1. DR PAUL JESUYAJOLU MBBS,DFM, PGD
6TH MAY, 2016
PAUL’S 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)
• Kisii’s 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.

5. DEMOGRAPHIC DISTRIBUTION

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. Paul’s 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
PAUL’S CIRCUMCISION METHOD:

15. Key advantages of Paul’s 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 baby’s thighs in a
double flexion externally
rotated position to give
good access to baby’s
genitalia.

17. Procedure continue:
• Baby’s genitalia
cleaned with salvlon.
• A skin mark is place
just below the glan’s
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.
• Paul’s 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

28. Proficiency
NoofCircumcision
Onset
Achieve
Mastery
Working Toward Mastery
Experienced

29. COMPLICATIONS:
• Glan’s 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 TBA’s
• We see many on a
daily basis.

32. SUMMARY
• Paul’s 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 Intn’l 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.