About the Procedure

The Circumcision Procedure

There are a number of different valid techniques used in performing circumcisions. These include the Plasti-Bell procedure, and the use of various clamps and shields to crush and cut the residual foreskin and protect the head of the penis at the same time. All are reasonable techniques in the hands of qualified medical practitioners experienced in that technique.

At the Perth Circumcision Clinic, the foreskin is separated from the head of the penis with the use of artery forceps and retracted to expose the entire head. Then the foreskin is folded back across the head, stretched and crushed with special forceps that reduce bleeding and protect the head of the penis. The excess skin is excised and the residual skin returned to position beneath the head of the penis. This technique is preferred because of the clean cut edge achieved, the good control of bleeding, the low rate of infection, and the short time it takes to perform.

The procedure takes less than 60 seconds, and then the dressings are applied and the child returned to the parents for feeding and settling. For discussion of anaesthetic choices see below.

Anaesthetics /Analgesics

At the Perth Circumcision Clinic we provide three types of anaesthetics/analgesics for pain relief. 

When a circumcision is performed with the technique used in the Perth Circumcision Clinic, the entire procedure takes less than 60 seconds. It is quick, simple and the child settles back down after this period of distress after a further 1 to 15 minutes.

1. Local Anaesthetic Creams  A combination of Lidocaine and Prilocaine in a cream is applied approximately 15 – 30 minutes before the procedure. We will supply and apply the cream. It can be used to reduce the sensation at the tip of the penis and/or for the purpose of reducing the discomfort of the regional block (see below).

2. Local Anaesthetic Injections (Regional Block)  Local anaesthetic injected under the skin either as a dorsal nerve block (centrally over the top of the penis near to its base to anaesthetise the dorsal nerve of the penis) or as a ring block (several injections around the middle of the shaft of the penis subcutaneously) is by far the most successful local anaesthetic technique available. It is used commonly around the world, although not always perfectly effective. We apply the local anaesthetic cream first to the base of the penis and later the regional block. In this way, most babies do not feel the procedure.

3. Sucrose Syrup   Sucrose Syrup has some minor analgesic benefit. Therefore at Perth Circumcision Clinic we use it immediately after the procedure to help settle the baby more quickly.

General Anaesthetic    

For children over the age of 6 months, general anaesthesia is the preferred method of anaesthetic routinely used in most parts of the world. Although general Anaesthetic is not without its risks, children of these ages require a longer procedure time and a general anaesthetic in hospital. 

Circumcision for older children and adults is not available at the Perth Circumcision Clinic, therefore a General Anaesthetic is not offered at Perth Circumcision Clinic.

If your child is older than twelve weeks of age, then please call us and make an appointment with no out of pocket expense, with our doctor to advise how to access a reliable and safe circumcision for your child.

Wound Care after the Procedure

There are two layers of dressings applied to your son’s penis after the procedure. The outer dressing is a square of “Combine” containing soft cotton wool, acting as a cushion to protect the penis from being rubbed on the nappy. It may come away with the next nappy change. If not, then remove it gently and discard at the next nappy change after the procedure, about 2 hours or so after the procedure.

The other dressing applied directly to the penis is a cotton wool ball unravelled to form a strip and soaked in a brown, sticky, antiseptic liquid, and then wrapped around the penis. This dressing adheres to the wound, sealing it, reducing blood loss and providing antiseptic cover. This dressing is to be left alone and the child not bathed until approximately 36 to 48 hours after the procedure. It will change to a grey/ yellow colour. Urine will soak through it and sometimes moist stools will cover it. Simply pick off the stools as best as you can, but you cannot keep it clean.

Bath your child at approximately 36 to 48 hours after the procedure. Soak him in a long warm bath for 3 -5 minutes, and then gently tease free the cotton wool dressing. It is best to have one person hold him in the bath, while another teases off the dressing, one hand holding the end of the dressing closest to the body and the other hand pulling the tip of the dressing against this first hand. If it all does not come away, then the remainder should be teased off in the next bath the following day. Occasionally, this dressing will fall off by itself before the 36 to 48 hour bath. If so, start applying the Vaseline Damage Ointment as described below, but still do not bath him until the 36 to 48 hour time.

The appearance of the head of the penis after removal of the dressing will vary depending upon how adherent the foreskin had been to the head of the penis prior to the procedure. It may look red and raw in patches with a thick yellow slough covering over parts or all of the head of the penis and at some edges of the cut area. This is part of the healing process and does not reflect infection. Vaseline or Dermeze in thick amounts should be applied to the head of the penis from the first bath onward at every nappy change and after every bath, until the entire area is pink and clean. This will usually take another 7-10 days after the bath.