The key feature of the Plastibell method is the use of the “bell”. This method causes the foreskin foreskin to fall off naturally by blocking blood supply, in a similar fashion to how an umbilical cord falls off. This contrasts with surgical methods where a cut is made to remove the foreskin – this will involve bleeding and require suturing to close the wound. Minimal bleeding and the lack of sutures are some of the key benefits with this device.

The procedure starts by ensuring adequate pain control. Many forms of pain relief exist including local anaesthetic injections, and topical local anaesthetics such as creams and sprays. The ideal regimen for a pain-free circumcision is a topical application plus an injection given by experienced hands. The local anaesthetics obtains a high level of pain control however other forms of sensation are still intact so the procedure may remain uncomfortable for the child. How these sensations are interpreted is variable, and depends on the child’s level of anxiety and calmness. That’s why we use also use multimedia devices to engage the child. encourage parents of slightly older children to be calm and recommend parents read of our advice about psychologically preparing a child for circumcision.

After the anaesthetic, an antiseptic is applied and the area is gently cleaned with swabs. A small incision is made from the tip of the foreskin down towards the middle of the penile shaft to allow for the bell to be inserted:

The bell is placed around the glans (head of the penis):

The foreskin is pulled over the device. A suture (surgical string) is tied tightly around the ring from the outside of the foreskin. This string blocks blood flow to the foreskin. Excess foreskin, that is now without blood supply and therefore at low risk of bleeding, is now surgically removed for a more hygienic healing process.

Depending on the level of pain at this point, a judgement is made as to whether more anaesthetic may be useful. The IMC never charges an extra fee for additional anaesthetic post-operatively as our goal is to provide a pain-free, or as close as is possible to get to a pain-free, circumcision procedure.

During the healing and recovery process, the area might be sore and sensitive so it is important to use the oral analgesic and ointment we give and ensure prompt nappy changes. After-care information to achieve a comfortable and healthy recovery will be provided in printed form on the day of the procedure. As the blood flow is now restricted to the foreskin, it will fall off naturally along with the bell around a week later or a bit longer for older children. By the time the ring falls off, the healing process would be complete. The result will be a neat cut due to the perfectly circular line formed by the string.

Advances in circumcision surgery have stagnated in recent decades. Ten years ago however, a landmark medical publication showed that circumcision strongly reduced the risk of HIV transmission in male participants of a clinical study, generating renewed interest in circumcision by the World Health Organisation and health officials worldwide. Realising that circumcision may help contain the HIV/AIDS epidemic in high-prevalence areas such as in Africa, researchers sought to find newer ways to perform circumcision that are more convenient for men and that are more likely to achieve high uptake. The Bill and Melinda Gates Foundation funded research to create the Shang Ring, a new circumcision device that fits this purpose.

The main benefits of the Shang Ring are:

• reduced pain
• minimal bleeding
• requires no stitching
• requires no bandages
• showering as normal during recovery
• minimal time off work needed
• no stitching marks

During the early stages of development, Dr. Said Bakir was invited to be an expert observer of the Shang Ring procedure. Today, years later, the Shang Ring has proved to be a very effective method of circumcision in high-prevalence areas. The IMC Circumcision Clinic London is the only private circumcision centre in the region to offer Shang Ring circumcision. Tens of thousands of men worldwide and hundreds at our own clinic report that they are very satisfied with the results that this device achieves.

Dr. Bakir with the inventor of ShangRing

[youtube http://www.youtube.com/watch?v=_ovf8GYfNbw&theme=light]

Read more about our adult circumcision services.

The IMC is able to offer many methods of circumcision. The Plastibell method is recommended for babies, infants and young boys while surgical methods and the ShangRing™ are more suited to adult men. The method we use depends on the age and size of the glans and your preference. We can often offer more than one method to you – this can be discussed during the consultation. Click to read more about these methods:

Plastibell Surgical methods Shang Ring

The National Health Service (NHS) took the decision not to offer circumcision for religious, cultural, social or personal reasons – also known as non-therapeutic – in 1949, very soon after its inception. This is because circumcision is not a medical necessity. Their decision led to a decline in the number of individuals undergoing circumcision in the United Kingdom.

