1 to 2 Years of Age
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Further Information About Circumcision In Toddlers
Circumcision is a simple operation which removes the foreskin. The foreskin is the sleeve of skin around the tip of the penis.
Circumcisions are carried out for religious, cultural, personal hygienic, medical and cosmetic reasons. The world Health Organisation estimates that approximately one third of males worldwide are circumcised. The rates vary by country, from 20% in the United Kingdom to 75% in the United Sates, to over 90% in Muslim-majority and Jewish countries.
At the Modality Circumcision Clinic, we carry out between fifty to one hundred circumcisions a week and to date have operated on more than ten thousand patients in all age groups and for all reasons.
Circumcision can have various health benefits, including:
- Easier hygiene.Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.
- Decreased risk of urinary tract infections.The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.
- Decreased risk of sexually transmitted infections.Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV.
- Prevention of penile problems.Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis. Other problems that can occur in uncircumcised men include Balanitis Xerotica Obliterans (BXO), recurrent paraphimosis (i.e. where the foreskin becomes painfully stuck behind the glans); recurrent balanitis (infection of the glans). Traumatic (zipper) injury may also be an indication for foreskin removal.
- Decreased risk of penile cancer.Although cancer of the penis is rare, it’s less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.
The Modality Circumcision Service carries out circumcisions on boys of all ages, including toddlers aged 1 year. Some parents prefer to have their sons circumcised within a few days or weeks after birth whilst others choose to wait until the age of one. Our clinic has carried out thousands of procedures in toddlers.
Some conditions and circumstances where a circumcision will be contra-indicated include:
- Acute illness. (Patients with chronic medical conditions may be fit to have a circumcision. Please contact the clinic for further advice).
- Known bleeding disorders (e.g. haemophilia or thrombocytopenia).
- Webbed penis.
- Buried penis.
- Lack of informed parental consent.
If you are unsure whether it is safe for a circumcision to be carried out, please contact us or see your own doctor.
Our policies with regards to consent are taken from the guidance issued by the British Medical Association (BMA) and the General Medical Council (GMC).
With regards to toddlers, consent to carry out the procedure may come from:
- all parents with parental responsibility or other persons or agencies with parental responsibility;
- a court.
The BMA and GMC recommend that consent should be sought from both parents. If parents disagree about having their son circumcised, we will not be able to carry out the procedure.
Where a child has only one parent, that person can give their consent alone.
In some cases, however, a doctor may make a professional judgement that the overall social, psychological, emotional and/or clinical benefits of a particular child undergoing a circumcision do not allow for the procedure to be deferred or cancelled.
Due to current COVID-19 restrictions we can only allow one parent or guardian into the clinic. They can choose to stay with the child throughout the procedure or may feel more comfortable to wait outside the operating room whilst the circumcision is being carried out.
The Modality Circumcision Service operates a very strict restraining policy. For clarity we have explained the policy, as applicable to toddlers, below. Please take your time to read and understand the policy before booking.
During the administration of the local anaesthetic and the circumcision procedure, the doctor will only restrain the legs of the toddler using a specially designed restraining board. Where a child shows signs of extreme distress or resistance and the doctor feels it would be harmful to continue, the procedure will be cancelled. This is very rare in toddlers and we have not yet had to cancel any procedures is this age group for such a reason.
In certain situations where there is a clinical contra-indication (such as anatomical abnormalities or the child is unwell), lack of parental consent or the failure to provide the required documents, the procedure will be cancelled.
While the overwhelming majority of procedures in toddlers go ahead with no problems, in certain cases the circumcision may have to be deferred or cancelled.
In all of the above circumstances where the procedure has to be cancelled, the booking deposit will be considered a consultation fee and is therefore non-refundable.
All deposits are fully refundable only if we are given a minimum of three working days’ notice.
Every child is different. We have had toddlers who have not cried for the injection and have remained quiet during the entire circumcision procedure. Other toddlers start crying as soon as they are undressed and put on the bed. Most toddlers find it soothing to suck on a bottle of sweet water. In some cases, the child may be hungry and will need to be given a feed after the anaesthetic. We recommend that you bring a bottle of water mixed with sugar and a bottle of milk.
Your child will not be put to sleep, but before the circumcision, the penis will be made numb by injecting a medicine around the base. This is called a local anaesthetic and ensures that there is no pain during the circumcision procedure.
Some toddlers can be further calmed by playing a song or something similar on your phone or electronic device.
After the injection, the doctor will test the foreskin, and proceed only when they are certain that the child is unable to feel any pain. The type of anaesthetic we use can last for up to six hours.
In the overwhelming majority of toddlers, we use the Plastibell circumcision technique. The Plastibell is a clear plastic ring with a handle and a deep groove running around it. This was invented in America in the 1950’s and is now one of the most popular circumcision methods in the world.
After the local anaesthetic, the penis and foreskin are separated by gentle pushing. A cut is then made from the top of the foreskin, allowing it to be pushed back and the Plastibell to be placed in position.
The appropriately 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. The excess skin is then 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 falls off within 10 days, leaving a small wound that will heal over the following weeks. No stitches are required.
