The principal of Circumcision Australia group of doctors is Dr Terry Russell OAM. Dr Russell was the first doctor in Queensland to use the Plastibell device, and he pioneered the use of anaesthetic cream in Australia for a safer, more comfortable circumcision. His research forms the basis for current best-practice.
Dr Russell, Dr Loth, Dr Gilbert, Dr Hupfeld and Dr Cahill are located in Brisbane, Queensland.
Since starting the use of topical anaesthetic cream in 1993, the circumcision Australia group of doctors have performed over 47,000 circumcisions using topical anaesthetic cream and the Plastibell. Dr Terry Russell is the only doctor ever appointed a mentor of the R.A.C.G.P for the teaching of circumcision. He has four children and fourteen grand-children of whom he is very proud.
meet the team
RUSSELL MEDICAL CENTRE…
Lets us help
Our friendly staff will help guide you through the entire process of making your visit to our practice as smooth as possible.
Circumcision is a simple surgical procedure that removes the foreskin – a sleeve of skin covering the end of the penis. Parents in Australia have the legal right to authorise circumcision. In order to make an informed decision, you must carefully consider the benefits and risks.
THE FOLLOWING ADVICE APPLIES ONLY TO CIRCUMCISIONS PERFORMED AT OUR PRACTICE AND NOT TO CIRCUMCISIONS PERFORMED ELSEWHERE
How to Apply Cream
Science Supports Infant Circumcision
Circumcision of Males
AAP Position Statement
Circumcision as a lifetime vaccination with many benefits
Should newborns be circumcised?
60 Minutes – Fore and Against
Circumcision on The Rise
How to Apply Cream Prior to Procedure
The following video shows how to correctly apply LMX4 cream to the penis prior to circumcision.
The procedure involves the use of the Plastibell, a small ring that fits inside the foreskin, over the tip of the penis. A ligature is fitted on the outside of the foreskin, so that the foreskin is compressed between the ring on the inside and the ligature outside. Advantages of the Plastibell
- The clamping cuts off the circulation to the foreskin so that it should not bleed.
- Because the circulation is cut off, it is difficult for infection to ascend beyond that point.
- The clamping also cuts off the nerve supply so that it should be quite painless afterwards.
- Because the Plastibell is sitting on the head of the penis, it accurately defines the level at which the circumcision occurs.
No dressings are necessary. You can bathe him normally, and the ring separates of its own accord usually three to seven days days later. Risks of conventional circumcision
- “Botched” surgery
The Plastibell is effective in minimising all of these problems. Anaesthetic cream is an effective and safe form of anaesthesia for circumcision, but the cream must be applied two hours before the procedure with correct application being essential for a successful result.
Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis.
Read full Article http://www.ncbi.nlm.nih.gov/pubmed/23201382
Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?-A Systematic Review.
Read full Article http://www.ncbi.nlm.nih.gov/pubmed/23937309
Science Supports Infant Circumcision So Should Skeptics
Read full Article Morris_SkepticUK_2013.pdf
Removal of the foreskin is part of the Plastibell procedure, so that when the procedure is over, circumcision is complete. Before the circumcision a generous amount of anaesthetic cream should be applied to the whole outside of the penis from base to tip so you can’t see any skin. Once that area is thickly coated with cream, wrap with cling-wrap (to keep the cream in place and not out in the nappy where it is wasted). The cling-wrap must be left open at the free end so that urine can pass through. It is important to check the cream once or twice over these two hours and add more if necessary. The cream is slowly absorbed over that two hour period so that if he has had lots of cream on for two hours he should not feel any pain. Important – Please read: Some people are under the impression that there is no cutting involved and that is not so. It is normal practice to cut off the surplus foreskin however not until after the circulation is cut off. If that is not done there is more chance of infection as it is too difficult to keep clean. Last Advice: Please try not to feed him for two hours before his circumcision. That way, he is less likely to wee, or poo, or throw-up, and also a feed immediately afterwards will help settle him down rapidly.
Advice to parents – What next?
You can bathe him as you would normally, even as soon as you get home if you wish. It is a good idea to leave him without a nappy after his bath to let the air get to it and dry it out and then you should apply some Vaseline.
Apply the Vaseline twice daily.
Applying the Vaseline
The Vaseline being greasy acts as a cushion between the head of the penis and the ring to minimise rubbing. The Vaseline should be applied down the inside of the ring, round the head of his penis and round the outside as well. Use a cotton bud to spread the Vaseline inside the ring.
