Infant male circumcision, the surgical removal of the foreskin from the penis, is a common procedure performed for various reasons, including religious, cultural, and personal preferences. Among the different techniques available, the Plastibell method is frequently chosen for newborns. This technique involves a specific device and process designed to achieve foreskin removal with a generally straightforward recovery.
Understanding the Plastibell Method
The Plastibell device is a clear plastic ring with a handle and a deep groove running around its circumference. The fundamental principle involves creating a tight ligature around the foreskin against the device.
This compression restricts blood flow to the foreskin, leading to tissue necrosis, or tissue death. The devitalized foreskin and the Plastibell ring then naturally detach after several days.
The Circumcision Procedure
The Plastibell circumcision procedure begins with careful preparation of the infant. The baby is positioned on a flat surface, with arms and legs secured to prevent interference. Pain relief is a significant aspect, with the penis made numb using local anesthetic injections, often administered both above and below the penis. Some practitioners may also offer sucrose solution (sugar water) orally to help calm the infant and reduce discomfort.
Once the local anesthetic has taken full effect, the medical professional gently separates any adhesions between the glans (head of the penis) and the foreskin. An appropriately sized Plastibell ring is selected and inserted between the foreskin and the glans. The foreskin is drawn over the ring, and a surgical string, or ligature, is tied firmly into the groove of the Plastibell, crushing the foreskin against the device. The handle of the Plastibell is broken off, and any excess foreskin protruding beyond the ring is trimmed away. The entire procedure typically takes about 5 to 10 minutes.
Post-Procedure Care and Healing
After a Plastibell circumcision, the penis will have the plastic ring in place, and some swelling or bruising around the area is common. A yellowish discharge or coating, often referred to as granulation tissue, may also develop on the glans; this is a normal part of the healing process and resembles a healing scrape.
The Plastibell ring falls off on its own, typically within 5 to 10 days, though it can range from 3 to 14 days. It is important not to pull on the ring, even if it appears to be hanging by a small piece of tissue, as this can cause bleeding. For cleaning, change diapers frequently and gently rinse the area with warm water, avoiding commercial diaper wipes which may sting. Apply petroleum jelly or an antibiotic ointment to the tip of the penis with each diaper change to prevent the wound from sticking to the diaper. Daily bathing is encouraged to keep the area clean, even before the ring falls off.
Important Considerations and Complications
While Plastibell circumcision is generally considered safe, parents should be aware of potential complications that warrant medical attention. One of the most common complications is bleeding, which typically presents as a few drops but requires immediate contact with a healthcare provider if it becomes continuous or heavier. Infection is also a possibility, though rare, and signs to watch for include fever (over 101 degrees Fahrenheit), spreading redness from the tip of the penis, pus-like drainage, or a foul odor.
Other concerns include:
- Difficulty urinating (fewer wet diapers or dribbling urine), which could suggest an obstruction.
- Displacement of the Plastibell ring, where it slips down the penis shaft and appears to be squeezing it, or if the head of the penis turns blue or black.
- Delayed separation of the ring (remaining on for more than 10 to 14 days).
- The ring falling off in less than three days.