Adult Circumcision in London

Our Adult Circumcision in London services are provided to individuals aged 16 and above, addressing medical and nonmedical reasons. Medically, the procedure is recommended for conditions like tight foreskin, recurrent infections and cracked foreskin. Nonmedical reasons may include religious, personal, or cultural considerations. Anaesthesia options include local penile block with circumcision methods such as glue, stitches, or stapler techniques.

Indications

Circumcision is advised for medical conditions such as tight foreskin, tight when erection, recurrent infections, and scarring conditions like Balanitis Xerotica Obliterans (BXO). Circumcision also addresses issues like a tight or short frenulum and is performed for hygiene, cultural, or religious reasons.

Circumcision Pros and Cons

While medically recommended, debates surround the consequences of circumcision. Health benefits include a reduced risk of urinary tract infections, sexually transmitted diseases (STIs), and penile and cervical cancer. However, potential risks involve bleeding, infection, poor cosmetic results, and changes in sexual sensation. Trials in Africa suggest preventive benefits against STIs and HIV among men.

Anaesthesia

Local anaesthesia is administered with 2-3 pricks around the base and shaft of the penis, ensuring a pain-free experience during the operation. This method also minimises post-operative pain for a few hours.

Cost in the UK

Our transparent pricing includes a £150 consultation fee if the procedure is done at the same time and various circumcision options:

- Full circumcision with stitches £580

- Full circumcision with Glue £660

- Revision or Redo circumcision £980

Informed Consent

Informed consent is a priority. Patients receive comprehensive information about the irreversible nature of circumcision and its potential impact on sexual anatomy.

Full or Partial Circumcision

Both full and partial circumcision options are available. Full circumcision involves moderate removal of the inner and outer foreskin to expose the head of the penis, while partial circumcision leaves some loose skin.

Procedure Techniques

Various methods of circumcision are employed based on individual needs:

1. Dorsal slit method: Mainly for phimosis and paraphimosis.

2. Sleeve method: Freehand cutting.

3. Forceps-guided method: Use of forceps to cut the skin.

4. Freehand method: Cutting with scissors.

5. Shang ring: A disposable clamp.

6. Glue vs stitches: Glue or stitches are applied to skin edges, while glue involves using a medical glue to seal the skin. Each method has advantages, with glue known for better outcomes, less pain, less complication and precise closures.

7. Stapler circumcision: stapler techniques involve using a specialised device to cut and seal the skin simultaneously. The stapler techniques are known for being quick but may require the removal of staplers in some cases.

Recovery

Circumcision with glue promotes quicker healing than stitches. Swimming and weightlifting should be avoided for 2-3 weeks. Full recovery typically takes 4-6 weeks, with oversensitivity of the glans possibly lasting a few months.

Healing Tips

To minimize the impact of nocturnal erections on stitches, glue or staplers, empty your bladder before sleep and sleep on your side. Wear tight underwear, follow aftercare advice, and keep the wound dry for 3 days. Regular vitamin C intake for ten days and application of vitamin E or bio-oil after 15 days can promote healing and scar improvement.

Risks

Patients are informed about potential risks, including bleeding, bruises, hematoma formation, infection, accidental damage to the glans, aesthetically unpleasing results, and changes in sensation during intercourse and masturbation.

Post-operative Care

Expect discomfort for a few days, manageable with simple painkillers. Urination is usually painless and unaffected. Swelling and bruising subside within 7-10 days. Dressings remain for three days, and light clothing is advisable for 2-3 days. Return to work when comfortable, but refrain from sexual activity for 4-6 weeks.

Note: This information is a guide and not a substitute for professional medical advice. For further assistance, contact our doctor at +447527314081 for free telephone advice.

Does Phimosis Always Require Circumcision in Men

Facts and Advice regarding tight foreskin

Male circumcision is rarely mentioned in everyday conversation, leaving many unaware of conditions related to the foreskin. Among these, phimosis—a condition characterised by a tight foreskin—often goes undiscussed, potentially leading to undiagnosed complications that can impact one's sexual health. This blog explores phimosis, its causes, treatments, and whether circumcision is always necessary.

Understanding Phimosis

Phimosis occurs when the foreskin is too tight, making it challenging to retract and reveal the tip of the penis. This tightness can lead to minor trauma during erections and sexual activity, causing scarring and the loss of elasticity of the foreskin. In adults, phimosis is associated with infections, including sexually transmitted diseases (STDs) and conditions like balanitis.

Facts About Phimosis

Physiological phimosis in children often improves with age, as the foreskin's attachment between the glans and foreskin breaks down, forming smegma pearls. Most boys have a fully retractile foreskin by the age of 10-12 years. Pathological phimosis, on the other hand, is a medical condition marked by a diseased or scarred foreskin. It's crucial to distinguish between naturally tight foreskin (physiological phimosis) and scarred tight foreskin (pathological Phimosis), as treatments differ.

Paraphimosis, a condition where the foreskin gets stuck behind the head of the penis due to a tight ring, requires emergency treatment. This can be addressed by pulling the foreskin forward or through widening the foreskin (preputioplasty or dorsal slit) to preserve the foreskin.

Causes of Phimosis

Various factors contribute to phimosis, including skin conditions (lichen sclerosis - BXO, Lichen planus, Eczema), infections (syphilis, chancroid, genital herpes), scarring, and a potential link to penile cancer. Studies suggest circumcised men have lower rates of certain infections and penile cancer.

