Can I be circumcised as an adult

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. 

London Circumcision Centre

NEWBORN AND ADULT CIRCUMCISION FROM EXPERIENCED SURGEONS AND UROLOGISTS

We provide glue, stitch, staplers, revision adult circumcision, frenuloplasty or preputioplasty at London Circumcision Clinic. We also give balanitis xerotica obliterans (phimosis) treatment

PLEASE CONTACT US FOR FURTHER DETAILS

Please see feedback from the patent after circumcision and frenuloplasty

“My experience with Dr Khan was very relaxing and quick. I felt comfortable throughout the whole procedure. In my first consultation with Dr Khan, everything was explained to me quite simply, so I knew exactly what to expect and all of my options. My procedure was very quick and very professional, I was given all the information required for post-operation care and also emergency contact just in case. Everything went seamlessly and I would definitely recommend Dr Khan to any prospective patient.”

— Written by a private patient at London Circumcision Centre Sept 2021

Adult circumcision with CircCurer (LangHe) staple device (ZSR Circumcision)

First Private Clinic in London, UK, that Offers  Circumcision with this Novel CircCurer (LangHe) staples Device

Many patients are asking Dr Khan to circumcise with ZSR or stapler devices. Adult circumcision can be performed by  CircCurer (LangHe) or ZSR staples suture device. Dr Khan has simulation training in CircCurer (LangHe) staples suture device. 

Dr Khan offers circumcision with this new CircCurer (LangHe) staple device at The London Circumcision Clinic, Leyton, London. 

Adult circumcision with CircCurer stapler is a quick procedure. When it was compared with conventional circumcision with stitches, stapler circumcision is associated with shorter surgical time, higher patient satisfaction with penile looks, lower operative pain, less operative blood loss, and lower wound bleeding post-operatively. However, wound healing takes longer than traditional circumcision in adults.

 Anaesthesia

A local anaesthetic is used for the circumcision with staplers and injected into the base of the penis and all around the shaft of the penis. This provides safe and effective pain relief during the circumcision. This also minimises post-operative pain for a few hours.

Men's Circumcision Cost with CircCurer in the UK (16-YEAR-OLD AND ABOVE)

Circumcision with stapler Device £780 includes consultation on the same day and one free follow-up visit.

Informed Consent

We provide the patient with all the information about the stapler circumcision ahead of time. Stapler Circumcision is an irreversible procedure and makes the head of the penis exposed permanently. Informed consent is taken before the procedure.

Full or Partial Circumcision

Full circumcision means moderately cutting the inner and outer foreskin to expose the full of head of the penis. Partial circumcision leaves loose skin, which partially covers the glans (head of penis). Partial circumcision may not work in all adults. 

Full circumcision might give a false impression of loose/partial circumcision when the penis is in a flaccid state, especially in patients with a buried penis. Partial circumcision is possible, but it has a few complications in the long term. These can be discussed with Dr Khan at the Adult Circumcision Clinic  in London, UK

 Procedure Technique

The following are methods for adult and boys over 16-year-old for circumcision: 

• After local anaesthesia, the foreskin was retracted, and assess the suitability.

• If there is scarring due to BXO, stapler circumcision is not advisable to perform.

• Apply the bell of the instrument inside the foreskin

• Secure the right position of the stapling device

• Cut the skin and staples applied at the same time

• Apply the bandage around the wound at the end of the circumcision

Recovery for Adult Circumcision with staplers 

Circumcision with a stapler heals quicker than one with stitches. Swimming and weight lifting should be avoided for 2-3 weeks. Full recovery following circumcision generally requires 4-6 weeks.  Over-sensitivity of the glans may take a few months to resolve.

Adult Circumcision Healing Tips

To reduce the effect of night erections, pull on the staplers during the first few days after the adult circumcision, empty your bladder before retiring and a few times during the night. Sleep on your side or back. It may be helpful to draw your knees up a bit into a more foetal position. Wear tight underwear after the circumcision to prevent unnecessary movement. Follow the aftercare advice and keep the wound dry for five days. 

Please take vitamin C regularly for ten days to promote healing. If the staplers are completely off, apply vitamin E cream, Mederma gel, or bio-oil to the scar after 15 days. This will improve the scaring. Please contact us at The London Circumcision Centre for further advice.

Medical evidence 

Five recent studies involving 2026 men were included in comparing the stapler and conventional circumcisions with stitches.  The statistically significant incidence of circumcision with staplers was intra-operative blood loss, operating time, the mean pain score on the operation day, the mean pain scores on post-operation days and wound healing time. The majority of the patients (88.0%) required the removal of residual staples postoperatively after four weeks. 

References: 

1. Brazilian Journal of Medical and Biological Research (2015) 48: 577-582

2. Asian Journal of Andrology (2017) 19, 362–367

3. Scientific Report (2016) 6, 25514 

Risk of Adult Circumcision

The risks of circumcisions are explained to the patients. Risks are failed staple procedure requiring traditional circumcision, bleeding, bruises, haematoma formation, infection, retaining of staplers for more than four weeks, unintentional damage to the glans, removal of too much or too little skin, lymphoedema, aesthetically displeasing results and a change of sensation during sexual activity.

The patient should also be informed that, during the postoperative period, erections can cause pain, bleeding and discomfort. There are slight chances of disruption of the staples or scarring of wounds, which might require a redo or revision circumcision. 

Postoperative Care

You might experience discomfort for a few days after the circumcision, but painkillers help to decrease the pain. Passing urine is not usually affected by the circumcision. There will be swelling and bruising of the shaft of the penis for 2 to 3 weeks after the stapler circumcision. This will then subside gradually and should not be a cause for alarm. Bleeding after circumcision can be stopped by applying pressure or a bandage.

