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 circumcision, preputioplasty 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.

No-Needle Local Anesthesia for Adult Male Circumcision - report

We are planning to do "no needle anaesthesia for adult male circumcision" in future at Thornhill Clinic and Leyton Clinic , London. Please ask for the details from the clinic. We will use "the Comfort-in™ system - compact, spring-powered device"for no needle local anaesthesia for adult male circumcision.

Following report was published in Journal of Urology in 2010

Purpose: We used a local anesthetic jet injection technique for adult male circumcision. This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision.
Materials and Methods: We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet® Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale.

Results: The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification.

Conclusions: No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision. 

Reference: DOI: https://doi.org/10.1016/j.juro.2010.04.080

Cosmetic appearance of penis in children before or after circumcision

Before the circumcision in infants and children, every child anatomy is different, and their shape or size of penis and foreskin are also different. Penis is sometimes  rotated, bended  or buried in pubic areas. When  parents arrange a circumcision,  they may have in mind that the child will look like the father or head of the penis may not be completely exposed as religious or cultural requirements, but this is definitely not the case in some children. Children develops differently as well. Degree of buried penis can change as child grows older.

Hypospadias describes an anatomical variant where the wee hole (external mental opening) did not complete its development and did not close fully to the tip of the penis leaving an opening along the underside of the penis. Opening could be present away from tip of the penis to scrotum or perineum. This also requires hypospadias repair under general anaesthesia and the foreskin may be helpful for this purpose, so circumcision must not be done until the hypospadias repair is done. In most of the cases, you can recognise as foreskin is hooded. In some cases, hypospadias may be present on intact foreskin and described as megameastus or glandular hypospadias.  This can only recognised after retracting the foreskin and circumcision should be postponed until hypospadias repair is done. 

Some babies, infants and children have long and skinny penis and others short and fat penis. Some have showed bending to the left or to the right before or after circumcision. Some children penis is buried into the abdominal fat. Some are more bent than others, even more to 90 degrees. This markedly bent penis is described as a penile chordee and requires paediatric urology to straighten, and the foreskin is useful for this procedure in these cases, so should not have circumcision until the corrective operation of penile chordee is done under general anaesthesia in the hospital.

Buried penis is very common now a days. In most of the cases, it is mild form which may not require any further corrective surgery and it is possible to do circumcision. Many boys have loose attachment of the skin to the shaft of the penis. In these children, there may be a high insertion of the scrotal skin along the underside of the shaft of the penis, or there may be a pad of “puppy fat” in front of the pubic bone pushing the skin forward and away from the penis which is anchored at its internal base to the pubic bone. The penis appears to disappear behind the skin, and this is sometimes referred to as the “Disappearing Penis Syndrome”. It is also referred to as a “buried penis”,  "hidden penis" or "inconspicuous penis"

It is primarily an issue of loose attachment of the skin and it is usual for the penis to “reappear” by the time the child is about 1-6 years of age, with the reduction in this pubic fat and the growth of the child. However, some few older children or adults retain this appearance at rest; yet, it looks and performs perfectly adequately in sexual situations.

This anatomical variant, however, causes the parents concern after a circumcision, because as the skin moves forward over the head of the penis, it appears that not enough skin has been removed. This is not the case. The paediatric urologist ( Mr A R Khan) has to estimate the length of skin to leave in order that when the child is grown, there will be enough skin to cover the erect penis and not leave too much area that will be covered by scar tissue. It is only in the infant years, then, that the child may appear to have been inadequately circumcised.

It is very important in such boys, that the parents retract the cut foreskin regularly to prevent the cut edge healing and attaching to the head of the penis after 3 days of separation of the ring circumcision and creating a cosmetic result that is not desired. Therefore, if you notice that the skin of the penis is falling forward covering the head of the penis at any time after the operation, even up to a few years later, ( such that it looks like not enough skin was removed), then please have the child reviewed at our clinic by Dr. Khan. He will explain to you how to manage the skin so as not to form permanent attachments to the head of the penis, and he may have to separate the skin from head (glans) of penis for you at times or referral to the GP for further managamnet at tertiary centre in UK..

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 The content on the our website 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 after circumcision.

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