Free advice for tight foreskin and tight frenulum

Phimosis is a term used for tight foreskin. Phimosis is when you cannot pull the foreskin back to see the tip of the penis. In some cases, the skin may fold back when the penis is relaxed but is unable to withdraw when the penis is erect. When the foreskin is tight, there is minor trauma to the foreskin during each erection and sexual activity. This generates to loss of elastic fibres due to scarring. In adults, sexually transmitted infections or other infections such as balanitis can be associated with phimosis.

Adult Circumcision is an operation that matches men’s cosmetic and functional requirements. Tightness of the foreskin can be due to BXO or Lichen Sclerosis.

What Is a Partial Circumcision? Is it suitable for children or adults?

What’s the difference between partial and full circumcision?

Partial circumcision is when part of the foreskin is removed. Head of penis will still partially or fully covered with foreskin.  

There is published report about partial circumcision in children. Following summary of report

Modified partial circumcision for phimosis: techniques and surgical outcomes

objective:

In the last years, many surgical techniques of preputioplasty have aimed to preserve the foreskin in case of phimosis. These techniques are not reliable for patients affected by phimosis linked to balanitis xerotica obliterans (BXO) and scarred foreskin. Authors tried an original technique of resection of the pathological foreskin, removing the mucosal internal layer followed by reconstruction of the foreskin. The aim was to evaluate the outcome of paediatric patients who underwent modified partial circumcision for pathological phimosis.

Patients and methods:  

In all, 360 patients with phimosis underwent modified partial circumcision at our institution. The mean age of the boys was 8.9 years, range 5–15 years. In 145 (40.3%) cases, indication for surgery was clinical suspicion of BXO, in 215 (59.7%) cases it was chronic inflammation of the foreskin.

Results:

In all cases, the postoperative period was uneventful. Cosmesis was considered by parents as excellent in 95.2% of patients. In these patients, the glans was almost completely covered by soft foreskin. Histopathological examination of the removed foreskin documented BXO in 162 (45%). Twelve (3.3%) patients complained of recurrences and five (1.4%) patients of smegmatic cysts.

Conclusion:  The described surgical technique of modified partial circumcision for the correction of pathological phimosis appears cosmetically well accepted, safe, and simple with low rate of late postoperative complications.

Ref: Annals of Pediatric Surgery 2018, 14:151–156

Keywords: balanitis xerotica obliterans, circumcision, partial circumcision, phimosis

Unit of Paediatric Surgery, Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, University of Messina, Messina, Italy

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This report showed the partial circumcision may be possible in some cases of phimosis. In our experience at London Circumcision Centre showed below :

• When partial circumcision is desired, about two-thirds of the foreskin is left to cover the head of penis.

• The success of this operation essentially lies in level of the skin incision. Incision line should not in front of the head because shrinkage of scar will cause tight foreskin (secondary phimosis)

• The inner foreskin should be incised immediately below corona to remove the tight band of ring, to ensure that the most of the inner foreskin (mucosa) is removed.

• Partial circumcision does not work in the presence of scarring like BXO in our experience.

• Partial circumcision may be suitable in children, it does not work very well in adult with tight foreskin ( phimosis )

• Please give further information and assessments by our specialist consultant urologist team

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Care Quality Commission has given "Good" rating to London Circumcision Centre in all five domains

This service is rated as

Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

CQC carried out an announced comprehensive inspection at the London Circumcision Centre. This inspection was conducted as part of CQC inspection programme of independent health providers.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC key findings of our clinic were:

• The service had systems in place which kept patients safe. These included checks on patients attending the service and risk assessments conducted to ensure staff and patients were safe whilst attending the centre.

• Staff at the service had the skills and knowledge to provide effective care.

• Feedback on the provider and service revealed high levels of patient satisfaction.

• Provision of services at the clinic considered patient demand and included timely access appointments which included face-to-face, telephone and video consultations.

• There was a focus on innovative, learning and improvement.

Good Ratings for London Circumcision Centre

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Good Ratings for London Circumcision Centre -

CQC inspected and Rated Good