What is circumcision?
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.
Is circumcision safe?
Yes. Out of the thousands of circumcisions carried out, there are only few cases of complications.
The risks of circumcision are:
- Bleeding (2%)
- Infection (2%)
- Meatal stenosis (Scarring and narrowing at the opening of the tip of the penis).
- Initial hypersensitivity of glans followed by reduced sensitivity after 6 weeks.
- Dissatisfaction with the appearance of the circumcised penis.
Complications from a circumcision are rare, but they can occur. Complications generally are less likely to occur if the circumcision is done by someone well trained in the procedure in a medical setting.
We advise clients to arrive at the clinic at least 1 hour before their procedure. You will initially have a consultation with our surgeon at which point he will examine your penis to ensure there are no anatomical abnormalities that will prevent us from going ahead with your circumcision. At this point we will also discuss the procedure in depth with you and go through the aftercare as well as advise you regarding all potential complications.
The circumcision is performed in 2 steps. Initially you will be taken into the operating theatre and the local anaesthetic nerve block will be administered to completely numb the penis and ensure you do not feel any pain at all during the procedure. The local anaesthetic consists of three injections at the base of the penis. These will sting and cause some discomfort but should only last for approximately 30 to 45 seconds and are generally very well tolerated. The anaesthetic will take effect within 10 minutes and should last for almost 2 hours. You will not feel any pain during the procedure and we will ensure the anaesthetic is working prior to starting. The local anaesthetic used is a 50:50 mixture of lignocaine (short-acting) and chirocaine (long-acting). There is no adrenaline used in the local anaesthetic.
The circumcision is performed as briefly described above. The procedure will take around 1 hour. There is a nurse assisting our surgeon. Should you feel uncomfortable with a female nurse being present during the procedure please let us know in advance and we will make every attempt to ensure we have a male nurse present to assist instead. We advise clients to bring a book or tablet to read, listen to music or watch a movie during the procedure. This will make the whole experience more comfortable for yourself.
We will ask you to remain in the clinic for 20 to 30 minutes after the procedure such that we can check to ensure there is no bleeding and also to review the aftercare instructions with you and answer any further questions you may have.
Mr Irfan Halim
MBBS MSc FRCS GDipLaw DIC MBA
All minor surgery services at Rejuvence Medical are provided by Mr. Irfan Halim. Mr Halim is a Consultant General Surgeon. He has a specialist interest in gastrointestinal and laparoscopic surgery as well as endoscopy.
Qualified from Guy’s and St.Thomas’ Medical School with Distinction, Mr Halim subsequently trained in General Surgery sub specialising in Laparoscopic Gastrointestinal Surgery. He is blessed with fantastic surgical skills and always strives for the best possible outcomes. Mr Halim provides a bespoke treatment package for all his patients.
Mr Halim is extremely well sought after, practising at several highly prestigious private establishments including BMI The London Independent Hospital, The Blackheath Hospital, BMI Hendon Hospitals as well as Highgate Hospital. He performs a large number of cases, seeing 300 new patients a month and performs on average more than 1200 procedures per year. His outcomes are excellent and regularly audits his work. Friends and family as well as colleagues always favour Mr Halim over others. We are so pleased to have him as part of the team at Rejuvence Medical. You really could not be in better hands.
For adult male circumcisions we use the forceps guided technique, sleeve technique or free hand technique. We perform the procedure with either stitches or dermabond glue. We are now offering skin glue as an alternative to sutures. This method of skin closure has significant advantages in terms of less postoperative pain, faster recovery and no stitch marks. The cosmetic result is excellent & superior to sutures. The suture-less method is preferred by many as there are then no stitch marks seen in the skin and is cosmetically more attractive.
This procedure is performed under a local anaesthetic and patients are comfortable immediately after the procedure and can travel home as soon as the surgeon has performed a post-operative check. Glue will slough off within 10 days and stitches dissolve in 2 to 3 weeks time.
The procedure will take between 45 to 60 minutes to perform. You can expect to be in the clinic for around 2 hours to allow for the consultation and post-operative observation.
Aside from religious reasons, cultural reasons and lifestyle choice, a circumcision may relieve problems such as a tight foreskin that:
- Is causing problems with passing urine and/or causing infections. Sometimes the cause of the tight skin or phimosis is a condition called Balanitis Xerotica Oblitarans (BXO)
- Is causing pain during sexual intercourse.
Under some circumstances, other treatments may be considered but circumcision remains the most common treatment option to relieve your symptoms. Alternatives to a circumcision include:
- Frenuloplasty – this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis. If the frenulum is short or torn, you may have problems pulling your foreskin back.
- Dorsal slit – in this procedure the foreskin is cut to widen and loosen it, so it can be pulled back more easily.
- Prepuceplasty – this is a more minor procedure than a circumcision. The foreskin is cut and stitched to widen it.
We can discuss these alternatives with you in clinic.
We use local anaesthetic to numb the area. You will not feel any pain during the procedure. The anaesthetic will last for approximately 2 hours. Thereafter you will have some discomfort for the next couple of days and will require regular painkillers such as paracetamol or ibuprofen. Night time erections in the immediate post-operative phase can be extremely uncomfortable and also risk breaking stitches or pulling apart skin edges that have been glued together. In order to minimise this risk we suggest ensuring you have emptied your bladder completely prior to going to bed.
Every patient reacts differently to anaesthetic and there is no definite rule as to when you should return to work. Most people take a week off, although this will depend on your recovery and the type of work that you do. If you work in an office, you should take at least two to three days off after your operation. If your job involves manual labour, please do not work for a week after your operation. Have some rest to help you to heal and to let the anaesthetic wear off properly.
Please do not return to work until you feel ready to do so. Please do not play any sports for 4 weeks after the operation.
Please do not have sexual intercourse for four weeks after the operation. This will:
- Help your wound to heal
- Help to avoid infection
- Help to lower the risk of bleeding.
If there are any anatomical abnormalities such as hypospadias or severe buried penis then circumcision is not performed. Hypospadius is when the opening to the urethra (where urine exits from) is not at the tip of the head of the penis but instead is running along the base of the head of the penis and in some cases the shaft. A buried penis is defined as when there is a large amount of pelvic fat sitting just behind the base of the penis and gives the illusion of the penis being shorter in length than it actually is. The result is that it is partially or completely hidden below the surface of the skin.
We do not routinely prescribe antibiotics after the procedure. We do, however, prescribe you an antibiotic cream to apply over the wound 3 times a day, everyday for the next 1 week.
At the initial consultation we will go through the entire aftercare process with you. We will also provide you with a comprehensive pack consisting of relevant prescriptions, a summary sheet of the after care instructions, a letter to be handed into your GP stating what specific procedure has been performed as well as our 24/7 contact details. At Rejuvence Medical we believe our clients are clients for life and we are always on hand to help answer your questions and address your concerns.