General Information

Male circumcision is the surgical removal of the foreskin. The foreskin is the hood of skin covering the end of the penis, which can be gently pulled back.

  • Circumcision may be performed for:

Religious reasons – circumcision is a common practice in the Islamic and Jewish faiths and is also practiced by many African communities as a tribal or ethnic tradition.

Medical reasons, although alternative treatments are usually preferred to circumcision. Circumcision is most commonly carried out when the foreskin is tight and won’t pull back (retract), which is known as phimosis; however, alternative treatments, such as topical steroids, are sometimes preferred.

Routine circumcision

During the 19th century, many medical practitioners believed that being circumcised was more hygienic than not being circumcised.

As a result, the routine medical circumcision of all boys, regardless of religious faith, became a widespread practice in England. However, routine male circumcision gradually became less common as many members of the medical community began to argue that it had no real medical benefit in the vast majority of cases.

Routine circumcision may offer a number of potential benefits, such as reducing the risk of some types of bacterial or viral infections. However, most healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, outweigh any potential benefits.

Advantages and disadvantages of circumcision

There are several potential advantages and disadvantages associated with circumcising boys shortly after they are born.

For example:

  • Circumcision may reduce the risk of developing a urinary tract infection (UTI), such as a bladder infection.
  • Circumcision may reduce the risk of getting some types of sexually transmitted infections, such as HIV and genital herpes.
  • Circumcision may reduce the risk of female partners developing some types of sexually transmitted infections, such as bacterial vaginosis and trichomoniasis.
  • Circumcision may reduce the risk of developing cancer of the penis.

However, there are much more effective and less invasive ways of preventing these conditions. For example, practising good hygiene to prevent UTIs, or using a condom to prevent STIs.

Most healthcare professionals maintain that the potential benefits of circumcision are not strong enough to justify routine childhood circumcision.

Critics of circumcision argue that it has disadvantages, such as:

  • Reduced sensitivity – an uncircumcised penis is more sensitive than a circumcised penis, meaning that circumcised men may experience less pleasure during sex.
  • Potential complications of circumcision – these include excessive bleeding, post-operative infection and, in rare cases, injury to the urethra. These complications are thought to outweigh any potential benefits.
  • Critics have also argued that routinely circumcising baby boys on medical grounds violates the principle of consent to treatment. They say that circumcision should only be performed when a boy is old enough to make an informed decision about whether he wishes to be circumcised.

NHS availability

The majority of clinical commissioning groups (CCGs) do not fund routine circumcision or circumcision that is carried out for religious reasons.

The NHS mainly funds circumcision that is used to treat a small number of medical conditions (see below). In such cases, circumcision is usually regarded as a “treatment of last resort”, when all other treatment options have failed.

It is important to note that some CCGs in England do currently fund religious or ritual circumcision on the NHS. The decision is based on priorities that relate to its own local population.

In rare cases, circumcision may be considered for the following health conditions:

  • Paraphimosis – a condition where the foreskin gets trapped under the tip of the penis
  • Balanitis xerotica obliterans – an uncommon condition causing hardening and inflammation of the tip of the penis

However, these conditions are extremely rare in children and other treatments are often preferred.

Circumcision may also be considered in some cases with the following health conditions:

  • Severe cases of phimosis – a tight foreskin that can’t be retracted
  • Recurrent balanitis – inflammation of the tip of the penis and foreskin

How circumcision is performed

Circumcision for medical reasons is usually carried out on a day-patient basis. This means that you will not have to stay overnight in hospital.

Older children and adults who are circumcised are usually given a general anaesthetic, where they are put to sleep.

In Mediwell Clinic Circumcision Centre, we perform circumcision for only religious and cultural reasons and use local anaesthetic injection which will numb the penis and the surrounding area.

The circumcision procedure is relatively simple. The foreskin is removed with a scalpel, scissors or a surgical clamp. Any bleeding is either cauterised (closed using heat) or the remaining edges of skin are stitched together using dissolvable stitches.

After circumcision, there may be some pain and swelling, and the penis will be easily irritated until it heals. The healing process can take up to four to six weeks.

Recovering from circumcision

In babies who are circumcised, the foreskin usually takes about 7 to 10 days to heal. In older boys and men, the healing process can take up to four to six weeks.

Self-care advice

As circumcision is a painful procedure, painkillers such as paracetamol or ibuprofen will need to be taken for at least the first three days after the operation. Children aged 16 or younger should not take aspirin.

