Adult circumcision

Revision or redo Circumcision for Adults

"I underwent a revision circumcision by Mr Khan on the 9th of April for a circumcision I had elsewhere 20 years ago. The care I received was excellent. He explained clearly what we could achieve and listened to my concerns. Both Mr Khan and the lovely nurse were reassuring me during the procedure which was uneventful. I didn’t feel any pain (apart from a small sting during the injection of local anaesthetic) and the end result was so neat. The use of glue sealed the wound nicely and I would recommend this to everyone rather than stitches. I didn’t feel any pain afterwards apart from a mild discomfort the first night. I didn’t even need to use any pain killers. I highly recommend Mr Khan".

Adult patient comments 

 

Please discuss free telephone consultation with Dr Khan for redo, revision or tidy up circumcision or re-circumcision at London Circumcision Centre

Preparation and aftercare for Adult Circumcision, Frenuloplasty or Preputioplasty 

Preparation for Adult Circumcision, Frenuloplasty or Preputioplasty

Pubic Hair

There is no need to completely shave your pubic hair, but it is desirable to trim it fairly short. This aids asepsis (prevent infection) during the operation and prevents hairs becoming painfully trapped in the bandaging afterwards. Trim your pubic hair a few days in advance of the operation to allow time for the cut ends to soften again. 

Sex

There will be a period of up to six weeks after circumcision when you will notbe able to indulge in sex. It is desirable therefore that you reduce your desires beforehand. On the morning of the operation either have sex with your partner or masturbate to climax. 

Alcohol

Do not take any alcohol, whether with or without a meal, prior to the circumcision as it can dehydrate you and may reduce the effectiveness of the local anaesthetic. 

Hygiene

On the morning of the circumcision ensure that you take a good bath or shower and pay particular attention to your genitals. Retract your foreskin as far as you can and clean well under it. 

Immediately before the time of the circumcision empty your bladder. 

Underwear

Adult men after the circumcision should bring a pair of tight fitting briefs to wear afterwards which will keep the surgical dressing in place. Continue to wear these at home until the swelling and soreness has eased.

Eat and Drinks:

If you are having a local anaesthetic, eat and drink as per normal. Keep your fluids going as this will ensure that you are well hydrated.

Smoking

If you smoke, then stop as this interferes with the healing of the wound. Smoking can slow this down and your recovery in general so stop smoking before your surgery.

Time off from work

Arrange time off school/work from 2-7 days.

 

After adult circumcision

After the circumcisionpreputioplasty or frenuloplasty,  your penis will be swollen and look very bruised. This is a normal effect of both the injected anaesthetic and the handling it necessarily receives during the operation. These will gradually reduce over the next week or two. 

Underwear

If you normally wear boxers you may find that they give insufficient support immediately post-operative. You may wish to consider some form of briefs which will hold your penis in position and thus reduce the frictional stimulation which it would otherwise receive if allowed to swing freely. 

The Bandage after circumcision

The doctor will bandage only the immediate area of the cut of circumcision. This bandage will normally be wound tightly around the penis. It serves two purposes, to protect the wound and to contain and reduce the swelling. 

Removal of the initial bandage is a compromise between maintaining the compression for as long as possible to reduce swelling as fast as possible and changing the dressing on the wound before it sticks too much to the healing skin. 

2 to 3 days after the operation is generally regarded as the most opportune time to change the dressing. The bandage will, most likely, be well caked in blood (particularly the inner layers) and will need to be soaked off in the shower to avoid tearing the healing wound. 

A thin coating of an ointment, e.g. Vaseline or Fucidin cream, before applying the bandage will reduce the possibility of blood making it stick to the skin. Use Fucidin cream according to Dr Khan advice. 

If you choose not to use a bandage, then a gauze pad may be useful to prevent the stitches catching in your underwear. 

Promoting Healing

Do not apply any antiseptic cream to your penis, nor add any antiseptic to bath water. Whilst they do help to kill germs, most are corrosive to new skin and actually slow down healing. In the rare cases where an infection develops, see a doctor as soon as possible. You can take Vitamin C regularly for 10 days, this will promote healing.

Pain Killers

Everyone reacts differently in respect of pain. For most people circumcision will not be truly painful, but a degree of discomfort is to be expected during the first few days. 

If you choose to take pain killing tablets, then follow the instructions precisely. Do not take more than the recommended maximum dose. 

If you have a favourite brand of pain killer and the doctor has prescribed something else, be sure to ask about the effects of 'mixing and matching'. 

Do not take Aspirin or any blood thinning medicine after your doctor (GP) advice  since these thin the blood and have an anti-clotting action which can increase bleeding from a wound after the circumcision. 

The Stitches and Glue

Circumcision with stitches (sutures in medical parlance) need to remain in place long enough for the cut edges to knit together but not so long as to allow the skin around them to fully heal. In practice this usually means they should remain for between 2 and 3 weeks. These soluble (or self-dissolving) stitches will fall off spontaneously in due course.  

Circumcision with glue usually comes off within 10 days. If there is any loose glue, you can cut this loose part of the glue but do not peel off rest of the glue from the wound.

Travelling

You can travel home safely within 1-2 hours distanceafter the circumcision or any other foreskin procedure. Avoid long journey for 24 hours. Do not fly for 24-48 hours. Take a flight after 48 hours if your flight is more than 4 hours.

Erections

To reduce the effect of nocturnal erections pulling on the stitches or glue during the first few days after the circumcision, empty your bladder before retiring and a few times during the night. Do not lie on your back, but on your side. It may be helpful to draw your knees up a bit into a more foetal position. 