The ring will separate of its own accord. This usually takes between three and seven days, although it can come off sooner, it can hold on longer. It doesn’t matter how long it takes, you simply continue applying theVaseline for a day or two after the ring comes off.
After the circumcision has healed
After the circumcision has healed it is usually necessary to separate the shaft skin from round the head of the penis. If that is not done, smegma can accumulate under the adherent skin. That is why it is so important that he should return for review after the circumcision has healed.
Smegma is a mixture of old mucus and dead skin cells. It always accumulates under the foreskins of uncircumcised boys. It acts as a focus for infection, but even more importantly it is the presence of smegma when they are young that predisposes to cancer of the penis later in life. The biggest single advantage in having him circumcised is that it is now easy to keep clean, and when he is old enough to shower himself, it should be totally self-cleaning.
Check for fresh bleeding, and if this occurs in the first 24 hours, please phone immediately because it just should not happen. Bleeding after the first 24 hours is usually only a drop or two and of no consequence.
The penis usually does get red and swollen. That is of no concern – it is just part of the normal healing process. That redness and swelling peaks when the ring is about to separate off and settles rapidly after the ring is off.
It is most important to bring him back after the circumcision has healed (about two – three weeks after the procedure). Do NOT neglect this.
If you have any concerns or worries, please contact us.
On the day of the procedure, keep your child quiet and rested. Don’t let him out of your sight until any sedative/anaesthetic is out of his system.
After the first day, it is important that your child resumes physical activity. Encourage him to play normally. Avoid any physical activity you consider risky or dangerous.
Firm, supportive underwear keeps the penis supported and toddlers must wear nappies.
If you think he has pain please follow the instruction sheet given after the procedure.
Many boys can develop a layer of “puppy fat” in front of their pubic bone. This “puppy fat” pushes the shaft skin forward so that it overhangs or covers the head of the penis.
The penis is anchored to the pubic bone and can get “covered” by the fat layer.
If that should happen with your boy, there will be a necessity, every day, when you bathe him, to push that shaft skin back firmly towards his pubic bone. This is for two reasons:
- If you can’t see it, you can’t clean it. Smegma will accumulate in the groove behind the head of the penis.
- Also, if those skin edges are allowed to remain in contact, undisturbed, for more than 24 hours, they can readhere.
Don’t be scared of it. You won’t have to do it forever. Most boys tend to lose that “puppy fat” with running around, riding bikes and simple exercise!
Unless parents direct otherwise, all removed tissue is forwarded to the Queensland Institute of Medical Research where it is invaluable for cancer research.
Q.I.M.R is a non-profit research organisation whose cancer research is recognised world-wide. Dr Russell has co-authored several research papers.
Circumcision of Males
Circumcision of males represents a surgical “vaccine” against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their life- time, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain-free and can be performed at any age.
The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia.
Circumcision has socio-sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis forappearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals.
2007 Wiley Periodicals, Inc
American Academy of Pediatrics Position Statement
From the American Academy of Pediatrics Technical Report
Task Force on Circumcision
Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.
Edgar J. Schoen
Think of newborn circumcision as a vaccination, a preventive health procedure which has lifetime benefits against not one, but many, medical disorders. The most significant protective effect of circumcision is against HIV/AIDS, a modern day plague that has killed over 20 million people in the past 20 years, and is now being carried by over 40 million men, women and children worldwide. Since the late 1980s over 30 separate clinical research studies have shown that circumcised men are significantly less likely to acquire HIV when exposed sexually to HIV-positive women then are men with intact foreskins. The evidence has become overwhelming since 2005 following the almost identical findings in three randomized clinical trials (RCTs), the gold standard of clinical research. Circumcision was 60% effective in preventing heterosexual HIV infection, a value equivalent to the protection afforded by many vaccines. The results of the RCTs were so convincing that all 3 studies had to be terminated early when it became obvious that it was no longer ethical to withhold circumcision from the control group. The US National Institutes of Health (NIH) and the World Health Organization (WHO) now recognize the powerful protection offered by circumcision and the potential for saving millions of lives. Both the WHO and the United Nations (UNAIDS) have recently advised that circumcision be added to current interventions to reduce the spread of HIV. Read Full Article.
