Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) takes longer (3 to 4 months). It is best to avoid sexual intercourse or masturbation for the first four to six weeks after circumcision. It is very important to use a condom during sexual intercourse to protect the healing wound for at least six months after the operation. It is always wise to use a condom whenever there is any risk of STI or HIV infection. Contact number for emergencies. __________________________________________________ __________________________________________________ Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-22
Male circumcision under local anaesthesia Version 3.1 (Dec09) Appendix 3.3 SAMPLE CERTIFICATE OF CONSENT FOR ADULTS AND ADOLESCENTS My name is ______________________________ (BLOCK CAPITALS) I am asking you to do a circumcision operation (removal of my foreskin) on me. I give you my permission to do this operation. Signed ……………………………………………………… (client requesting circumcision) If the patient is too young to give legal consent, the form should be countersigned by a parent or legal guardian. I am the parent/legal guardian. I am asking you to do a circumcision operation on my son/ward and I give you permission to do this operation. Signed ……………………………………………………… (parent or guardian requesting circumcision on behalf of a minor) My name is ________________________________ (BLOCK CAPITALS) I am the counsellor/surgeon who has given information to the above client. I have given information about: • what circumcision is; • the benefits of circumcision; • how circumcision is done; • the risks of circumcision; • what to do before circumcision; • what to do after circumcision; • what to do if there are any complications or problems after circumcision; • an emergency contact number and information about where to go in an emergency; • why it is important to use condoms after circumcision. I have given the client an opportunity to ask me questions about all the above. I have asked the client some questions to make sure that he understands the information I have given. To the best of my belief the client is capable of giving consent and has enough information to make a proper decision about whether to proceed with the operation of circumcision (removal of the foreskin). Signed ……………………………………………. (Circumcision clinic counsellor or surgeon) Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-23
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Manual for Male Circumcision under Local Anaesthesia

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