Toddlers & Children
On the day, we will first explain the procedure and discuss any potential complications. Then, we will go through the details of the immediate aftercare and provide contact details should you have any further questions once you get home. You will have our support through every step of the process.
We will require consent for all procedures. To gain consent for a procedure to be carried out on one’s son, it is necessary that both parents are present on the day and are in complete agreement with regards to going ahead. Both must sign the consent form. If one or both parents are not able to be present, a signed consent letter will be required alongside proof of signature. Single mothers must demonstrate full custody and parental rights if they are the sole consenters. In the case of single fathers, we will require some form of documentation to confirm that the mother has given consent or that court approval has been granted.
The circumcision process consists of two steps. Initially, babies and infants are given a local anaesthetic block that will numb the entire penis to ensure a painless procedure. Unlike a general anaesthetic, the medication will not put the child to sleep. Administration of the local anaesthetic can be painful. It involves three small injections at the base of the penis. This will sting a little and it is normal for babies and infants to cry at this point. The injections are very quick and should take no longer than 30 to 45 seconds. The local anaesthetic used is a mixture of lignocaine (short-acting) and chirocaine (long-acting) which takes effect within about 5 to 6 minutes and lasts for at least 1 hour. This will easily cover the duration of the circumcision and part of your journey back home.
In order to make this process more comfortable, we will often apply topical anaesthetic cream to the area in and around the base of the penis half an hour before starting. This will help to reduce the pain of the injections. For those children who are particularly anxious, we can also administer a small dose of midozalam and paracetamol under the tongue to act as a mild sedative and help with anxiety. It is essential that parents communicate with their sons at this point in order to allay their fears as much as possible. Close cooperation between parents and the surgeon will ensure that this phase of the procedure runs smoothly.
For toddlers and young children, we normally opt for the ‘Plastibell’ technique. On returning to the operating room following administration of the local anaesthetic parents will often find that their sons are initially quite apprehensive. This is because they will recall receiving the anaesthetic injections in the same room. It is important at this stage that parents continue to talk to their sons throughout the procedure reassuring them that they will feel no pain. For babies and infants, we normally opt for the ‘Plastibell’ technique.
- We start by stretching the foreskin and revealing the head of the penis.
- We then clear any adhesions and usually separate what is known as the frenulum from the base of the penis’ head. There can be some minor bleeding at this point. We will usually use a cauterisation technique to stop any bleeding and proceed to size the ring.
- The Plastibell ring comes in a variety of sizes. After selecting the appropriate size, the ring is passed over the head of the penis.
- The retracted foreskin is pulled back over the ring.
- A tight suture is tied against the ring trapping the foreskin.
- Over the course of the next 7 to 8 days, the thread will cut through the foreskin.
- Subsequently, the foreskin and ring will drop off revealing a fully circumcised penis. The process is akin to the umbilical cord falling off soon after birth.
Once we have completed the circumcision we will ask you to remain in the clinic for a further 15 to 20 minutes so that we can check to ensure there is no bleeding and that the child is settled. We will also answer any final questions and concerns you may have. You will be given access to our 24/7 aftercare service, allowing you to return home with your minds at ease.
Although the ‘Plastibell’ ring is considered the gold standard there are times when it may not be appropriate. In certain circumstances, we may choose to use the ‘Circumplast’ ring instead. This is normally when there are concerns over the possibility of a ‘buried’ penis. A buried penis defines the situation where a large amount of pelvic fat sits just behind the base of the penis and gives the illusion of the penis being shorter in length than it actually is. The result is that it is partially or completely hidden below the surface of the skin.
In some instances, neither Plastibell nor Circumplast maybe an option. This is usually because the penis is extremely well developed and much larger than can be accommodated by the Plastibell or Circumplast rings. In this case, a traditional cut and stitch technique is required. This takes longer but rest assured that the local anaesthetic will last for the entire duration of the procedure. It is important to note, however, that a traditional cut and stitch technique is more expensive than the ring method.
We always place the safety and comfort of the clients first and, in rare circumstances, we may defer or indeed cancel your son’s procedure for a variety of reasons. There are a few anatomical abnormalities that would mean that circumcision has to be deferred. These include a condition called Hypospadius. This is when the opening to the urethra (where urine exits from) is not at the tip of the head of the penis but instead is running along the base of the head of the penis and in some cases the shaft. In this case, we will instruct your GP to refer your son to a paediatric urologist.
Other anatomical abnormalities that may result in the procedure being cancelled or postponed include a severe buried penis or a scrotal web. At the time of consultation, your child will be examined to make sure there are no conditions, such as an irregular temperature or jaundice, that will compromise the safety of the procedure. In these instances, the circumcision is delayed by around 1 week or until the child fully recovers and we are satisfied that the procedure will be safe.
A child must be willing and cooperative where applicable; occasionally the procedure may have to be abandoned if a child is frightened and not co-operative or withdraws his consent. We will not compromise the child’s safety. In addition, the child has to be medically and mentally fit. If your child suffers from any mental or physical disabilities then the procedure will not be done. It may be safer to carry out circumcision under General Anaesthetic (GA) in such instances. Please inform the surgeon, as we take the welfare of your child very seriously. If our surgeon believes any conditions have not been met, he will not carry out the circumcision.