its own by the time the child is about 2 to 5 years of age. The foreskin of a baby cannot be pulled all the way back over the head of the boy's penis until around this time. The general care of an uncircumcised penis is discussed in Class 11.

To enable the foreskin (or 'prepuce') to be removed for circumcision, the surgeon must first insert a fine probe between the foreskin and the head of the penis to separate them. This causes a small amount of bleeding and makes the head of the newly circumcised penis look very red and raw for a week or so, until it heals.

Once the foreskin is freed from the head of the penis it can then be removed. This can be done by using a:

Mogen clamp

Gomco clamp

Plastibell

Mogen clamp.

A Mogen clamp is the method used for a traditional Jewish 'bris' and was the original method of choice for circumcisions up until 30 years ago (when alternative methods were introduced). It is still a popular method for circumcising babies less than 2 weeks of age but it may also be used for older babies and adults.

Up until the last decade, using a Mogen clamp did not entail the use of any anaesthetic. Many caregivers justified this (and still do in some cases, for religious reasons) because the procedure is believed to be 'so quick'. The Mogen clamp method is thought to be less painful because it involves less handling of, and trauma to, the foreskin tissues during the procedure. It is also the easiest method to perform if the person is experienced at circumcising in this way.

These days, circumcision using the Mogen clamp (for non-religious reasons) may use a local anaesthetic cream, a local injection or possibly a general anaesthetic if the baby is older.

The use of the Mogen clamp is as follows:

Once the foreskin is separated from the head of the penis, the foreskin is pulled further up and forward. This causes the penis to slip back inside the foreskin, further towards the baby's scrotum (or testes). The Mogen clamp is then placed across the foreskin about 1cm down from the end, or tip, of the foreskin (but before the head of the penis inside, to protect it from being damaged). About 1cm of the tip of the foreskin can be seen protruding from the thin clamp.

The clamp is then closed tightly on the foreskin for about 30 to 90 seconds to reduce blood flow to the area. If the baby is more than 6 months old the clamp is left on for about 5 minutes or so. (In a traditional Jewish 'bris', the clamp may only be applied for a few seconds.) After this time a scalpel (or an instrument similar to a razor blade) slices off the tip of the foreskin. The clamp is then removed and the remainder of the foreskin (or 'preputial' skin) is pulled back behind the head of the penis.

The Mogen clamp method may leave the remaining skin around the head of the penis with an uneven or 'dog-eared' appearance in some babies. This usually becomes less noticeable as the boy grows older.

Gomco clamp.

The Gomco bell and clamp has been used more in the last 30 years or so. The metal instrument comes in different sized 'bell' shapes that sit over the head of the baby's penis (or 'glans'), but inside the foreskin to protect the glans during the procedure. The foreskin is placed over the outside of the bell. This method can take from 10 to 15 minutes and is believed to be the most painful method for circumcision. It is recommended that the baby have some form of pain relief for this procedure.

The foreskin is first separated from the head of the penis (as for all the other methods). The top of the foreskin is then cut vertically down about 1 cm from the tip of the skin to where it meets the head of the penis. The Gomco bell is placed over the head of the penis and a sterile safety pin is put through the end of the foreskin and attached to the top of the bell to keep the skin in place.

The Gomco clamp is then placed about 1 cm down from the tip of the foreskin around the whole circumference of the foreskin, lying over the metal bell. About a 1 mm ring of the foreskin is then compressed very tightly for about 5 minutes (to control bleeding) while the remaining foreskin is removed with a scalpel blade.

This method usually leaves a fairly even looking 'preputial' skin. Care must be taken not to remove too much of the foreskin.

Plastibell or Tara Klamp.

The Plastibell works on similar principles to the Gomco clamp, except rather than the foreskin being cut, the blood supply to the foreskin is stopped, so that the foreskin tissue dies (or 'necroses') and eventually falls off (within 7 to 12 days) after the procedure. The Tara Klamp is another version of the original Plastibell.

Using a Plastibell is thought to be similar in pain levels (but possibly taking less time) when compared to a Gomco clamp. From the surgeon's perspective it is generally easier to perform than using a Gomco clamp. The Plastibell also has a slightly increased risk of the baby developing an infection of the penis (which would need to be treated with antibiotics). It is recommended that the baby have some form of pain relief for this procedure.

The Plastibell is a plastic bell shaped device (that comes in many sizes). The foreskin is first separated from the head of the penis (as for all the other methods). The top of the foreskin is then cut vertically down about 1 cm from the tip of the skin to where it meets the head of the penis. The Plastibell is placed over the head of the penis and the foreskin is pulled up and over the outside of the bell and a small clamp is used on the tip of the foreskin to hold the skin in place.

A string is then placed around the foreskin (with the Plastibell underneath) and tied tightly (about 1 cm down from the tip). There is a groove in the bell that acts as a guide for the surgeon and helps to hold the string in placed. Sometimes excess foreskin is trimmed from around the bell using scissors or a laser and then the bell is removed. Otherwise the bell device and remaining foreskin fall off after a week or two. If it is unsuccessful the baby may need a further operation to remove the foreskin.

The Plastibell can sometimes result in a 'frilled' appearance of the remaining skin. A further operation may be needed to correct this.


Last revised: Thursday, 27 December 2012

This article contains general information only and is not intended to replace advice from a qualified health professional.

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