Circumcision exposes the sensitive skin of the tip of the penis (glans). In babies, nappies can rub against the glans, making it sore. Therefore, make sure that you tuck down your baby’s penis before putting the nappy in place. You may be advised to apply an antibacterial cream for up to a week.

After circumcision, the penis will be red and swollen for a few days. You or your child may find it more comfortable to wear loose clothing for a while. Putting petroleum ointment directly on to the area can also reduce irritation.

After a boy has been circumcised, make sure that he does not ride a bike or use other sit-on toys until the swelling has completely gone down. If he is of school age, he should be able to return to school about a week after being circumcised. However, let his teacher know that he has had the operation.

It is important to practise good hygiene and ensure that your child’s nappies are frequently changed after a circumcision.

Do not use scented products in the shower or bath and leave the penis to dry naturally.

For adults, the surgeon will also give advice about sexual activity. Usually, sex should be avoided until the wound has healed, to avoid it reopening.

When to seek medical advice

After a child has been circumcised, speak to your GP if:

  • There is any infection or bleeding from your child’s penis
  • Your child’s penis remains swollen after two weeks
  • Your child still finds passing urine painful a few days after the operation
  • Older boys and men should also see their GP if they have any problems after circumcision.

Complications are rare when circumcision is performed for medical reasons, but there are some risks of circumcision that should be considered.

Risks of circumcision

As with all types of surgery, circumcision has some risks. However, complications from circumcisions carried out for medical reasons are rare in England.

Bleeding and infection are the most common problems associated with circumcision.

Other complications can include:

  • A decrease in sensation in the penis, particularly during sex
  • Damage to the tube that carries urine inside the penis (urethra), causing it to narrow and making it hard to pass urine
  • Removal of too much of the foreskin
  • Accidental amputation of the head of the penis, which is very rare
  • A blood infection or blood poisoning (septicaemia)

Problems with circumcisions carried out for religious or cultural reasons may go unreported.

Circumcision is not carried out on boys born with a specific birth defect of the penis that affects where the opening of the urethra (urinary tube) is found. This is because the foreskin is used to reconstruct the urethra.

F.A.Q's

Is the service available throughout the year?

Yes. Procedures are usually carried out from the clinic every day, mostly weekends. We have prolonged opening during school holidays. Weekday procedures can be arranged on special request on advance notice.

Is the procedure painful?

Circumcision should be a pain free procedure, as long as the local anaesthetic has been administered correctly. We do get a few horror stories of procedures being done during which the child has felt the pain and the whole experience of both parents and child has been awful.  You can rest assure that your child will not be in any form of pain during the procedure. The only thing to warn you would be that children in the age group 1 – 5 years of age can be difficult to circumcise, as they are at an age where they are weary of strangers and won’t let anyone go near them. This age group of patients do pose a challenge for us – nevertheless, we do cater for them as well.

How long does the local anaesthetic last?

Usually 1 – 2 hours. Following which the feeling will return and the child may be in pain for about 15-20 minutes acutely. Therefore, it is advisable that painkillers are given just before or soon after the procedure, so that while the anaesthetic wears off there won’t be too much pain.

Can the procedure be carried out with the child asleep?

Not at our clinic. All procedures carried out at the Mediwell Circumcision Centre are under local anaesthetic (LA). However, you are looking to have it done under a general anaesthetic (GA) will have to get in touch with your local private provider.  Be warned that they can quote you a price around the region of £2000. More importantly, there are no added benefits of doing a circumcision under a GA – if anything; you have the added complications that are associated with a GA.

What is the best age to get a child circumcised?

The best time is when the child is born, soon after birth at the age 2-3 weeks. However, it can be carried out at any age.

What is the average time to recovery?

You are looking in the region of approximately 2 weeks.

Will someone explain the procedure and the after-care to us?

As part of taking informed consent, it is imperative on the circumcision practitioner that they explain the procedure to you in full, the likely complications and the after-care.

What level of experience does the circumcision practitioner have? Is he a GP or a Surgeon?

Our practitioner is practising NHS Surgeon who is involved in their day to day work operating. He has a wealth of experience (25 years’ experience) and you can chat to him directly about his experiences – it is important that you have full confidence in the practitioner that will operate on your child.

Are parents allowed to be present during the procedure?

Generally, we prefer parents to be present during the surgery – as this gives a great deal of confidence to the child undergoing the procedure (in the case of the older child). However, if a parent or relative feels they do not want to be present – then this will be respected, and they can remain in the waiting room.

Can I take my child home straight away?

