Once you have booked your appointment with us, we will send you (via whatsapp or email) a detailed information pack about the circumcision procedure and aftercare service to go through in your own time. You are required to bring with you the baby’s red book OR birth certificate (if issued) and a photographic ID (e.g. passport or driving licence, biometric card) for both the parents. We require both parents to be present and sign the consent form. Exceptions to this rule will apply to single parents and other similar circumstances however we would need evidence for this. You may be required to fill in additional consent form in case of single mum. You will have the opportunity to ask any questions.
Before the procedure a detailed head to toe examination of the baby will be performed. If there is any health related issue or any abnormality is detected that may render the procedure to be delayed or contraindicated the doctor will discuss all the aspects with the parents. In these circumstances we will inform the registered GP of the baby. If you have any concerns regarding notification to the GP please discuss with us. After the procedure, and in case of any complications we will notify the registered GP of the baby. Shall you have any questions please discuss with us before hand so as to have a detailed discussion.
Infants do tolerate the procedure better than young children and older children. We suggest getting this done within the first few months. If your baby is born premature let your baby reach the corrected gestation/pregnancy age of 40 weeks i.e. if your baby is born at 36 weeks , wait for 4 more weeks to consider the procedure. Our paediatric specialty doctor has researched that new-born babies need some time to make specific proteins that help to fight for bleeding or infection so we strongly suggest NOT having the procedure in the first week of life.
It should be noted that we are unable to perform the procedure if your baby has received his immunisation within 48 to 72 hours of the appointment, so we do ask patients to allow 48 to 72 hours after immunisation before booking your appointment. Please let us know in advance if your baby is having temperature of more than 37.5 oC or any other issues so that we can ask our paediatrician for further advice.
Circumcision is fairly a simple procedure that involves the removal of the foreskin of the penis. It is undertaken for variety of reasons including religious and cultural believes and also if medically indicated.
The operation comes under the category of minor surgery and is done with local anaesthesia in a clean and safe clinical environment. Local anaesthesia is injected at the base of the penis under the skin with a very fine needle. Injection takes 2-4 minutes to work and its effect lasts up to 4-6 hours. New-born babies do feel pain, but they seem to get through the procedure easier than older children do. So we recommend undergoing this ritual ideally within first few months.
We make use of the patented Plastibell® device (made by Hollister Incorporated) for circumcising male infants. This procedure, developed in the USA is quick to perform and is straightforward . Since 1955 this Plastibell method has won confidence and safety. The Plastibell is a clear plastic ring with a handle and a deep groove running around it. This does not involve any stitching, dressing or any removal of stitching. Chemical (Silver nitrate) or electro-cautery (bipolar diathermy) is used to control minor bleeding during the procedure which is commonly seen during the procedure. After administering the local anaesthesia, the penis and foreskin are separated by gentle pushing. Then a cut is made from the top of the foreskin allowing it to be pushed back and the Plastibell to be placed in position.
The appropriate sized Plastibell is chosen and placed over the head of the penis. It is then covered over by the foreskin. A ligature is tied firmly around the foreskin in order to hold the skin against a groove in the Plastibell. Then the excess skin is carefully trimmed off. Finally, the handle of the plastibell is broken off at the end of the procedure. The entire circumcision procedure takes 10 to 15 minutes.
The ring normally takes 7-10 days to come off. If this does not come off in 14 days, you must see the doctor who should remove it by cutting this open. Please do inform us on day 10 anyway , by all means if the ring is still attached.
Penis becomes quite red and swollen and may swell upto the double the size of normal for upto 7-10 days. When the ring falls off, the penis will become more red, swollen and raw looking which is normal. It may take another 2 weeks for the swelling to go down and final cosmetic appearance may take upto 8 weeks to achieve.
The local anaesthetia blocks the nerves that carry the pain sensations and the child therefore does not feel any pain during the procedure. The effect of the anaesthetic injection will last for up to 4-6 hours.
Some babies do cry more than the others, we sometimes use sugary water to calm the babies that has evidence to help with pain relief as well. We also advice to give small amount of feed to the baby before the procedure and bring the dummy/soother if your baby is already used to this. Please avoid giving full feed to the baby just before the procedure as they cry during the procedure and may vomit all the feed. There is a chance they may choke on the feed.
The actual procedure only takes about 10 to 15 minutes however the patient is expected to be in our clinic for up to one and half hours as we explain the procedure again to the parents, our experienced paediatrician takes a detailed history of the baby and examines the baby from head to toe before the procedure.
We use a medicated bandage to prevent the bleeding. After the procedure is done we observe the baby for upto 20 minutes for any immediate problems and to make sure that procedure is successful and the baby is comfortable. The chances of post procedure bleed with the use of medicated bandage is quite rare is it does not happen in the first 20 minutes.
We advise parents to wait outside the operating room whilst the circumcision is being carried out as our experience shows for most of the parents it’s uncomfortable to see their baby going through this distress. Many parents have reported this a traumatic experience to watch the procedure. We do understand ,however some parents would feel more comfortable to be in the procedure room with their baby. We fully understand this could be an anxious time for the parents , we believe watching the procedure will make the anxiety worse. We currently do not allow the parents to watch the procedure. Please discuss with us.
Even though this is not a major surgical procedure, we still aim to provide exceptional level of care and after care. This helps a speedy recovery and for the wound to heal properly, as quickly as possible and without any complication.
