Your surgeon will always discuss with you and recommend the treatment that is appropriate for you. During the consultation, the surgeon will also explain the treatment, its results and benefits, the duration of the result and the frequency of repeating the treatment.

Circumcision or Foreskin Removal

Circumcision or foreskin removal is a minor surgical procedure to remove the prepuce (foreskin) of the penis. This is commonly performed for religious reasons but primarily for medical reasons such as improved hygiene, cosmetic reasons and for the elimination of medical problems such as phimosis (where the foreskin is too tight), paraphimosis (where the foreskin is retracted and becomes too swollen to return to normal position) and balanitis (inflammation of the foreskin). Although most often performed on newborns, foreskin removal may be performed at any age with minimal pain and discomfort.

Foreskin (also called prepuce)

The prepuce is the part of the skin system of the penis covering the glans (head of the penis). The outer skin folds inward at the end of the foreskin. From this fold, to where it joins behind the glans is the moist mucosal area. The foreskin is a remnant of earlier stages of evolution where it was necessary to protect the glans from abrasion from undergrowth and tree branches. The foreskin serves no further purpose and can lead to phimosis, paraphimosis, balanitis, urethritis (inflammation of the urethra) and retained smegma.

WHERE THE SURGERY WILL BE PERFORMED

Circumcision is performed in our Harley Street clinic.

TYPE OF ANAESTHESIA

Circumcision is carried out under intravenous sedation so there will be no pain and you will sleep through the operation.

THE SURGERY

The procedure usually takes one to one and a half-hour.

PREPARING FOR YOUR SURGERY

You will be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medicines.

If you smoke, plan to quit at least two weeks prior to the surgery and not resume smoking for at least two weeks after your surgery. Avoid overexposure to the sun before the surgery, especially on the abdomen, and do not go on astringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, it is important to inform the surgeon, as your surgery may need to be postponed.

You will need to arrange for someone to collect you after your surgery, as you will be unable to drive. It is also advisable to have someone to stay with you for a few days to help you out, if needed.

BEFORE YOUR SURGERY

In your initial consultation, your surgeon will evaluate your health and discuss your reason for wanting or needing a foreskin removal. This is also the time to discuss with the doctor any particular outcome that you require, e.g. a ‘tight’ or ‘loose’ foreskin removal,’ “high’ or ‘low’ placement of the scar line, removal or retention of the frenulum. Be specific and show him where you want the scar line placed.

Be sure to tell your surgeon if you smoke and if you’re taking any medications, vitamins or other drugs. Be frank when discussing your expectations with the surgeon, and they will explain the risks and the limitations, together with the alternative surgeries, which may be more suitable.

THE CIRCUMCISION PROCEDURE

Your procedure will be performed at our Harley Street clinic, under intravenous sedation. This is not a general anaesthetic, but you will not feel any pain and will not remember the procedure.

The foreskin is pulled out in front of the glans and a pair of forceps is then used to secure the foreskin. A scalpel is then run across the face of the forceps furthest from the glans to remove the foreskin. The glans are protected by the forceps. This method does not cut the frenulum (the membrane attaching the foreskin to the glans) but this can be removed before, during or after the circumcision if desired. The tightness and relative amounts of inner and outer foreskin remaining depend on adjustments made before the forceps are fully closed. The minimum amount of inner skin remaining equals the length of the glans. The cut edges of the inner and outer foreskin are then brought together and sutured. These sutures (stitches) will dissolve in 7 – 10 days.

AFTER THE PROCEDURE

After having had intravenous sedation, you will need to remain at the clinic for about 2 hours, to allow us to monitor your recovery from the sedation. You will need to arrange for someone to come and collect you, as you are not permitted to drive or take public transport for 48hrs after having sedation (it is also advisable to have someone to stay with you overnight).

You will have a bandage around the tip of your penis, which will stay on for about 4 days. 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. Once this bandage has been removed, there is no need for further dressings. However, it is important to keep the tip of your penis clean and dry until the sutures have healed. You will need to return to the clinic to see the nurse after one week, and again in a further six weeks to see the surgeon.

Couples activity can be resumed six weeks after surgery.

ALL SURGERY CARRIES SOME UNCERTAINTIES AND RISKS

When performed by a qualified surgeon, complications from circumcision are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including reaction to the anaesthesia, infection, haematoma (bleeding under the skin), bleeding – resulting in increased bruising, temporary swelling and a slight asymmetry in healing or scarring. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

If you have any further questions or queries about this procedure, please feel free to call and speak to either Dr Roberto Viel, Dr Maurizio Viel or any of our nurses. Please note that it is necessary to attend a consultation prior to your operation, this is also the case with existing patients, it may also be necessary to have repeat blood tests.

To book an appointment for Circumcision, please call: 020 7636 4272