In the vast majority of cases you can. However, if the doctor is concerned that there may be a slight chance of bleeding, then he may request that you wait for about half an hour, so he can perform interval checks to ensure that there is no bleeding. Only when he is confident that it is safe, he will tell you that you may go.

Should I be aware of any risks associated with a circumcision?

One thing you have to bear in mind is that circumcision is a surgical procedure. All surgical procedures are associated with an element of risk.  However, these risks can be minimised if the procedure is carried out by a fully trained and professional circumcision practitioner, in particular if someone has a surgical background or is a practicing surgeon.

The risks associated with a circumcision are commonly (1) bleeding (1-3%) and (2) infection (1-3%). To minimise the risk of infection   – the procedure is carried out in a sterile fashion and antibiotic prophylaxis is usually given.

Are there routine follow-up checks?

Routine checks are not necessary on the new-born infant. For the older child it may be necessary depending on how the procedure has been performed. In all cases, if the parents wish to re-visit for whatever reason, they may do so without incurring any further costs.

Articles

Circumcision ‘is the best weapon in fight against Aids’

http://www.independent.co.uk/news/science/circumcision-is-the-best-weapon-in-fight-against-aids-824587.html

Circumcision ‘does not curb sex’

http://news.bbc.co.uk/1/hi/health/7174929.stm

Circumcision ‘reduces HIV risk’

http://news.bbc.co.uk/1/hi/health/4371384.stm

Circumcision decreases the risk of HIV in men

http://www.bmj.com/cgi/content/full/320/7249/1592

Females with a circumcised partner have a reduced risk of cancer of the cervix

https://www.webmd.com/cancer/cervical-cancer/news/20110106/male-circumcision-cuts-womens-cervical-cancer-risk#1

Procedure

We use the ‘Freehand Technique’. This method starts with a local anaesthetic. Freehand excision of the skin is performed, after which some stitching is necessary.

Please bring with you an over the counter painkiller – either Paracetamol or Ibuprofen. Once you attend the clinic we will advise you to take the first dose just before the procedure.

How the procedure is performed

The procedure is performed under a local anaesthetic that is injected at the root of the penis. An interval of about 10 minutes is given before the actual procedure is started so that the penis is completely anaesthetised, and no pain will be felt during the procedure.

The groin is fully prepped and draped to undertake the procedure in a sterile fashion.

A surgical marker pen is used to mark the line of incision on the foreskin to guide the level of the cut – this ensures that the skin removed is symmetrical and that the best final cosmetic result can be achieved.

Freehand excision of the foreskin is performed along this mark. The procedure finishes with a thin strip of non-adherent dressing along the line of the wound. This serves two purposes: (1) it protects the wound from contamination and; (2) it helps to keep the swelling down.

The length of time required in total for the procedure is approximately one hour. This is broken down into (1) consultation (20 mins); (2) local anaesthetic application and time for it to take effect (10 mins) and; (3) surgery itself (30 mins).

After the procedure

All post-operative care instructions are given.

Your son will be able to wear all his clothes as normal and walk as if he has not been circumcised. Babies can be having their nappies and trousers put on immediately and also be carried out of the clinic as if they have not been circumcised.

He is welcome to sit and wait for a bit in the clinic if you so desire. You can take public transport immediately after the procedure.

The pain that your child will experience depends on the individual – it is more a dull ache than a sharp pain once the feeling returns. It is advisable that he takes painkillers for 2-3 days following the procedure. Pain of course is an individual experience, the threshold of which differs between individuals.

Return to school and function

It is advisable to take at least 3 days off school following the circumcision.

Why Choose Us

Deciding to have a circumcision done can be a very anxious time. It is important to be well informed about the nature of the procedure, the aftercare and any complications that may be involved.

We pride ourselves on our comprehensive service and once you give us a call, we will try our very best to give you an appointment at your convenience (including evenings and weekends). Before the day of the circumcision, you can feel free to call us and our friendly staff will be happy to answer any questions you may have. On the day of the circumcision, we will provide you with a full briefing of the procedure, the aftercare and the healing process. We will also provide you with printed information of what you need to do during the healing process.

Circumcision is something you do once in a lifetime, so it’s important to get it done professionally and competently the first time.

As mentioned above, every procedure has risks and if the circumcision is performed by someone who is inexperienced, then complications may arise and if untreated properly may cause scars and a re-circumcision will be needed.

By choosing Mr Comez, you can be reassured that you are in safe hands. We assure you the procedure is pain free and the cosmetic results are excellent.

