Plastibell circumcision in Jordan

Plastibell circumcision is a common technique for infant circumcision that uses a small plastic ring. The doctor separates the foreskin from the glans, places a correctly sized ring over the glans, and ties a ligature around the foreskin into the groove of the ring, which cuts off the blood supply to the excess tissue and prevents bleeding. The protruding tissue is trimmed, and the ring with its ligature then falls away on its own after several days up to about two weeks. The procedure needs no sutures and no cautery in most cases, and is performed with analgesia or local anaesthesia appropriate for the infant's age. The reassuring nickname used for it in Arabic deserves correction: **it is a popular label, not a medical claim that the procedure is painless or free of risk.** The infant does feel pain and deserves adequate analgesia, and like any surgical procedure it carries possible complications: bleeding, infection, adhesions, an unsuitable ring size, or delayed separation of the ring. It should therefore be performed in an equipped setting by a qualified doctor, never at home or by an untrained person. Its limits matter before you consent. The ring technique generally suits young infants and does not suit every age; older children and adults usually require a different surgical technique. **Circumcision must be avoided or postponed if there is hypospadias, meaning the urinary opening is not in its normal position, or penile curvature, a buried penis, or any anomaly of the urethra, because the foreskin itself may be needed for later surgical repair, and removing it makes that operation harder for the child.** It is also postponed in significant jaundice, infection or fever, prematurity and low weight, or when there is a family history of a bleeding disorder or any unexplained bleeding. Afterwards the home care phase begins, and it is the most important part: cleanliness, a loose nappy, and watching for urination. **Never pull the ring, and never try to remove it or cut the ligature yourself no matter how long it takes**; it normally falls off unaided. If it has not separated within the expected time, or if it slips back onto the shaft of the penis, seek medical review immediately. Do not apply powders, kohl, oils or any traditional substance to the wound, and use only what the doctor has prescribed. Whether to proceed, when, and with which technique are decided by clinical examination of the infant by a qualified doctor, not by a social date on the calendar or by other families' experiences.