Boys & Teenagers
Under Local Anaesthetic
Under Local Anaesthetic
8 -16 years
It is quite common for parents to get their son’s circumcised at an older age and during their teenage years. This is very different to getting them circumcised at a younger age or as babies. At this age it is very important to get them involved in the process as much as possible. Although parents are required to give consent it is essential to listen to your son’s thoughts and opinions. At Circumcision Pro our surgeons are extremely professional and take great care to counsel all patients and their families prior to performing the procedure.
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.
Emotional preparation for parents is extremely important as this can have an influence on the child’s experience of the procedure. First and foremost, it is extremely important that both parents are happy to go ahead with their son’s circumcision and that they are happy with the timing. Any disagreement regarding going ahead with the procedure will be a flashpoint before, during and after the procedure and can potentially have a negative impact on the whole experience. This is especially important in mixed-race families where the practice of circumcision is alien to one of the parents. Ensure that you have discussed the procedure amongst yourselves and you are both fully committed to going ahead with it. At Circumcision Pro, we are very keen to ensure that both parents are comfortable with the consent process. If we feel that either parent is uncomfortable then we will not proceed with the circumcision.
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 favourite 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 to calm him down. 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 short-acting and long-acting anaesthetic.
There will be some discomfort for the next couple of days and your son will require regular painkillers.
Understandably some boys are extremely anxious when it comes to having a circumcision under local anaesthetic alone. In cases where boys are very anxious and don’t feel they will be able to tolerate the procedure under local anaesthetic we are now able to offer Circumcision under Sedation. We are the only Circumcision Clinic in the UK able to offer this.
In the majority of cases we perform the circumcision under local anaesthetic alone. This means we numb the penis with an anaesthetic injection and following this nothing is felt at all. The boys are completely awake and aware of what is going on and we usually encourage distraction by watching an Ipad or listening to music.
For some boys, understandably this is extremely distressing despite not being able to feel anything. In this case we are able to perform the circumcision under sedation. This means they are given medication to reduce level of consciousness without making them completely unconscious. At the end of the procedure once they have recovered from the sedation they will have no recollection of the procedure. For further information please look at our Circumcision Under Sedation section.
For older boys and teenagers 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 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.
On the day
You need to arrive at the clinic one hour before the circumcision for your son to have topical anaesthetic cream applied.
On the day, we will first explain the procedure and discuss any potential complications. Then, we will go through the details of the immediate aftercare and provide contact details should you have any further questions once you get home. You will have our support through every step of the process.
We will need both parents to sign the consent form with verbal approval noted from your son.
The circumcision is carried out in 2 steps. Initially, he will be taken to the operating room to have the local anaesthetic nerve block administered. We will then allow the anaesthetic to take effect and subsequently call you back in for the main procedure. The procedure is likely to take around 45 minutes to 1 hour.
If the circumcision is carried out under sedation your son will initially be met by Dr Swart (our sedation doctor) and Nurse Joanne Delaney who will keep him calm and start the sedation process. Once relaxed and slightly asleep the local anaesthetic nerve block is administered. Your son will remain in the operating theatre until the procedure is completed and he has recovered from the sedation. The entire process under sedation takes slightly longer – around 90 minutes to 2 hours. Whilst under sedation parents and family members are not allowed in the operating theatre.
For further information on Circumcision under Sedation please refer to the Sedation section.
Once we have completed the circumcision we will ask you to remain in the clinic for a further 15 to 20 minutes so that we can check to ensure there is no bleeding. We will also answer any final questions and concerns you may have. You will be given access to our 24/7 aftercare service, allowing you to return home with your minds at ease.
Your son 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 he 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.
Your son 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.
Do not soak or scrub the wound whilst showering, gently blot the area to dry it using a soft towel.
Your son 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.
Erection, 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 your son empties his bladder before retiring and a few times during the night.
A week off school is very desirable. He should naturally avoid energetic or contact sports, cycling and swimming until his circumcision has fully healed. This normally takes about 6 weeks.
FAQ's: Boys & Teenagers
Every patient reacts differently to anaesthetic and there is no definite rule as to when your son should return to school. Most take at least a week off. Many parents often opt for their sons to be circumcised during the school holiday, this way there is little disruption to their academic and sporting activities. In addition, it also means your son is not having to explain his treatment to other colleagues at school – something he may find awkward and embarrassing. They also have ample time to rest and recover during the school holidays. Please do not let your son return to sporting activity for at least 4 weeks after the operation.
We recommend planning ahead and ensuring you call and book your appointments with the clinic well in advance to avoid disappointment.
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.