Below are important factors to take into consideration when choosing a surgeon to perform the circumcision:

  • Mr Comez is a General Surgeon with 25 years’ experience in all fields of General Surgery as well as circumcision.
  • Mr Comez is fully registered with the General Medical Council (GMC) and is licensed to work as a doctor and a surgeon in the UK.
  • He has the knowledge and clinical skills that are needed to carry out a safe circumcision according to the GMC regulations.
  • Mr Comez has had long experience in giving local anaesthetic since most of his work requires this skill. You can be sure that your son will not feel any pain at all as Mr Comez will make sure that no pain is felt before the start of the procedure.

Considerations After Circumcision

  1. Your child felt no pain during the circumcision because local anesthesia was used; he may have cried due to the psychological effect as only touching could have been perceived. The effect of local anesthesia will regress after 2 hours and your child may start to feel pain. Feeling pain in the first 24 hours is absolutely normal. Therefore, your child should take the prescribed painkiller syrup immediately after the circumcision. You need to give the painkiller for at least three days at 6-hour intervals, even if there is no pain.

 

  1. The first night after a circumcision can be sleepless; this is very normal. The child becomes very sensitive and may show crying behaviours to attract attention. It will be sufficient that painkillers are used during this period. Pain will regress 50-75% at most after 24 hours and will be nearly completely alleviated at 48 hours.

 

  1. Your child can eat and drink right after the circumcision.

 

  1. Children mostly urinate before a circumcision, but some children may urinate during the procedure as well. Pain that develops after the circumcision may cause involuntary spasm in the regional muscles. Therefore, your child may have his first urination a little bit late; this is a normal scenario. The first couple of trials to urinate may be unsuccessful due to excessive spasm. Warm compression can be applied to the region of the urinary bladder in these cases.

 

  1. Some sensation of burning or interruptions may occur during the first urination. This is a completely normal condition. However, if your child does not urinate for a long time (24 hours), if pain aggravates gradually and excessively, or if blood is noticed along with or in the urine, you should contact our clinic.

 

  1. The dressing (circumcision bandage) can be removed at home after the first 24 hours in normal conditions. This period can sometimes be extended to 48 to 72 hours. You can remove the dressing by having your child sit in warm water or while washing him, or you can remove it directly by making it soaked. Do not be afraid to remove the dressing. It is extremely beneficial to perform daily warm water dressing and bathing routines. Do not feel worried or concerned while performing this procedure, it is totally painless. A few drops of blood can also be seen while the dressing is removed, that is normal too.

 

  1. Once the dressing is removed, use a very thin layer of the antibiotic cream that is given to you at the location of the stitches; continue to do so two to three times a day for a week.

 

  1. Mild bleeding stains in the dressing are not important; however, you need to present to our clinic in the event of leakage-like bleeding.

 

  1. The first 24 hours after circumcision are critical and your child needs to rest as much as possible. It is very important that the first 6 hours are spent lying down. If there is no risk of bleeding or infection, your child may move and go out after 24 hours.

 

  1. Some swelling and bruising after the circumcision is normal secondary to local anesthesia, you do not have to worry. There may be long-standing bruising on the penis head in children with adhesions on the penis skin (phimosis) before circumcision, do not worry.

 

  1. Since excess pubic fat accumulation is observed in overweight children, the penis may appear embedded in the skin and the wound dressing may come off earlier after the circumcision; do not be concerned.

 

  1. After circumcision, i. If not, a second procedure may be required.

 

  1. Post-circumcision embedded penises secondary to pubic fat accumulation may appear as though less skin has been removed. Since the penis protracts during adolescence, the foreskin will also gain the normal position.

 

  1. It is extremely important to act normally with children after the circumcision. It will be more correct to give encouraging and relaxing advice like “you can walk, go to the toilet, take a shower, but be careful” rather than worrying or giving frightening advice such as “it will hurt, it will bleed, do not walk, do not go to the toilet, eat less, do not wear anything”.

 

  1. You may need to contact our clinic in the following conditions:

 

  • If the dressing is totally covered with blood or if there is visible bleeding.
  • Excessive darkness in the penis head especially 6 hours after the circumcision. Bruising can normally be seen at the penis head and location of local anesthesia and this can persist for several weeks.
  • If there is no urine output 24 hours after circumcision, if pain aggravates despite the medicines, if blood is accompanying urine
  • Excessive nausea, vomiting or fever

As Mediwell Clinic, we are pleased to offer you all the opportunities of modern medicine.

Please contact us if you have any concerns or encounter any abnormalities.

 

Mr Turhan COMEZ

General Surgeon