The ritual of circumcision has been around since Biblical times; however, the circumcision ring is an invention of the 20th century. The Gomco clamp was invented in 1936, the Mogen Clamp in 1954 by a Jewish Rabbi, and the 1950s also saw the introduction of the Plastibell device.
The circumcision ring has changed the lives of millions who have benefitted from the procedure. Currently, CO2 laser surgery is mainly used for adult circumcisions. However, although there is a move to laser surgery for infants, the circumcision ring is currently used in most circumcisions.
Circumcision rings used by various religious groups
The majority of infant circumcisions are performed on Muslim and Jewish babies. According to the Jewish faith, circumcision should be performed on the eighth day after birth and is only delayed if the child’s health warrants a waiting period or if a medical condition prevents the circumcision procedure from being carried out.
Hypospadias, where the opening of the penis is on the underside rather than at the tip, or haemophilia are examples of conditions that may prevent circumcision from taking place. For Muslims, it is performed at any age from seven days up to around seven years or delayed until puberty, depending on the group’s beliefs.
Healthcare programs advocating for circumcision ring
With the global percentage of circumcised males estimated at between 37 and 39%%, circumcision doctors perform millions of procedures annually, mostly in-office or special circumcision clinics.
Since HIV programs worldwide are now advocating male circumcision to help curtail the spread of the virus, numbers of circumcisions are climbing, particularly in sub-Saharan Africa, where HIV/AIDS is rampant.
Public healthcare clinics advocate using the various circumcision rings to enable these circumcisions to be performed quickly and efficiently with the best prognosis for the patient.
In the US, the Gomco and Plastibell devices are favoured, with the Gomco clamp slightly ahead as the procedure takes less time than the Plastibell. The longer the procedure, the more discomfort for a newborn even though local anaesthesia is used.
Outdated practices can result in sepsis and death
In South Africa, where tribes like the Xhosa allow young men to be circumcised by an elder (not a qualified circumcision doctor), hundreds have died or suffered the effects of botched circumcisions when blunt or unsterilised knives have been used.
Inadequate wound care is also a contributing factor. These complications and fatalities could be avoided if the circumcision ring was used and the procedure took place in a sterile environment, but cultural traditions are difficult to change.
Circumcision rings ensure protection
The circumcision ring is vital in ensuring the best prognosis for circumcision that does not involve a significant amount of pain and ensures protection of the glans and frenulum during the procedure.
Most modern methods of circumcision use a circumcision ring – these include the Mogen Clamp, Gomco Clamp, Plastibell and Shang Ring, among others. These rings provide a shield, ensuring a circumcision doctor does not accidentally cut part of the penis or frenulum should the scalpel slip or the patient moves.
With the Plastibell device, there is no cutting involved other than the dorsal slit that may be required to ease the prepuce over the ring to secure it with suture material so it can be tied tightly. A dorsal slit is often required to enable the prepuce to fit over the ring.
Risk of bleeding reduced
The circumcision ring is clamped tightly, trapping the prepuce between the rings and cutting off the blood supply so that when the doctor does the excision of the prepuce, the clamp helps prevent bleeding.
The patient is monitored after removing the ring to ensure no excessive bleeding occurs. Should this happen, the patient will be admitted for further treatment. In some cases, suturing may be necessary.
The Plastibell device involves no cutting of the prepuce, other than the dorsal slit if necessary, as it relies on restricting the blood supply, eventually causing the prepuce to wither and fall off. Parents who use this device can rest assured that bleeding will not be a concern unless they get impatient and try to pull away the ring and prepuce, should just a part still be attached.
As circumcision using a ring is mainly performed on newborns, the child’s diaper/nappy will hold the ring in place until it simply falls away with the shrivelled tissue.
Cosmetic outcomes improved with the circumcision ring
Disfigurement is virtually eliminated as the circumcision ring allows for proper placement and symmetry when the circumcision doctor removes the prepuce. The circumcision ring keeps the glans protected, and the scalpel can be used precisely with the shield as a guide.
The circumcision ring is favoured for best practice and excellent outcomes in circumcision clinics worldwide.
To find out more about the use of the circumcision ring, contact Small Surgery Courses today.