Preparation

Boys & Teenagers

9-15 years

Preparing Boys & Teenagers

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For older boys and teenagers we use the forceps-guided technique, sleeve technique or freehand technique. We perform the procedure with either stitches or suture-less 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 on the skin and is cosmetically more attractive.

This procedure is performed while 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.

Please note that for boys older than around 6 to 7 years of age we routinely do not recommend using the plastibell or circumplast techniques as at this age the penis is normally larger than the largest ring sizes. In addition, even if the ring can be fitted the rate of complications including failure of the ring to fall off as well ring migration are much higher and hence it is normally better to opt for a traditional cut and stitch method.

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.

For older boys and teenagers, often the reason for performing a circumcision is a religious or cultural one. There are however, further indications for having a circumcision.

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)

It is important to speak with your doctor about why a circumcision is being recommended to you.

Since your son is likely to be old enough to understand why and how the circumcision is to be performed, it is very important to fully explain the procedure to him and why you feel he needs to have it done. It really is vitally important to be honest with your child, otherwise, they will lose trust in you and the medical profession. With regards to your explanation of the procedure it is important to be precise and where appropriate very thorough. We, of course, will help during your consultation prior to having the circumcision.

Emotional preparation for parents is also extremely important as this will influence in many ways how your son will do during the procedure.

Your son will be nervous about the procedure. Hence if you are at your wit’s end and failing to control your own emotions you won’t be helping your son to settle. It is important to try to stay calm and focus on being there for your son. From our experience of over 6,000 circumcisions, anecdotally, we have noticed that very anxious parents go hand in hand with children who do not cope well with the whole experience. So ‘KEEP CALM AND CARRY ON’.

In the majority of cases, we will insist that parents are present during the procedure – this gives a great deal of confidence and comfort to the child undergoing the procedure. Seeing a familiar face or hearing a familiar voice is reassuring to your child. In the absence of any family members in the operating room, we will be reluctant to carry out the circumcision.

During the procedure, it is essential that parents use different forms of distraction to keep their son’s focus away from the operative site. Hence we actively encourage the use of phones and tablets for watching their favourites TV shows, reading or listening to music. At Circumcision Pro, we have made every effort to ensure the operating room is as child-friendly as possible and where necessary we will provide suitable distraction tools.

Where children are involved parents give consent for the circumcision. Despite your son not being above the age of formal consent (aged 16 years or older), this does not mean he has no say in consenting to the procedure. At the consultation, if there is clear evidence that he fully understands the procedure and is capable of making sensible decisions (often referred to as being Gillick competent), and he outright refuses to have the procedure we will be forced to defer or cancel his circumcision. Gaining and maintaining his trust, and ensuring he is involved in the consent process is paramount in order to allay his fears and also to ensure the experience is not distressing for all parties concerned. It is well documented that excessive levels of anxiety preoperatively can be associated with greater distress after the procedure.

At Circumcision Pro, we do everything possible to make your son’s procedure as comfortable as possible. On arrival to the clinic, we will apply topical anaesthetic cream to the area around the base of the penis and leave this in place for 20 to 30 minutes. This will numb the surface of the skin.

Prior to the procedure, if your son is very anxious, we can also administer some premedication consisting of an oral dose of midazolam and paracetamol. This will help with pain control and also help to settle him down. Understandably he is likely to be nervous.

We use a local anaesthetic block to numb the entire penis. Your son will feel the initial sting of the anaesthetic being injected into the base of the penis but this should last for no more than 30 to 45 seconds. The local anaesthetic will take effect within 6 minutes and should last for approximately 2 hours. The local anaesthetic administered is a 50:50 mix of lidocaine (short-acting) and chirocaine (long-acting).

There will be some discomfort for the next couple of days and your son will require regular painkillers such as paracetamol and/or ibuprofen.

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