A dressing (bandage) is applied around the wound line to prevent the wound from sticking to your underclothes. A bandage with self-adhesive stretch gauze will stay for three days (Cobain). The wound will be at least 2-3 weeks before healing is completed, and you may return to work when you are comfortable enough.

Most people require at least 2-3 days off work. You should gently wash the wound daily after one week if the wound is dry and shower regularly.  It would be best to stop going to the gym or lifting heavy weights for 2 weeks. You should avoid any sexual activity for 4-6 weeks after the circumcision to avoid the breakdown of the wound.

Follow up visit

 Some of the staplers come off themselves. However, some staples remain over the wound after 3 weeks. All patients require arranging an appointment after 3-4 weeks so that we can remove the residual staples. 

PS: This information is for suggestions only. It is not a substitute for professional medical advice. Please call Dr. Khan at +447527314081 for free telephone advice without any obligation.

 © London Circumcision Centre, 2024. Unauthorised use and duplication of this blog without express and written permission from this blog’s author and owner is strictly prohibited.

Aftercare Instructions for Glue Circumcision

How do I look after a circumcision treated with skin glue?

Skin glue is a special medical adhesive gel that is applied to the circumcision wound edges. It can be used on its own or with stitches. It takes only 3-5 minutes to dry and set, forming a thin layer over the wound. It forms a waterproof coating over your circumcision wound. Glue circumcision is the best method. 

How does skin glue work on circumcision wounds?

The inner and outer foreskin have edges that can be easily joined together with medical liquid glue using a special technique. 

Will glue get separated during the erection of the penis? 

No, glue is strong enough to stay on the skin during your erection in our unique technique of glue circumcision.

Why is the skin glue used in circumcision?

This will give a waterproof seal, less pain, less risk of infection, and better results than stitches. 

Can glue be used to redo or revise circumcision?

Yes, redoing or revision circumcision with glue gives the best outcome of the previous scar. Glue revision circumcision is the best method.

How long does glue stay on the circumcision wound?

The glue usually comes off itself within 5-15 days 

Will I feel pain after glue circumcision?
For the first few days, you may feel pain and use simple pain relief medication. Take simple over-the-counter painkillers for a few days. Glue circumcision is less painful than circumcision with stitches only. The head of the penis (glans) remains very sensitive after circumcision; you can apply a small amount of Vaseline or olive oil only to the glans penis. Sensitivity may last many weeks or months.

How do I care for a circumcision treated with skin glue?

Please follow the aftercare advice from Dr Khan

• Wash your hand before you touch/change the bandage 

• Only wear tight underwear with the head of the penis upwards toward the belly button. 

• Avoid soiling the bandage with urine

• Do not touch the glue for four days 

• Keep the circumcision wound dry for the first four days

• Keep the bandage for four days and take showers after four days. Afterwards, change the bandage daily for seven days after applying Fucidin cream only on the stitches

• No bath for 15 days to prevent soaking the wound

• Wrap the circumcision wound with cling film if you would like to take a shower for four days. 

• If the circumcision site gets wet, pat it dry. Don't rub the glue site, and do not apply cream or an antiseptic solution to it.

• If the wound edges join together securely and the glue is still in place after 15 days, you can remove it in the shower.

• Apply bio-oil on the wound for 2-3 months after four weeks to decrease the scarring.

What are things to avoid during the healing of the circumcision with glue?

• Do not scratch, rub, or pick at the glue; doing so may loosen the film before the wound fully recovers.

• Do not soak or scrub your wound for 15 days.

• Do not swim until the adhesive film (glue) has fallen off naturally

• Do not apply liquid, ointment medications, or any other product to the wound while the glue is in place. It could loosen the glue film before the wound is fully healed

• Do not do any heavy lifting, gym or exercise for two weeks

• Do not do any sexual activities for 4-6 weeks

How long will swelling or bruising settle down? 

The shaft of the penis will have swelling for 4-6 weeks, and bruising of the glans and shaft of the penis will settle within four weeks. 

How long frenulum is will heal? 

If you have frenuloplasty with glue circumcision, we put a few stitches covered by glue at the frenulum, which will take longer (about four weeks) to heal. Apply Fucidin cream after changing the bandage. The frenulum area will heal later than the circumcision site.

When should I get help from the Doctor?

Most circumcision wounds are sealed with skin glue and heal normally with excellent results. You should get medical help from our specialist doctors if: 

• Your wound gaps open or start to bleed

• You think your wound may be infected

What are the symptoms of wound infection?

• The circumcision wound looks redder or swollen

• The pain in the wound gets worse after three days

• Discharge of pus or blood comes from the circumcision wound

• You have a fever of 38C (100.4F) or more 

• Wound edges get separated by bleeding

Please get in touch with our doctors for medical advice if you have any questions.

Written by a patient at Leyton Clinic, London, February 2020

“I got circumcised by Dr Khan using the glue method and I can only praise both the surgeon and the technique. He was extremely friendly and approachable. I had a long list of question before the procedure which he happily answered over the phone. Booking an appointment was very easy and hassle-free. On the day of the operation, Dr Khan asked me about all my wishes and preferences and gave me personalised suggestions. The operation itself was virtually completely painless. I kept talking to Dr Khan and his lovely nursing assistant throughout the procedure. Having followed his post-operative care plan to the letter, my recovery was very quick and uneventful. I only needed to take simple over-the-counter painkillers (paracetamol and ibuprofen) for 2 days. The pain was completely gone after that. The swelling settled in about a week. As I'm writing this review, I am only 4 weeks post-op and it feels like I have been circumcised forever. The glue method achieved an excellent cosmetic result. I cannot recommend Dr Khan highly enough.”

© London Circumcision Centre, 2023. Unauthorised use and duplication of this blog without express and written permission from this blog’s author and owner is strictly prohibited.