partial circumcision

Tight foreskin - what is the treatment

Phimosis (tight foreskin): What are the alternatives to full circumcision?

When there is a tight foreskin called phimosis, a person wonders whether he need to be circumcised.  There are many alternatives to full circumcision.

Following non-surgical treatments are an alternative to circumcision.

•          Children usually grow out of natural tight foreskin

•          Stretching exercises: It may help in some cases

•          Steroids - topical or local injections: There is medical evidence that steroid cream cures the phimosis

•          Stretching exercises with steroids:  Both treatments may be more effective than one only.

•          Vitamin E cream: More medical evidence may require its effectiveness.

Following surgical treatments are an alternative to circumcision.

 •          Frenuloplasty: Frenuloplasty provides releasing the frenulum which is a simple and effective treatment of dealing painful or torn frenulum

•          Frenular grafting: Free frenular skin grafting an alternative to circumcision in some men with a combination of tight frenulum and phimosis.

•          Preputioplasty: This operation is mainly to widen the ring noticed after retraction of the foreskin beyond the head of the penis

•          Partial circumcision: There are very limited role of partial circumcision in tight foreskin.

However, tight foreskin with balanitis xerotica obliterans (BXO) is treated with steroids, biopsy and full circumcision.

In conclusion, alternative treatments (surgery or no surgery) consider before male circumcision who have a tight foreskin. We have discussed a method of treatment and every treatment must be considered individually and carefully

Benefits Of Circumcision

Circumcision is a common procedure with minimum risks of complications by trained professional doctors. There are different opinions whether there is a need for a male to be circumcised.The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis (tight foreskin) and paraphimosis ( foreskin stuck behind the head of penis) When the men later becomes sexually active he has substantial protection by circumcision against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced.

Adult patient feedback from France

 "Excellent after service, called me late in the evening very quickly to respond to an email when I was expecting to a reply in the morning" 

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CQC published the case study- London Circumcision Clinic fulfils 95% standards

Case study – good practice for Newborn or Baby circumcision

This case study is taken from a GP practice that has conducted traditional circumcision for 28 years. ( published CQC website)

In this practice, parents receive written information and advice in advance of the procedure. This includes a consent form and information about aftercare. The practice requires both parents to give consent to the procedure.

Parents are advised not to feed the infant for two hours before the procedure. This ensures that the baby feeds immediately afterwards to provide comfort.

The doctor assesses the level and type of local anaesthesia appropriate for each infant, taking account of their age and weight and the requirements of the procedure. Pain relief is proportionate and appropriate for the individual needs of the infant.

If the doctor concludes that the procedure cannot be safely conducted in his GP practice, he advises parents of this and suggests alternative options (for example, referral to hospital care).

During the procedure, the infant is held comfortably still. Another person is always present to assist and respond to the infant’s needs if they are in any distress.

The family is advised to remain at the practice for at least an hour after the procedure and once the doctors is certain that the baby is not bleeding.

The doctor is available for aftercare and the arrangements for follow up are clear.

Written instructions for parents include a request to text or ring the doctor after their first check. The parents are advised to contact the doctor at any time by text or phone if they have any concerns. If this happens, the doctor will visit the baby at home or see him at the surgery, as is most appropriate.

The doctor encourages good practice among other providers by offering training in the procedure.

Ref: 

Advice for inspectors

Circumcision of male children

January 2016 Care Quality Commission