Sex after circumcision

Do not be over eager to have sex until your circumcision has healed, which will normally take up to six weeks. If you need relief during the healing process then try techniques which stimulate places other than the glans and scar line. These can include squeezing the shaft alone, massaging the nipples or prostate massage. 

To avoid excessive friction on the healing scar line you may wish to consider the use of a condom. A condom should always be used for penetrative sex (even with a regular partner) until the scar line is completely healed and settled down, which may take two to three months to achieve. 

Time off School or Work after circumcision

There is no absolute need to take time off school or work after circumcision, but you may find it very hard to concentrate on work for the first few days and so may find it useful to take a week off. 

A week (or even two) off work is very desirable if you do heavy lifting or if your job keeps you seated and unable to move around freely for long periods. 

Do not schedule a circumcision immediately before major examinations if you wish to pass them, as you cannot get up and walk around to relieve any pressure on your penis. 

You should naturally avoid fast-moving or contact sports, cycling and swimming until your circumcision has fully healed for at least 2-3 weeks. 

NOTE: The content on our information page is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice from Dr. Khan regarding any medical questions or conditions developed before or after circumcision.

Frenulectomy of penis

Minor Tears at the Penile Frenulum Can Cause Pain and Bleeding During Sex.

What should you do if your penis frenulum is torn?

The penile frenulum, often referred to as the "banjo string," plays a crucial role in male anatomy by connecting the foreskin to the head of the penis. When this small piece of skin is too short, it can lead to a condition known as frenulum breve, causing discomfort during erection and sexual activities.

Adults feel pain during sex due to several reasons.  Some men have recurrent pain during sex. This may be due to a short or tight frenulum or a tear to the frenulum.   However, pain can occur due to other reasons as well. 

What is Frenulum Breve?

 Frenulum breve occurs when the penile frenulum is too tight. This small band of skin can cause pain, tears, bleeding, and scarring during sexual activities, making it a concern for many adolescents and men. In some cases, frenulum breve is associated with a skin condition called Balanitis Xerotica Obliterans (BXO), which can result in more severe scarring.

 Understanding the Stages of the penile frenulum

1. Tight/Short Frenulum without Tear or Scar:

   - Mild cases with no visible issues.

   - Lubricants during sex can help prevent problems.

2. Torn Frenulum with Healing:

   - Tear and healing occur, but no lasting scar.

   - Considerable discomfort during this stage.

3. Visible Frenulum Scarring with or without BXO:

   - Scar tissue becomes visible.

   - Associated with a skin condition (BXO) in some cases.

4. Complete Scarring of BXO Beyond the Frenulum:

   - Severe scarring extends beyond the frenulum.

   - Can result in significant complications.

Treatment Options

1. Observation:

   - For mild cases, no specific treatment.

   - Using a lubricant during sex can help avoid problems.

2. Steroids Cream:

   - In the early stages of scarring, applying a steroid cream can be effective.

3. Penile Frenuloplasty or frenulectomy:

   - A procedure to release the tight frenulum.

   - Dissolvable stitches used for healing.

   - Loose bandage applied for a day or two.

4. Circumcision:

   - Removal of the foreskin, suitable for more severe cases.

Frenuloplasty or frenulectomy of the penis or release or division of frenulum breve can be cured the pain during sex. Frenulectomy, is simply a foreskin-releasing procedure. An incision is made on the frenulum or excised the ridge underneath the surface, thus allowing full retraction. This will allow you to retain your foreskin but at the same time be able to keep the area underneath clean. 

Frenulectomy and circumcision can be done at the same time. Sometimes, adults preferred frenulum removal during the circumcision. 

Frenulectomy is the first-line treatment in these cases in which pain or tear to the frenulum is the main complaint. 

The benefit is that he retains his foreskin. Frenuloplasty helps to get rid of most of the bending of the penis.

What Happens During Frenuloplasty or Frenulectomy

- Done under local or general anaesthesia.

- The frenulum is cut and stitched in a way that lengthens it.

- Wound is sealed with glue

- Dissolvable stitches are used, and a bandage is applied temporarily.

Risks and After-Effects:

- Expect swelling and bruising, which can last a few weeks.

- Minimal bleeding, usually manageable with pressure.

- Infection is a rare complication treated with antibiotics.

- Changes in sensation over the penis head may occur.

- Some tenderness at the scar site.

- 5-10% chance of foreskin tightness recurrence.

Taking Care After the Procedure:

- Swelling and bruising may persist for a few days.

- Stitches dissolve in 3-4 weeks.

- Painkillers can help with discomfort.

- Keep the area dry. Avoid baths for 10 days.

- No swimming or intense exercise for two weeks.

- Maintain wound hygiene after urination.

- Apply Vaseline to the penis tip.

- Wear tight underwear for a couple of days.

- Start withdrawing the foreskin daily after 4 days.

- Sexual abstinence for 4-6 weeks.

Dr. Khan and Our Consultant Urologists, who are fully trained and most experienced in frenuloplasty or frenulectomy (removal of frenulum), will give you professional advice on whether this frenulum removal suits you.  

Methods of Adult and older boys Circumcision

Dorsal slit method: 

The dorsal slit method for circumcision is mainly used for phimosis (tight foreskin) and paraphimosis. After a partial dorsal slit, the surgeon needs to identify the corona of the glans to cut the correct amount of foreskin.  

 

Sleeve method  

Freehand cutting of the skin

Forceps guided method  

Use of forceps to cut the foreskin.

Freehand method  

cutting with scissor  

Shang Ring 

disposable clamp to use  

Glue vs stitches circumcision

glue to apply to skin edges.  

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