A/Prof Mahmoud performs infant male circumcision up until six weeks of age (corrected). He uses the Plastibell technique.
One of the most important aspects about operating on an awake newborn is adequate pain relief. The penis can only be rendered completely numb, after two local anaesthetic injections are administered. These injections are as painful as those given for immunization. After waiting for 4-5 minutes the local anesthetic has taken full effect and the penis is numb – the baby can be operated on without further discomfort.
During the operation which takes approximately ten minutes, the plastibell is placed between the foreskin and the head of the penis, protecting the head of penis during the procedure. A surgical string used to secure the plastibell device in the correct position and excess skin is removed. It is the string that gradually works its way through the layers of the foreskin, healing it as it goes. Once the string has completely cut through the layers of the foreskin, the plastibell ring and string will spontaneously separate from the penis and the ring will be found in the nappy.
Aftercare:
- Your baby may require panadol for the first 24 hours. Instructions will be given at your appointment.
- At every nappy change for the first seven days after the circumcision, apply a smear of vaseline to a piece of gauze and then sit this over the head of the penis. This keeps the area moist and prevents the healing tissue from sticking to the nappy.
- The baby should be given a bath every day from day two – use your usual product in the bath.
- About 36 hours before you find the ring free in the nappy you will notice some swelling and redness around the ring, this is normal and means the ring is about to completely separate.
- When the ring falls off and you find it free in the nappy you need to follow the directions below for the next month.
- After the ring has fallen off you should use a nappy wipe to push any skin off the head of the penis towards the abdomen. This needs to be done every nappy change for one month. This is very important as is prevents the skin on the penis from fusing back down to the glans (head) of the penis.
- The circumcised newborn penis looks different from an adult circumcised penis. In the newborn, there are three distinct colours. The head of the penis appears deep pink/purple, there is a cuff of shiny pink skin that encircles the base of the head of the penis, and finally the skin coloured shaft skin.
- With each nappy change, use a nappy wipe to push any pink skin or shaft skin off the head towards the abdomen and ensure you can clearly see each layer.
- Cover the entire penis with vaseline every nappy change for one month. After this time, just push the skin completely off the penis once a day for the next two months, with no vaseline needed after this time.