PAUL'S CIRCUMCISION
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This document provides information on Paul's method of circumcision. It begins with a brief history of circumcision and then outlines Paul's method. Some key points: - Paul's method is an adaptation of the excision-ligation method. It is a simple, safe, bloodless procedure best for babies 2 weeks to 5 months old. - The procedure involves clamping the foreskin with forceps to cut off blood flow before severing the foreskin. This makes it a bloodless procedure. - It has minimal pain, a short exposure time, and allows for varying shaft sizes. Complications are rare if done properly. - The method can also be used to correct poorly done
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PAUL'S CIRCUMCISION
- 1. DR PAUL JESUYAJOLU MBBS,DFM, PGD 6TH MAY, 2016 PAULS CIRCUMCISION METHOD
- 2. HISTORY OF CIRCUMCISION The Origin of circumcision is really not known Evidence suggest Ancient Egypt Socio-Cultural reason: Africa( Niger-Congo Areas of Africa) Kisiis people in Kenya, SA Zulus, Senegal and and around Gambia Cross Rivers in Modern Nigeria(6-7,000yrs ago)
- 3. Determinant of Circumcision 1. RELIGEON( account for about 30%) 2. CULTURE(mainly Africa) 3. SOCIAL NORMS( plays a vital role) 4. MEDICAL(The least factor and even now debatable)
- 4. DEMOGRAPHIC PERSPECTIVE Most circumcision occur under 1 year In East & Southern Africa, it is usually done as a right of passage into adulthood. In Nigeria, it is mostly done under 1year but there are situations where it can be delayed for anywhere between 1-25years and more.
- 6. DEMOGRAPHY CONTINUE The un-shaded areas shows reports of circumcision figures less than 20% of the population Yellow show figures of between 20 60% Orange is 60 -80% Red is over 80%
- 7. Perceived benefit of circumcision Improved penile hygiene Protection against STI, HIV. Female sexual preference & attraction Social influence and Cultural imperative
- 8. OTHER METHODS OF CIRCUMCISION 1. Surgical Methods: a. Dorsal Slit-Sleeve method b. Excision-ligation method c. Pauls Method 2. Non-Surgical Methods: a. Circumplast b. Plasibell c. Gomco clamp d. Mogen clamp etc.
- 9. THE TEAM The Surgeon A Nurse assistant A ward maid for errand.
- 10. INSTRUMENTS: A small instrument Tray. A galley pot A medium size kidney dish. A bottle of Olive Oil
- 11. 3 nos artery forceps preferably number 3 A bone Crushing forceps A small sterile pack. A tongue depressor or a wooding spatula. INSTRUMENT continue
- 12. A tiger Blade. A pair of sterile glove [Over the years we have been using Latex glove with the same outcome]. INSTRUMENT continue
- 13. Welcome
- 14. BLOODLESS1 SAFE2 AFFORDABLE3 PAULS CIRCUMCISION METHOD:
- 15. Key advantages of Pauls method: Simple Cost effective Safe and Bloodless
- 16. PROCEDURE: The baby is placed back down and face up with his head towards the assistant. The assistant stand facing the surgeon on the other side of the couch. The assistant will grab the babys thighs in a double flexion externally rotated position to give good access to babys genitalia.
- 17. Procedure continue: Babys genitalia cleaned with salvlon. A skin mark is place just below the glans impression using an artery forceps. The urethra orifice is dilated to allow forceps introduction
- 18. Procedure Conti Forceps is introduced Prepuce free from the glans
- 19. PROCEDURE continue The glans is milk down Prepuce held between the left thumb and index finger.
- 20. .Procedure Conti Bone Crushing forceps(BCF) introduced Clamped firmly just above the gland Moderate pressure is applied for btw 2- 3minutes
- 21. PROCEDURE continue With a tiger blade The redundant skin is severed Pressure sustained on the BCF for 1-2minutes before release
- 22. PROCEDURE continue Pressure on bcf maintained for 1- 2minutes more after the removal of foreskin
- 23. PROCEDURE continue The BCF is released The sealed skin is priced open The glans is popped out Dressing done with a strip of gauze soaked in olive oil. Gauze is taken off the second day
- 24. PROCEDURE continue The glans is gently popped out and the skin pushed down with a thin(about 1cm) clearance below the glans
- 25. Circumcision just concluded The clearance should be obvious here. Pauls Method make rooms for various shaft sizes Minimal pains and shorter time of exposure to painful experience
- 26. PROCEDURE continue A thin strip of gauze soaked in Olive oil is used as the dressing. The dressing comes off by the third day Thereafter the wound is dabbed with generous Olive Oil daily until full healing btw 7-10days
- 27. PROCEDURE continue The baby requires no antibiotics and no antipyretics.. But some mothers do press for pcm syrups
- 29. COMPLICATIONS: Glans amputation Heamorrhage Infection(rare) Erectile Dysfunction Excessive skin loss Insufficient skin removal Swelling Delay wound healing
- 30. Risk of Un- Circumcision Cancer of the penis. Stds e.g Hiv Infection of the Penis Phimosis & UTI
- 31. Shoddy Job Not enough skin taken Social burden Usually from TBAs We see many on a daily basis.
- 32. SUMMARY Pauls Method is an adaptation of the old Excision/Ligation method. Best at ages 2weeks 5months and sometimes older babies with small penile shaft . Neat, safe, simple & bloodless procedure It can be use to correct shoddy jobs Easy mastery after a few attempts.
- 33. CONCLUSION: Male circumcision is an old surgical procedure Origin traceable to Egypt It is a practice that has a universal appeal mostly among educated families around the world. Neonatal circumcision is more popular than adult circumcision and Has fewer complication than adult circumcision
- 34. CAVEAT Studies are on-going to see if circumcision affects male-male sexual transmission of HIV. Circumcision is not recommended for men living with HIV. It is important to use condoms and get tested for HIV even if the man is circumcised. Safe sex is advised for all and at all times
- 35. Reference: Wikipedia: Male Circumcision. Sorells, M. et al, Fine-Touch Pressure Thresholds in the adult Penis BJU Intnl 99(2007:864-869. How Male Circumcision Harm Women, By Ronald Goldman, Ph.D. Magoha GAO. Circumcision in various Nigerian & Kenyan Hospitals. East Afr med J 1999; 76:583-6pmid: 10734511. Jump up Encyclopaedia Britanica, 10th Edition(1902), article about Circumcision. Un-published work and 24years experience of the Author. WHO & Joint UN Joint Programme on HIV, @007
- 36. THE END.