In a very small percentage of toddlers, the Plastibell method may not be suitable and a formal surgical circumcision technique may need to be used. The doctor will discuss this with you if the procedure becomes necessary. The formal circumcision techniques require the use of a scalpel to remove the foreskin, bipolar forceps to control any bleeding and then the cut edges are stitched with absorbable sutures. The area is then cleaned and a dressing applied. The entire process can take approximately 45 minutes.
- Lack of informed consent. A toddler cannot consent to the procedure. The decision must be made by the family/legal guardians. The procedure is considered permanent and there is a risk that when the toddler is older he will be unhappy he was circumcised.
- The toddler may experience some pain whilst the local anaesthetic is being injected and also after the procedure, once the effect of the anaesthetic has worn off.
- Complications during circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.
- Change in sexual satisfaction. Some people believe that circumcision leads to decreased sexual pleasure later in life. Data recently collected from a large group of adult males who underwent circumcision later in life suggest that there is no change in sexual satisfaction between circumcised and uncircumcised men and their partners. However, some patients may be unhappy that they were circumcised.
The Modality Circumcision Service provides a comprehensive aftercare service. Once the procedure is finished you will be taken to a separate recovery room and the doctor will go through the aftercare in more detail.
When your child goes home, he may not be his normal self for a few days:
- He may feel unwell for some hours and experience some discomfort. The site will be sore after the procedure. Paracetamol (CALPOL) will help to relieve this discomfort and can be given every six hours.
- Please give your child plenty of fluids to drink over the next few hours and make sure he has passed urine within 6 hours of the operation.
- It is normal for the skin to be dark brown or black in colour around the plastic ring. This will disappear when the ring drops off. It is normal for some bruising and swelling to occur around the site.
- As with any procedure/operation, there is a chance of infection. A way to reduce the risk of infection is to ensure that the area is bathed once a day. You should start bathing him the day after the operation. To the warm bath water, add:
- two tablespoons of salt. Any type of salt is suitable. And
- two caps of TCP or Detol antiseptic liquid.
- You may also add normal baby wash or shampoo.
The bath should be deep enough to ensure the penis is submerged. Your child should sit in the water for 5-10 minutes. Afterwards you may leave the penis to dry on its own or dab it with a towel. You should stop the bathing once the plastic ring has fallen off.
- The plastic ring usually comes off within ten days after the circumcision.
- Apply Vaseline or Sudocrem around the area as shown by the doctor. Once the plastic ring has fallen off, continue with the Vaseline or Sudocrem for another 3 days.
- When the ring is starting to fall off, and once it has fallen off, the penis will look red and swollen, and may have a yellow rim around the area where the ring was sitting. This is normal and will settle over the next few weeks.
- During regular nappy changes you can clean the bum and penis area with wipes or water.
- If any of the following should occur, please seek medical advice immediately:
- If the child has drank plenty of fluids and still not passed urine six hours after discharge.
- The plastic ring has not fallen off within 10 days.
- The plastic ring has slipped onto the shaft of the penis.
- If the child develops a temperature or is unwell in any other way.
It can take six weeks or more for complete healing to take place. After the circumcision, the glans penis (the exposed part of the penis) may look pale, pink, purple or bluish, the colour differs from child to child. This is absolutely normal.
Our circumcision clinic operating theatres are modern and of a high standard. They are equipped with electro-hydraulic operating beds and overhead theatre lights. This ensures a safe operating environment.
We have strict infection control procedures that meet all Care Quality Commission standards. We use only sterile single use equipment and instruments for the circumcision. This means we do not reuse any surgical instruments.
After the circumcision we dispose of all used materials. This ensures that we comply with the highest level of infection control and reduce the risk of our patients acquiring any type of infection. Because of this we do not use certain circumcision methods that require the same equipment to be reused on other patients.
Our COVID-19 policies.
After booking the appointment you will be sent detailed information about the circumcision procedure and aftercare service. This will allow you to read through all the necessary details and prepare any questions you may want to ask the doctor. You will also be sent directions to the clinic. On the day of the appointment please bring the following:
- Due to COVID-19 restrictions we require the parent or guardian to wear a face mask.
- The consent form and health questionnaire must be completed, signed by BOTH PARENTS and brought on the day of the appointment. The doctor will contact the parents a day or two before the appointment to go through the procedure and consent over the phone. Where there are no extenuating circumstances and both parents have not consented, the doctor may cancel the procedure.
- Photographic ID for both parents (passport, driving license or other similar documentation) must be brought to the appointment.
- ID for the child (Red Book with a record of the most recent weight, birth certificate or other similar documentation) must be brought to the appointment.
- Please bring a bottle (with teat) of water mixed with a couple of tea-spoons of sugar. Research has shown that sucking on something sweet helps reduce pain in new-born and older children. Please also bring a bottle of milk in case your child is hungry and needs a feed. Both of these items should be brought even if your child is breastfed
- Please bring Paracetamol (also called Calpol), a tub of Vaseline or Sudocrem and also extra nappies and a change of clothing.