Men’s circumcision

Understanding Men's Circumcision: Medical Perspectives

Introduction:

Circumcision, a surgical procedure involving the removal of the foreskin covering the penis, is a practice that spans both medical necessity and cultural traditions. This article seeks to comprehensively examine the medical dimensions of male circumcision, shedding light on the conditions that may warrant the procedure and the corresponding therapeutic interventions.

Medical Reasons for Circumcision in Men:

1. Tight Foreskin (Phimosis):

- Phimosis, characterised by a foreskin too tight to retract, can result in discomfort during erections or urination.

- Before opting for circumcision, alternative treatments like topical steroids are considered.

2. Recurrent Balanitis:

- Inflammation and infection of the foreskin and penis head may necessitate circumcision as a viable treatment option.

3. Paraphimosis:

- In cases where the foreskin cannot be restored to its original position, causing swelling and pain, circumcision becomes a preventive measure against serious complications.

4. Balanitis Xerotica Obliterans:

- This condition, inducing scarring and inflammation of the foreskin (BXO) and penis head, may find resolution through circumcision.

5. Cancer of the Penis:

- Although penile cancer is rare, circumcision could be recommended as part of the treatment protocol, often coupled with surgery, radiotherapy, or chemotherapy.

Other Treatment Options:

- Exploring less invasive approaches, such as topical steroids for phimosis or corticosteroid ointments for balanitis, precedes the consideration of circumcision.

HIV Prevention:

- Evidence from African trials suggests that circumcised men may have a reduced risk of HIV acquisition. However, the procedure's effectiveness against other sexually transmitted infections remains inconclusive.

The Procedure :

- Circumcision, generally a straightforward outpatient surgery, offers options for either general or local anaesthesia.

- Employing a scalpel or surgical scissors, the foreskin is excised, and the remaining edges are meticulously stitched together.

Recovery:

- Postoperative care involves adherence to instructions, including refraining from sexual activity for at least four weeks.

- Initial discomfort, swelling, and mild pain are anticipated, but persistent issues may signal infection, warranting prompt treatment.

Risks:

- Complications post-circumcision for medical reasons are infrequent in the UK, with bleeding and infection representing the most common concerns.

- Potential complications encompass reduced sensation, tenderness around the scar, and, in some instances, additional surgical interventions are necessary.

Conclusion:

Men's circumcision, whether motivated by medical necessity or cultural considerations, necessitates a thorough evaluation of potential advantages and risks. Engaging in meaningful discussions with our Consultant Urologist and exploring alternative treatments are indispensable to the decision-making process.

Foreskin problems

Understanding Foreskin Problems: Causes, Signs, and Treatment

The foreskin, a protective fold of skin covering the penis in uncircumcised individuals, requires proper care to prevent potential issues later in life. Here's a comprehensive guide to foreskin problems, their causes, signs, treatment, and preventive measures.

What is the Foreskin?

The foreskin is a layered fold of skin that shields the end of the penis in uncircumcised individuals. While it requires no special care in early childhood, attention to hygiene becomes crucial as one grows older to prevent problems like swelling, infection, tightness, irritation, and dryness.

Causes of Foreskin Problems:

In young children, the foreskin is naturally attached to the penis head by the synechia membrane, which dissolves over time. Forcing it back prematurely can lead to issues. Phimosis, where the foreskin is too tight, is another cause, usually resolving between ages two and six. STIs, infections, BXO (lichen sclerosis ) or injuries can trigger problems in teenagers and adults.

Signs of Foreskin Problems:

Look out for pain during urination, itchiness, inability to retract the foreskin, pain during intercourse, redness, soreness, swelling, dryness, or split and bleeding skin. Consult our specialist Urologist if you experience these symptoms.

Treatment for Foreskin Problems:

Treatment varies based on the issue. Dryness may be managed with creams or ointments like steroid cream, while infections like balanitis can be treated with medications. In some cases, procedures may be required, such as moving back the foreskin in children with phimosis or circumcision in adults with persistent issues. Our approach with circumcision with glue is the best option.

Prevention of Foreskin Problems:

Proper care is crucial. Change underwear regularly, opt for loose underwear, avoid heavily scented hygiene products, clean the foreskin daily with warm water, and use protection during sex to reduce STI risks.

Specialists for Foreskin Problems:

A urologist, or a pediatric urologist for children, is the specialist to consult for foreskin problems. We provide these services in the London Circumcision Centre.

When to Consider Circumcision:

Circumcision is only considered when foreskin problems are severe and impact daily life, causing persistent pain or frequent urination issues. Phimosis with a scared or cracked foreskin will require circumcision.

When to Seek Medical Advice:

Call us if you experience difficulty urinating, a burning sensation, increasing pain, or inability to return the foreskin to its original position.

Understanding and addressing foreskin problems early is essential for maintaining male reproductive health. Regular hygiene practices and prompt medical attention can make a significant difference in preventing and managing foreskin-related issues.

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.