The main complication, although very rare, that is experienced by circumcision is the bleeding, that is why at our clinic we ask all of our patients to remain at the clinic for atleast 20 minutes after their operation to allow our specialists to be able to monitor the wound after the procedure.
We do stress the parents that once you return home with your baby to monitor the wound every hour for first 12 hours and then every few hours for next 24 hours and then with each nappy change. Small spots of blood where the wound touches the nappy is normal, however, if those spots are large, or bigger than a 50 pence coin, dark in colour, fresh spots, any sort of clots, or bleeding spots which are increasing in size, we strictly recommend that you contact our 24 hour aftercare support line for advice. We may advise you to take the baby to the hospital, though its very rare.
This is advisable with any surgical wound to keep the area clean all the times and dry for at least for first 48 hours hours. This will ensure the recovery as soon as possible without any complications.
We strongly advise to keep the nappy area clean and dry and keep on checking the nappy area frequently for any abnormal swelling, oozing or bleeding.
No bathing should take place for the first 48 hours from the time of the procedure, however, from this time we suggest that babies are sit in the mild (luke) warm water (no need to mix any antiseptic or salt in the water as it may sting) 1-2 times a day that would keep the wound clean as much as possible until the Plastibell ring falls.
Our paediatric specialist has researched that use of topical antibiotics helps to heal the wound few days earlier as compared to no treatment applied. We will provide GERMOLENE CREAM or Antibiotic Ointment whichever is appropriate for the baby to be applied to the wound. You can apply petroleum jelly OR Vaseline on to the front of nappy. This will prevent the wound to stick to the nappy. This will help early recovery. Do not apply Germolene Cream on the tip of the penis. Once the ring has started to fall off, STOP applying GERMOLENE Cream
We advise to see the wound every hour for the first 12 hours, then every few hours for next 24 hours, followed by each time when you change the nappy. Most of the time it takes 7-10 days for the Plastibell ring to fall off, should this not happen in 14 days please contact the 24 hour after care team. Please update us on day 10 anyway, by all means if the ring has not fallen on day 10. Please note , after the plastibell ring falls off, the wound would look red and slightly swollen however if you see any bleed or big swelling, any pus or oozing of wound please contact our team as soon as possible.
Naturally a scab will be formed at the area, we advise to let the scab mature and fall off naturally.
Right from the start of the procedure we take optimum measures to keep the surgical area clean and free form germs. After the procedure we expect from the parents to continue providing a clean and dry environment for the wound to be able to heal effectively and quickly. At any time if you feel there is increasing redness, swelling, discharge, oozing or pus coming from the wound please seek urgent advice by calling our 24 hour after care service.
We advise to keep on giving the regular and usual feeds to the baby. However due to discomfort for some days after the procedure, the pattern of feeding may change. As long as baby is feeding and tolerating sufficient amount of feeds this is normal. Make sure baby passing good amount of water/urine and is having good amount of dirty nappies as well. If any concerns noted like delay in passing urine for more than 6 hours do not hesitate to contact our 24 hour after care service.
The procedure is done with local anaesthesia in a clean and safe clinical environment. New-born babies do feel pain, but they seem to get through the procedure easier than older children do. The effect of local anaesthesia wears off in 4-6 hours of time, following which your baby may feel some discomfort. Most of the babies would only require general soothing and calming measures that your baby likes cuddle or rock your baby. We recommend giving regular Paracetamol/Calpol only 2 ml every 8 hourly, regularly for 2 days. If an doubt, please contact the oncall team.
We will give you the written piece of after care advice or will text you to consolidate that you should know what to expect after the procedure when you are at home. We will also inform your GP about this procedure.
There is less than 1% risk of bleeding, infection, urinary obstruction or need for revising the procedure. Minor bleeding is quite commonly seen during the procedure that is very easily and effectively treated by applying a chemical called Silver Nitrate. If significant bleed occurs after the surgery please contact us immediately for our accordingly advise. We may advise you to take the baby to the hospital. If you see the dressing/bandage around the wound is fully soaked with blood , its an emergency – take the baby to the hospital immediately.
The main complication, although very rare, is the bleeding We do stress the parents that once you return home with your baby to monitor the wound every hour for first 12 hours and then every few hours for next 24 hours and then with each nappy change. Small spots of blood where the wound touches the nappy is normal, however, if those spots are large, or bigger than a 50 pence coin, dark in colour, fresh spots, any sort of clots, or bleeding spots which are increasing in size, we strictly recommend that you contact our 24 hour aftercare support line for advice.
The injection site can swell and can leave a bruise/haematoma which can take a week to settle down. Ring displacement can also be seen - please call our team for advice if the ring has slipped down onto the shaft of the penis or if your son seems unsettled. When the ring comes off completely please do examine the penis of your baby closely to see if any string remnants are left on the skin that needs to be taken off. If any piece of thread is left behind and is buried in the skin can give significant complications. At any stage if you see the penis is more red, swollen, hot, pale or dusky call the team immediately or go to your nearest hospital.
The chances of need for redoing or revising the surgery are extremely thin. Re-do circumcisions or revision surgery is carried out because the foreskin has not been adequately removed at the initial (primary) circumcision which can potentially happen as every baby has got different foreskin with varying elasticity. If you are concerned about this, please get in touch with us as we can help you accordingly.