Compelling published medical evidence, particularly over the past 20 years, has shown that circumcision offers protection against multiple medical conditions. The most important role of primary care physicians, particularly when caring for children, is preventive health care, as exemplified by childhood immunizations. Consider newborn circumcision as a vaccine that has a preventive health role against not one but many disorders. In chronological order from infancy through old age these include severe infant urinary tract infections (UTIs) during the first year of life; local penile infections (balanoposthitis) and mechanical retraction problems (phimosis) in childhood; sexually transmitted diseases, particularly HIV and AIDS, in young adults; and penile and cervical cancer in older adults. Circumcision makes genital hygiene easier throughout life. Read Full Article
It’s been going on for thousands of years but it’s still controversial. We are talking about male circumcision. Not only is it contentious, it’s confusing. Depending on who you speak to, rates of circumcision in Australia are both rising and falling. It’s either a life or death decision or a complete waste of time. The only certainty in this debate – it’s sure to raise hackles.
DR TERRY RUSSELL OAM
Dr Terry Russell is the principal of circumcision Australia. Dr Russell was the first doctor in Queensland to use the Plastibell Device.
Below is a list of commonly asked questions. Feel free to contact us for any inquiry.
What age is best?
85% of circumcisions involve boys under 6 months of age, but in general the younger the boy, the better.
What are the risks?
The risks of any surgical procedure are:
- Risk of bleeding
- Risk of infection
- Surgical mishap
- Anaesthetic complications
The Plastibell technique has proven effective at minimising all these problems.
If my child is circumcised, will he be the odd one out?
Approximately 50% of all boys born in the greater Brisbane district are being circumcised. Queensland-wide, about 15% of boys generate a claim against Medicare which is only for medically necessary procedures and does not include those done for preventative health, those done in public hospitals or traditional or ceremonial procedures.
How many have you done and have you had any complications?
- There has never been a significant bleed
- There has never been a transfusion
- There has never been a systemic infection
- There has never been a major cosmetic problem
- There has been one minor anaesthetic problem, which resolved spontaneously overnight
- Minor bleeds (drops, not mls) affect about 0.5 % of all boys and are easily treated in house
- Minor infections (purely localised) affect less than 2% of all circumcisions and are always treated in-house and often don’t need antibiotics
Should I be present in the room when my son is being circumcised?
No, this is not required or even a good idea. Having a parent present is a distraction for the doctor, and we minimise distractions so as to focus totally on “doing a good job”. Parents have a big part to play in applying and reapplying the anaesthetic cream prior to the procedure, and again immediately post-op in comforting and feeding.
Some people suggest we should wait till he’s older and have surgery under general anaesthesia?
- Is virtually a closed procedure
- Reduces the risk of bleeding
- Reduces the risk of systemic infection
- Accurately defines the level at which the circumcision occurs
- Can be performed out of hospital
- Is less traumatic to parents and child than a hospital admission
- Avoids exposure to hospital bugs
- Avoids the costs of an anaesthetist and theatre and day-bed fees
- Is less costly to the health system
- Frees beds for other cases
- Last but not least, when a general anaesthetic wears off, the pain is there. By comparison, the anaesthetic effect of the cream lasts for about four hours after the procedure, and by that time, the tissue beyond the ligature is dead, so that even afterwards there shouldn’t be any period during which the boy experiences pain.
What is the best method?
In Australia, 75 to 80% of all circumcisions are by the Plastibell technique. Most of those circumcisions Australia-wide are performed using some form of anaesthesia or analgesia. We will only perform a circumcision if it can be done with the Plastibell, and these are only made up to a size that will fit a boy at about puberty.
Is it painful for older boys?
Each year, we perform more circumcisions on boys aged 6 months to 10 years than any other practice in Australia, and a follow-up study, rated by parents, has shown that most boys have little or no pain either at the time of the procedure or post-operatively.
What if shaft skin is still over or adherent to the head of his penis when it has healed?
Please bring him back for a review. If that skin is adherent, we will separate it off. Do give him a salt bath/sponge followed by air drying when you get home from your follow up appointment and daily for two weeks. Add a handful of salt to a shallow bath, clean the newly-exposed area using a face washer if necessary. Air dry for another two or three days, while it’s a bit raw looking to make sure it doesn’t get infected. Then after that it is simply a matter of keeping it clean and dry.
CIRCUMCISION FAMILIES TRUST…
Our caring staff will work with you to answer all your questions..