
Overview
This module describes how to anaesthetise the penis using a subcutaneous ring block.
Indications
Penile anaesthesia for minor procedures
Contraindications
Overlying infection
Patient information and consent
Always verify your patient’s identity and obtain informed consent before proceeding.
How do I explain this procedure?
“I need to give you an injection that will stop your penis from feeling pain while we do the procedure.”
What can my patient expect?
“I am going to prick your skin three times with a needle and inject numbing medication around the base of the penis. Each injection might sting a bit, but after that your whole penis will be numb for a short while. The numbness will wear off by itself.”
What is my patient’s role?
“Let me know if you have any allergies. Fearing blood or needles is normal, but tell me if you have fainted from it. Try to keep still while I give you the injections.”
Preparation

Documentation
Patient notes
Equipment
- Non-sterile glovesNon-sterile gloves
This procedure may be done as part of a surgical procedure, in which case surgical skin preparation, draping, scrubbing and gowning, and sterile gloves would be used.
Alcohol-based hand rub
- Sharps containerSharps container
If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.
10 ml syringe, alcohol swab, aspiration needle (ideally blunt fill), injection needle & choice of
local anaestheticlocal anaestheticIt is current best practice to avoid the use of adrenaline in the penis and digits due to concerns of ischaemia; however, this seems to be controversial in the literature.
Alcohol swab
Site & Positioning
Position the patient supine.

Procedure
Follow medical asepsis with non-sterile gloves.
Perform hand hygiene and don non-sterile gloves.
Clean the skin around the base of the penis with an alcohol swab and allow it to dry.
- local anaestheticlocal anaesthetic
Remember to calculate the maximum dosage of local anaesthetic.
in a 10 ml syringe.
Insert the needle into the 12 o’clock position at the base of the penis. Guide the needle towards the lateral aspect of the base of the penis.
Aspirate to check for blood.
While withdrawing back to the skin, inject ¼ of the local anaesthetic.
Staying just under the skin, guide the needle to the contralateral side of the penis.
Aspirate to check for blood.
While withdrawing back to the skin, inject ¼ of the local anaesthetic.
Insert the needle into the 3 o’clock position. Guide the needle inferiorly to the
6 o’clock position6 o’clock positionInserting the needle directly at the 6 o'clock position is not recommended as there is a risk of urethral injury.
.
Aspirate to check for blood.
While withdrawing back to the skin, inject ¼ of the local anaesthetic.
Insert the needle into the 9 o’clock position. Guide the needle inferiorly to the 6 o’clock position.
Aspirate to check for blood.
While withdrawing back to the skin, inject ¼ of the local anaesthetic.
Wait 5-10 minutes.
Dispose of medical waste safely.
Record the completion of the procedure in patient notes.
Troubleshooting
My patient is still feeling pain.
Make sure you wait a full 10 minutes before testing the patient’s sensation. If there is still pain, make sure you injected enough anaesthetic into the entire area. Check the anaesthetic expiry date. Local infection can also reduce the effectiveness of local anaesthetics. Rarely, some patients may be resistant to local anaesthetics.
Risks
Minor pain, bleeding & haematoma
Intravascular injection of local anaesthetic
Allergy to local anaesthetic
Penile ischaemia
Local infection
Sharps injury to healthcare provider
References
Palinrungi MA, Palinrungi ALR, Christeven R, Faruk M. Penile Ischemia as a Complication of Epinephrine Use in Penile Nerve Block: Truth or Myth?. Res Rep Urol. 2021;13:553-555. Published 2021 Aug 4. doi:10.2147/RRU.S308428
Holman JR, Stuessi KA. Adult circumcision. Am Fam Physician. 1999;59(6):1514-1518.
World Health Organization. Circumcision Methods for Adolescent Boys and Men. In: Manual for Male Circumcision Under Local Anaesthesia and HIV Prevention Services for Adolescent Boys and Men. 2009.
Rosen DA, Broadman LM. Ring Block of the Penis: A Proven Addition to Multimodal Pain Relief for Newborn Circumcision. Pediatrics. 2017;140(6):e20172678; DOI: 10.1542/peds.2017-2678