The subject of male circumcision sparks hot debate between the pro-circumcision and anti-circumcision camps. According to the 2022 World Population Review, over 99% of men in countries like Morocco, Palestine, Afghanistan, Tunisia and Iran are circumcised.
The 2022 circumcision rate for Australia is given as 58%. Circumcision is practised for cultural or religious reasons in many countries, but in others, health is the motivator for infant circumcisions. For example, the American Academy of Pediatrics (AAP) recommends newborn male circumcision to reduce certain STDs, cancer, and HIV infection.
The three most common early male infant circumcision techniques worldwide are the Mogen Clamp, the Gomco clamp and the Plastibell device. All the procedures are performed under local anaesthesia, the most common being a penile dorsal nerve block. The penile ring block is also used, with both methods easily mastered by circumcision doctors taking short online health courses in circumcision.
Mogen Clamp as an early male infant circumcision technique
The shield and clamp have become the most popular method of early male infant circumcision techniques as the glans and frenulum are protected from an accidental scalpel slip during the procedure. The Mogen clamp is slid over the prepuce once it is extended by the circumcision doctor distal to the glans.
The doctor will then excise the prepuce that is distal to the shield. The clamp on the shield cuts off blood supply, thereby minimising the risk of bleeding. To ensure the glans is fully exposed after healing, the circumcision doctor will slit the inner preputial layer and remove it.
Gomco Clamp as an early male infant circumcision technique
The Gomco clamp has been used for over 85 years and is still the first choice for many circumcision doctors.
The plate and bell of the reusable clamp must fit together tightly to clamp the skin for around 90 seconds to minimise bleeding before proceeding with the cut. The circumcision doctor also needs to ensure that he chooses the right size of bell and clamp for the patient.
After local anaesthesia, the circumcision doctor carefully avoids the urethral meatus as he uses implements to ensure that the foreskin is separate from the penis, down to the corona level.
After pulling the loosened prepuce forward, the surgeon will make a dorsal slit. The prepuce is then retracted to place the metal bell of the Gomco device over the glans. The surgeon then pulls the prepuce over the bell of the device before placing a metal plate over the bell that sits tightly into the rim.
With the prepuce isolated between the bell and plate, the doctor tensions a bar to keep the prepuce in place, cutting off the blood supply to minimise bleeding once the doctor uses the scalpel around the edge of the plate to remove the foreskin.
A dressing is placed on the wound afterwards to ensure any oozing does not make the infant’s nappy stick to it. Parents need to keep the area clean and apply a little petroleum jelly to ensure the site is not affected by urine sting with the Mogen and Gomco methods.
Plastibell device as an early male infant circumcision technique
The bell-shaped plastic device has been used in circumcision clinics since the 1950s.
The Plastibell device is worn after the procedure, making it different from the Mogen and Gomco clamps that are removed immediately afterwards.
The Plastibell with a groove at the rear is slipped between the prepuce and the glans after the circumcision doctor has ensured the prepuce is loosened from the glans. Usually, the surgeon makes a dorsal slit before the Plastibell is placed. Pulling the prepuce slightly forward allows the doctor to place the suture material into the groove on the device, ensuring it is positioned correctly and symmetrically for a better final cosmetic effect.
Once it is tied tightly, there is no further cutting as the blood supply to the prepuce positioned above the groove is cut off, resulting in it withering and dropping off anywhere between three to ten days after the procedure.
There is little to differentiate between the three techniques for circumcision outcomes nor are rates of complications substantial between the three methods. It is up to the individual surgeon to use the device preferred by both doctor and patient.
To find out more about early male infant circumcision techniques, contact Small Surgery Courses today.