incidence of circumcision 

In the USA, 75% of men are circumcised; however, 6% of men are circumcised in the UK. Jews and Muslims are circumcised as a part of their religious obligation. Historically, Christianity has had periods of both pros and cons. In most societies, males are circumcised at birth. Adults are circumcised if they have medical problems or cultural or personal reasons in our London clinics. 

Indications of adult circumcision 

General Indications

Several medical indications for adult circumcision are phimosis, paraphimosis, and Balanitis, and non-infectious causes include lichen sclerosis (also called BXO - balanitis Xerotica Obliterans), allergic dermatitis, trauma, and Zoon’s balanitis.

 
Phimosis is a condition in which the foreskin (also called prepuce) is unable to be reduced over the head of the penis (glans penis). This can result in pain with erection and intercourse. 

Diabetes is a risk factor for phimosis, recurring balanitis and BXO. 

Paraphimosis is a condition in which the foreskin can be retracted over the glans but stuck or tight behind the head of the penis. When there is a partially tight band at the inner skin of the foreskin, and the foreskin does not reduce naturally over the glans, the tight band acts like a constricted ring over the shaft of the penis. A history of recurring paraphimosis may result in a more tight foreskin, leading to swelling of the glans and significant pain. This may require urgent medical treatment. 

Balanitis is also a medical indication for circumcision. Balanitis is the infection of the glans penis. Balanitis may occur along with infection of the foreskin. This combination of infections is called balanoposthitis. 

The combination of phimosis and diabetes is a recognised risk factor for balanitis. Balanitis can be caused by both infectious and noninfectious causes. In the case of phimosis, fungal infection is also expected along with bacterial infection. Non-infectious causes include allergic dermatitis, trauma, and Zoon’s balanitis.

Sexually transmitted disease (STD) Prevention

Circumcision is a preventative measure against the spread of HIV and AIDS, as shown in many African studies. The inner preputial skin has special cells called Langerhans cells, which contain receptors for HIV. Removing most of the inner preputial foreskin by circumcision may prevent to prevent HIV viruses. Additionally, the inner preputial skin contains a little protective keratin layer relative to the outer foreskin, making it less mechanically resistant to injury, which may be a source of HIV. 

Lichen Sclerosis or Balanitis Xerotica Obliterans (BXO) 

Lichen sclerosis (LS) can affect both children and adult populations. LS has been known as lichen sclerosis or balanitis xerotica obliterans (BXO). The typical peak ages of presentation of BXO are 8–10 years of age and 30–50 years of age. The clinical presentation can be variable; however, the advanced classic appearance is atrophic white scarring. Purplish scaly scars, red abnormal blood vessels, tears, splits, and ulcerations have also been documented. The foreskin is the largely common site of involvement; however, it can affect the glans, wee hole (meatal opening), and wee tube (urethra).  Symptoms can vary according to the different areas of involvement. Please see further information for BXO. Circumcision in men is a medical indication for BXO symptoms. 

Circumcision for medical reasons is available in the NHS.  However, there is a long waiting list for urological consultation and circumcision in the NHS hospitals. 

Surgical Techniques

Although circumcision is done in our London clinic, the best method of circumcision is with the glue with different circumcision styles. We do circumcision with stitches and surgical staplers (ZSR or CircCurer (LangHe) staples suture device). Adult circumcision costs £680 with glue at our London Circumcision Centre. Circumcision cost in the UK depends upon the technique and methods of circumcision. Circumcision is a low-risk surgical procedure, at least in our hands. History of bleeding disorders needs to be excluded, and all medications affecting platelet function (aspirin, clopidogrel, warfarin ) should be stopped 5 days before adult circumcision after a discussion with your doctor. 

Anaesthesia

Circumcision can be performed under local or general anaesthesia. Most patients are suitable for local anaesthesia, which involves injections into the skin. 

Informed Consent

We provide the patient with all the information about the circumcision, and consent is taken before the procedure in our centre. Circumcision is an irreversible procedure and exposes the glans permanently. 

Forceps-guided method, sleeve technique and Glue circumcision are standard techniques used. 

The most common method is the glue circumcision technique. It has been reported that the stretched length of the penis is the equivalent length of the erect penis. By having the penis on stretch, we make sure that no excessive shaft skin is excised, which would produce penoscrotal webbing due to underneath skin deficiency and hairy skin from the pubic area pulled to the shaft of the penis due to less shaft skin, especially during erection. 

Complications

Risks are bleeding, bruises, haematoma formation, infection, removal of too much or too little skin, lymphoedema,  displeasing results that require revision circumcision and a change of sensation during sexual activity.

Sexual Dysfunction

Change in sexual function after circumcision is very controversial. Studies investigating sexual dysfunction have shortcomings of self-reported variables, non-validated questionnaires, small population studies, and the investigation of patients with prior foreskin disease. 

Summary 

Adult circumcision is a safe surgical procedure with uncommon complications. Adults have circumcision due to tight foreskin (phimosis, paraphimosis), infection (balanitis), and scaring due to lichen sclerosis (BXO). A lot of African studies also reported that circumcision can be preventative in HIV and AIDS transmission and some sexually transmitted infections. Several methods of performing an adult circumcision exist at the London circumcision clinic, but glue circumcision remains our method of choice. Although sensation appears to be different in circumcised adults in the first 6-12 months, studies have not proved if there is any difference in sexual function as compared to uncircumcised men. The benefits of circumcision are well-reported in the literature. Men can be circumcised in our London circumcision Centre.

This is for information about purposes that can not replace professional advice. Please contact Dr Khan or a consultant Urologist for further details.