A number of NHS hospitals did re-start offering offer a free circumcision service locally to parents, especially during the 1980s, however this is this is now rare or non-existent.

The situation may be changing in light of recent data showing that the impact of circumcision on HIV prevention is greater than what was previously thought. For this reason, the United States Public Health Department (the CDC) have recently change their stance on circumcision and state that the the benefits now outweigh the risks and recommend circumcision. In the last decade, many organisations fighting HIV, such as the Bill and Melinda Gates Foundation, have launched circumcision promotion campaigns in Africa to prevent HIV.

Non-therapeutic circumcision on the NHS

Circumcision is common among certain religious groups (such as Muslims and Jews) and cultural backgrounds. The NHS generally funds circumcision for specific medical reasons therefore most non-therapeutic circumcisions must be funded privately. Individual Clinical Commissioning Groups (CCG) (who locally decide how to spend NHS money) may choose to fund non-therapeutic circumcision for their local populations. We try keep an up to date list of CCGs and NHS providers that offer circumcision services:

• Tower Hamlets CCG: until recently, GPs in Tower Hamlets were able to refer to a CCG-run circumcision service however this was not a free service. The service ended in early 2016 and patients are now adviced to seek a private provider
• Sheffield Hospital: After ceasing free non-therapeutic circumcision in 2013, Sheffield Hospital now offer a paid service for children aged six months and above for £850
• All other NHS trusts have stopped offering free circumcision

Patients may be considered on an individual basis where their GP or consultant believes there is an exceptional circumstance that warrants deviation from the normal rules. Individual cases are considered by a treatment panel at the CCG. You can find out about ‘Individual Funding Requests’ by visiting your local CCG website (use the CCG finder tool on the NHS website) or speaking to your GP.

Therapeutic circumcision on the NHS

The NHS provides circumcision free of charge when a urologist decides there is a medical reason for the procedure. The most common reasons are:

• Phimosis
• Paraphimosis
• Recurrent balanitis
• Balanitis xerotica obliterans

To get this type of circumcision on the NHS, see your GP who will make a referral to a local hospital urology service. There is usually a delay to see the urologist for non-urgent referrals. The urologist will then examine you or your child to decide whether an alternative treatment might be useful. If circumcision is offered, a circumcision appointment in theatre will be booked. There is usually another delay with this as it’s unlikely to be considered urgent.

Waiting list times for NHS circumcision can vary from between 8 weekss to 32 weeks, varying greatly between different areas of the United Kingdom and the severity of the condition, however even minor to moderate pain is not usually considered an urgent situation. Situations where an operation can be arranged quickly include:

• Where there is a suspicion of cancer where a 2-week wait referral may be arranged by your GP. The urologist may examine you and decide to operate as soon as possible.
• Paraphimosis can be a medical emergency and an emergency circumcision may be performed. Paraphimosis is when the foreskin is retracted and cannot be replaced. This results in swelling and colour change of the tip, pain in the penis and may also result in the inability to pass urine. This condition requires immediate attention.

Health Insurance

In the UK, health insurance only covers therapeutic (medical) circumcision. If you have health insurance, your GP will still need to make a referral and then an appointment can be made through your insurance provider. The operation can usually occur much sooner through this route than through the NHS.

Private circumcision clinics such as the IMC

Individuals looking for a private circumcision service for themselves or their son should choose a doctor-led circumcision clinic or a hospital. Ask the doctor who is operating about the level of experience he or she has. Some patients choose to fund their own therapeutic circumcision despite this being available on the NHS. If you choose a private clinic, the main disadvantage is cost. The main advantages are:

• individual choice whether you would like to undergo circumcision, no GP referral required
• no long waiting lists
• avoidance of hospital-acquired infections such as MRSA
• no hospital admission required
• usually, a method of circumcision is used that requires only local anaesthetic
• more flexibility to choose the doctor
• less embarrassment within a private environment the clinic can provide
• no need to attend hospital in the early morning and wait your turn on the theatre list