Nonsurgical Treatment

Treatment depends on age and the degree of phimosis. It may involve steroids, stretching exercises, or antifungal/antibiotic medications. However, caution is needed with pulling scarred foreskin, as it may lead to further tearing and scarring. Home treatments are possible for mild cases, involving daily cleansing, washing, and controlled stretching exercises. Diabetic men may need more blood sugar control to avoid cracked foreskin.

Surgical Treatments

Several surgical options exist, each targeting the tightness of the foreskin:

1. Frenuloplasty: Releasing the frenulum to detach it from the head of the penis.

2. Preputioplasty: Increasing the foreskin's diameter through an incision in front of the foreskin to allow full retraction.

3. Partial Circumcision: Leaving part of the foreskin covering the head of the penis.

4. Full Circumcision: The standard surgical option for severe cases primarily associated with cracked foreskin (BXO) phimosis, traumatic injury, or penile cancer.

Considerations for Full Circumcision

While full circumcision is a standard option, it is irreversible. Alternatives include antibiotics, antifungal medications, steroids, frenulum excision, V-Y preputioplasty, and frenuloplasty. The choice should be discussed with a specialist or urologist based on individual circumstances.

In summary, phimosis is a condition with various treatment options. Full circumcision is not always the only choice, and alternatives should be explored based on personal preferences and medical Advice. Prioritising your health and engaging in open discussions with healthcare professionals for informed decisions regarding phimosis management is essential.

Jet injection without needle local anaesthesia in adults’ and children's circumcision - recent study

Circumcision: Exploring Different Approaches for Adults and Boys for local anaesthesia

Circumcision is a practice that is often carried out for religious, traditional, and medical reasons. In our country, most men undergo circumcision, and most of these procedures are performed using local anaesthesia. Since circumcision is primarily performed for religious purposes, families typically want their children to know the procedure. Therefore, the preschool period is often chosen as the ideal age for circumcision in Turkey. However, circumcisions performed during this stage, when a child discovers their sexual identity, can negatively affect psychosexual development.

Additionally, using a needle for local anaesthetic injections can significantly increase anxiety in children. Despite the use of topical anaesthetic creams to reduce stress, needle phobia remains unresolved. Research indicates that 63% of children in the USA are afraid of needles.

Needle phobia is a concern for children and adult patients in circumcision procedures. To address this issue, some studies have explored using needle-free jet injectors. For example, Peng et al. found that a no-needle jet injector technique was safe, effective, and well-tolerated for adult circumcision. Similarly, jet injectors have been used in urology practice, such as vasectomy procedures, with high patient acceptance rates. However, the literature has conflicting opinions regarding the pain associated with jet injector injections compared to conventional needle injections.

In urology, jet injectors have been used for intracavernosal alprostadil injections in patients with erectile dysfunction. However, studies have shown that the procedure is more painful and less effective than the conventional needle method, leading patients to prefer the latter. This study aimed to evaluate the effectiveness of jet injector anaesthesia in children who reject needle injections during circumcisions performed under local anaesthesia. However, we observed that local anaesthetic injection with a jet injector did not provide sufficient pain relief for a comfortable circumcision.

The epidermis, the outer layer of the skin, varies in thickness across different parts of the body. For instance, the thickness of the epidermis on the eyelid is 0.04 mm, while it can reach up to 1.6 mm on the palm. The dorsal part of the penis has a thicker epidermis than the ventral surface, which can affect the penetration of the anaesthetic agent when using jet injectors. Injections on the ventral surface may pose a risk of urethral injuries due to the thinner epidermis in that area.

Several parameters are crucial for jet injectors, including thrust pressure, contact pressure, drug volume per shot, nozzle opening, and the distance from the nozzle tip to the skin surface. For small operations, the recommended anaesthetic dose delivered with a jet injector is 0.07-0.1 ml per spurt, with a nozzle diameter of 0.1 mm and an application pressure of 130-160 psi. However, studies have shown that increasing the nozzle diameter may result in deeper penetration and increased pain. Using newer-generation jet injectors with lower pressure has been demonstrated to achieve the same penetration depth with less pain.

In this recent study, consistent with findings in the literature, injection with a jet injector without a needle was better tolerated than the conventional needle method. However, the time for local numbness was long, and the amount of anaesthetic agent used was lower in the jet injector group. However, the FLACC scores (a pain assessment tool) measured during circumcision were higher in the jet injector group, and additional anaesthetic medication was needed for circumcision in children and adults. 

We provide a service for needless anaesthesia with some additional fees for needle-phobic adults and children. 

Please get in touch with us for further details. 

“We provide without needle local anaesthesia in our clinic ”

— https://doi.org/10.1080/08941939.2020.1817635

Free advice for tight foreskin and tight frenulum

Phimosis is a term used for tight foreskin. Phimosis is when you cannot pull the foreskin back to see the tip of the penis. In some cases, the skin may fold back when the penis is relaxed but is unable to withdraw when the penis is erect. When the foreskin is tight, there is minor trauma to the foreskin during each erection and sexual activity. This generates to loss of elastic fibres due to scarring. In adults, sexually transmitted infections or other infections such as balanitis can be associated with phimosis.

Adult Circumcision is an operation that matches men’s cosmetic and functional requirements. Tightness of the foreskin can be due to BXO or Lichen Sclerosis.