Circumcision can be a simple and safe procedure to remove the foreskin from the penis. Though circumcision is typically associated with infants, boys, teens and men routinely receive the procedure.
For many, circumcision is a decision related to faith or culture. New parents often follow family tradition and have their newborn sons circumcised. As boys reach adolescence, circumcision can sometimes be a solution to health issues such as phimosis. Many adult men choose circumcision for cosmetic purposes.
Circumcision does have health benefits across the age spectrum – from infants to adult men. Foreskin can cause a build-up of bacteria that contributes to UTIs in babies and uncircumcised men are shown to be at higher risk of penile and prostate cancer. Foreskin can also encourage the colonization of human papillomavirus – a leading cause of cervical cancer, affecting female partners.
Circumcision is always going to be very personal decision. But once it’s made, the next step is to find the right physician and chose the surgical procedure that makes the most sense for your circumstances.
Different Approaches to Circumcision
When a male infant is born, the foreskin naturally adheres to the penis shaft. In every circumcision procedure, the foreskin has to be freed from the shaft, so it can be retracted or extended at will. This is to allow the doctor access the skin for removal.
Pollock Clinics have chosen two approaches that we consider to be the most effective – in terms of safety and speed:
- The Pollock Technique ™ uses a Mogen Clamp for infants, boys or adults.
- The Shang Ring – an innovative new technique for adult circumcision
This is the oldest and most traditional method used by many hospitals and physicians. First the doctor injects a local anaesthetic, targeting the dorsal penile nerve to numb the genital area. Then a hemostat (a straight line medical clamp) is slipped under the foreskin to detach it from the penis shaft.
Once the foreskin is loosened, a bell-shaped section of the Gomco clamp is slipped underneath it, covering the glans (or head) of the penis. It’s not unusual for a dorsal slit (a cut on side of the foreskin) to be necessary to fit the clamp.
Once the bell’s in place, the foreskin is pulled up and over it. Then the doctor tightens the clamp around the extended skin to cut off the blood flow. Using a scalpel, the doctor lops off the skin to complete the procedure. Typically, no sutures are required.
The Pollock Technique ™ uses a Mogen clamp. After much research, we find this approach is less invasive, there’s less handling of the tissue. It’s also 10x faster than traditional circumcisions. The shorter the duration of any surgical procedure, the easier it is on the patient.
First a numbing cream is applied to the penis and scrotum. This freezes the area to eliminate any discomfort from the injection of long-lasting long anaesthesia. Then a hemostat is used to separate the foreskin from the penis shaft.
The foreskin is extended over the head of the penis (no incision required) and captured in a slot on the Mogen clamp to cut off blood flow to the foreskin. The clamp stays in place while the foreskin is cut away to eliminate any bleeding during the removal.
Unicirc is a single-use circumcision instrument that is fit to the penis head. As in other procedures, the foreskin is separated from the penile shaft and a local anaesthetic is injected.
The head of penis is placed in an appropriately-sized clear plastic tube and the foreskin is pulled up over the tube. A second piece is lowered down over the tube, with a plate on the bottom and tightening screws on each side.
The screws are tightened to cut off the blood flow to the skin. After a 5-minute waiting period, the foreskin is cut, using the bottom plate as a guide. As the device is removed, the detached foreskin comes off with the original tube. A skin glue is applied to seal off the incision line where the foreskin was cut.
The Plastibell method is unique in that the foreskin is not removed during the procedure. A bell-shaped ring is left in place that allows the foreskin to desiccate over time and fall off – typically over a 10-day period.
As in other procedures, the foreskin is detached from the shaft. It is extended and clamped so a dorsal slit can be made to accommodate the device. An appropriate sized “bell” (with a handle on top) is placed over the head of the penis and the foreskin is pulled up over it. A string or ligature is tightly bound around the skin.
The doctor then cuts away the foreskin at the edge of the ligature using a scalpel or scissors. The handle of the “bell” is removed but the bell itself remains in place. The rim of tissue beneath it will slowly die (necrotize) and both the bell and skin will fall off.
The Shang Ring is a single use device that consists of an inner and outer ring. The procedure begins with local anesthesia – uniquely, only a topical anesthetic is usually required. The inner ring is placed right below the head of the penis. The foreskin is then rolled back to expose the glans and is wrapped over the inner ring. Then the outer ring is placed over the inner ring and the clasp is tightened locking the redundant skin in place and is then surgically removed.
The patient leaves with the ring in place, returning in a week to have it removed. The most common cited benefits of Shang Ring include:
- Less pain
- Topical anesthetic
- Minimal bleeding
- No stitching
- Minimal time away from work
- No stitching marks
Comparing Circumcision Methods
The best decision in any surgical procedure starts with choosing an experienced doctor. Though circumcision is a relatively simple procedure, it can also be an emotionally challenging experience for parents or older patients.
Most infants actually sleep through the whole thing, but mom and dad can have a harder time. Older boys and men can sometimes experience anxiety, but an experienced circumcision physician will minimize discomfort during the surgery and before.
|Circumcision Method||Duration Surgery||Anaesthesia Injections||All Ages||Risk of Complication|
|Gomco Clamp||10 minutes||Yes||Yes||Average|
|Mogen Clamp||5 minutes||Yes||Yes||Low|
|UniCirc||10 minutes||No||Mostly Adults||Average|
|Plastibell||20 -30 minutes||Yes||No (infants)||High|
|Shang Ring||5 minutes||No||Yes||Low|