Does Diabetes Mellitus increase the risk of circumcision?

Introduction

The intersection of tight foreskin (phimosis), balanitis, and Diabetes presents a complex interplay of factors that can significantly impact men's sexual health. In this blog, we'll discuss Diabetes and circumcision and explore evidence-based strategies for optimal care.

Medical Indications for Circumcision

In diabetic men, we have identified three main conditions where circumcision may be necessary: balanitis xerotica obliterans (BXO), recurrent balanitis and symptomatic phimosis.

Insights from Recent Studies

Recent epidemiological research has investigated the relationship between type 2 diabetes mellitus and certain penile conditions that might require circumcision. Researchers Wang et al., in a nationwide population-based study, found that type 2 diabetes significantly 42% increased the risk of penile inflammatory disorders like BXO and refractory phimosis.

Correlation Between Diabetes and Penile Inflammatory Disorders like Balanitis

Another study by Hirji et al. from the UK General Practice Research Database showed that diabetes patients were nearly three times more likely to develop balanitis compared to those without Diabetes.

Fakjian et al., in an outpatient setting, discovered that uncircumcised men with Diabetes had a 35% prevalence of symptomatic phimosis, indicating a potential association between Diabetes and tight foreskin.

Clinical Indicators and Demographic Patterns of Diabetes

Certain clinical presentations, like balanoposthitis with a distinctive appearance, have been proposed as early indicators of undiagnosed Diabetes, particularly in older age groups. In the fifty- to sixty-year-old age group, a staggering 83.3% of circumcised patients had Diabetes. This indicates that Diabetes might not only increase the risk of penile inflammatory diseases but also drive the need for circumcision in adult males.

Type 2 diabetes mellitus and the likelihood of undergoing circumcision

A notable recently published study conducted in 2024 analysed a large population from 1997 to 2010 to explore the influence of type 2 diabetes mellitus on the likelihood of undergoing circumcision among men aged 30 to 69. The findings revealed that individuals with Diabetes were significantly more likely to opt for circumcision compared to those without Diabetes, further strengthening the association between diabetes and circumcision decisions.

Conclusion: Implications for Circumcision in TYPE 2 Diabetes

The accumulating evidence underscores a substantial link between diabetes mellitus, penile inflammatory diseases, and tight foreskin, potentially increasing the likelihood of circumcision in affected individuals. In conclusion, the research showed a relationship between Diabetes and penile health, leading to more circumcision in Diabetes.

Preparation for circumcision with Diabetes at London Circumcision Centre

1. It is essential to check Hb1C within six months before circumcision.

2. The level of Hb1C should be less than 70 mmol/mol (8.6%) before the operation.

3. Antibiotics may be required after the circumcision.

4. Diabetes must be controlled after circumcision to prevent delayed wound healing

5. A biopsy is needed if signs of an inflammatory condition called BXO are diagnosed during the examination.

6. Follow-up is required 4-6 weeks after circumcision.

This information is only guidance and not a replacement for professional opinion by our urologist.

References

1. https://londoncircumcisioncentre.co.uk/blog-circumcision/Diabetes/tight-foreskin

2. BMC Urol. 2024; 24: 3. Published online 2024 Jan 3. doi: 10.1186/s12894-023-01392-6

3. https://londoncircumcisioncentre.co.uk/blog-circumcision/cracks_foreskin

Frenulum breve - short frenulum

Understanding Frenulum Breve: Causes, Symptoms, and Treatment

Introduction

Frenulum breve is a condition that affects men, causing discomfort and potential challenges in their sexual activities. This blog will discuss what frenulum breve is, explore its causes, identify symptoms, and discuss available treatment options.

What is Frenulum Breve?

The frenulum is a small band of tissue located on the underside of the penis, connecting the glans to the foreskin. In individuals with frenulum breve, this band is shorter than usual, restricting the movement of the foreskin. This condition can lead to pain, tearing, and difficulty retracting the foreskin during activities such as sexual intercourse or masturbation.

Causes

Frenulum breve can be caused by various factors, including congenital conditions where the frenulum is naturally shorter than average. Additionally, trauma, injury or scaring (BXO) to the genital area may contribute to the development of frenulum breve. Understanding the underlying cause is crucial for determining the most appropriate treatment.

Symptoms

Common symptoms of frenulum breve include pain during sexual activity, difficulty retracting the foreskin and tearing of the frenulum. Individuals experiencing these symptoms should seek medical advice to diagnose the condition and explore suitable treatment options properly.

Treatment Options

1. Topical Steroids: In some cases, topical steroids may be prescribed to reduce inflammation and promote frenulum stretching. This conservative approach is often recommended initially.

2. Stretching Exercises: Gentle stretching exercises may be suggested to elongate the frenulum gradually. It's essential to follow medical guidance to avoid injury and ensure the effectiveness of these exercises.

3. Frenuloplasty: In more severe cases, a surgical procedure known as frenuloplasty may be recommended. This involves making a small incision in the frenulum to release tension with stitches and sealing it with glue, allowing for increased mobility.

4. Circumcision: In cases with tight foreskin or when other treatments are unsuccessful, circumcision – the surgical removal of the foreskin – may be considered as a last resort. However, this is a significant decision that should be thoroughly discussed with our urologist.

Conclusion

Frenulum breve is a condition that can impact the quality of life for affected individuals. Seeking medical advice is crucial to determine the most appropriate treatment plan based on the severity of the condition. With various treatment options available, individuals experiencing symptoms of frenulum breve can find relief and regain comfort in intimate situations. Always consult an experienced consultant urologist for personalised advice tailored to your problem.

Please call us to discuss about tight frenulum

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.