16 years+ (glue)
At Circumcision Pro we are an inclusive clinic and understand that there are many reasons why an adult male may wish to get circumcised. Medical indications for a circumcision in adulthood are more common than in children. There are a number of medical conditions that require a circumcision for resolution of symptoms.
Others may be seeking a circumcision for lifestyle reasons such as religious and cultural preferences or perhaps even for their partner. Many consider a circumcised penis to be aesthetically more pleasing and hence opt for this procedure. Whatever the reason, we are here to help and provide you with the best available care.
Aside from religious reasons, cultural reasons and lifestyle choice, circumcision may relieve certain medical problems. The most common medical complaint is a tight foreskin. A tight foreskin can cause:
- Problems with passing urine and/or recurrent urine infections.
- Pain during sexual intercourse.
Often the cause of a tight foreskin (or phimosis) is a condition called Balanitis Xerotica Oblitarans (BXO). BXO is inflammation of the glans (head of the penis) and can be the result of skin irritation or recurrent infections. It is associated with skin conditions including lichen planus, eczema, psoriasis and dermatitis. Persistent inflammation from irritation or an allergic reaction can be treated with mild topical steroids. However, if this persists the foreskin can become very tight and scarred.
Fungal and bacterial infections can also be responsible and require topical antibiotics and antifungal creams. Balanitis can also be the result of sexually transmitted infections and has a strong association with the spread of HIV.
Symptoms and signs of balanitis include tight, shiny skin on the glans, redness around the glans, Inflammation, soreness, itchiness, or irritation of the glans, a thick, lumpy discharge under the foreskin, an unpleasant smell, tight foreskin that cannot be pulled back, painful urination, swollen glands near the penis and sores on the glans.
It is important to speak with your doctor about why a circumcision is being recommended for you.
How is the circumcision performed?
For adult male circumcisions, we use the forceps-guided technique, sleeve technique or freehand technique. We perform the procedure with either stitches or sutureless circumcision – 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 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.
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 more of a minor procedure than a circumcision. The foreskin is cut and stitched to widen it.
- Your surgeon can explain these treatments if they are suitable for you
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.
There are a number of different, well recognised, styles of circumcision. Some of the variations in circumcision have medical benefits whereas others are purely for aesthetic reasons. At Circumcision Pro we can cater for most styles of circumcisions.
On the day
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 short-acting and long-acting 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.
After Care for Cut & Stitch
You will receive a local anaesthetic nerve block to numb the penis before his circumcision. This nerve block should last for at least 60 to 90 minutes. For this period you will not feel any pain.
After the operation the penis will be swollen and look very bruised. This is a normal effect of both the injected anaesthetic and the handling it receives during the operation. These will gradually reduce over the next week or two.
The bandage will normally be wound tightly around the penis and it will consist of some simple gauze. We advise that you try to keep this in place for the first few days. If it comes apart you can obtain sterile gauze swabs (4 pack) and micropore tape from your pharmacy or GP practice nurse if you require anymore.
You will receive absorbable stitches and hence these do not need to be removed. They will fall off themselves. Please do not pull at the stitches.
The glue will get absorbed in 5 to 10 days and will naturally fall off the skin. Do not apply liquid or ointment medications or any other product to the wound whilst the glue is still in place.
Avoid having a bath for the first few days. Do not soak or scrub the wound whilst showering. Gently blot the area to dry it using a soft towel.
You may need to take pain killers for a few days afterwards. Please follow the instructions on the packet. Do not take aspirin or any other medicine which may thin the blood and have an anti-clotting action which can increase bleeding from a wound.
Erections, particularly soon after the operation, can result in excessive pulling on stitches and also cause some bleeding. To reduce the effect of night erections pulling on the wound or bleeding during the first few days, ensure you empty your bladder before retiring and a few times during the night.
When can I return to work?
Every patient reacts differently to the 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 at least 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 and do not play any sports for 4 weeks after the operation.
A week off work is very desirable. You should also avoid energetic or contact sports, as well as cycling and swimming until your circumcision has fully healed. This normally takes about 6 weeks.
Please do not have sexual intercourse for four weeks after the operation. This will:
- Allow your wound to heal
- Help to avoid infection
- Lower the risk of bleeding.
If there are any abnormalities such as Hypospadias or a severe buried penis then circumcision will not be 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 to the wound 3 times a day in the week following the procedure.
At Circumcision Pro, we believe our clients are clients for life and we are always on hand to help answer your questions and address your concerns. 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 aftercare instructions, a letter to be handed into your son’s GP stating what specific procedure has been performed as well as our 24/7 contact details.