For Older Boys and Adult Men (Patients 13+ Years Old)
This information is intended as a general guide to the preparations you should make for your elective adult circumcision and the after-care of your newly circumcised penis. The guidance also applies to the circumcision of pubescent and post-pubescent teenagers but not to infant or childhood circumcisions.
Preparation
In holiday periods our sessions fill up months ahead. If timing is important to you, e.g. to fit in with available holiday dates, then be sure to make your initial contact with the doctor well in advance. You can always fix a date for several months ahead, even if earlier dates are available.
The Centre requires you to have a preliminary consultation. At this time the doctor will ensure that you know what is involved and will collect some medical details from you to eliminate obvious contra-indications.
Be sure to tell the doctor if you are allergic to any anaesthetic or antibiotic; if you suffer from diabetes; if you are on any prescribed medication; or if you have recently had any other medical treatment.
This is also the time to discuss with the doctor any particular outcome that you require, e.g. a ‘tight’ or ‘loose’ circumcision, A ‘high’ or ‘low’ placement of the scar line, removal or retention of the frenulum. Remember that the terms ‘high’ and ‘low’ may mean something different to you compared with the medical profession. So be specific and show him where you want the scar line placed. (link to styles of circumcision)
Ask any other questions you may have about the proposed circumcision.
Pubic Hair
There is no need to completely shave your pubic hair but it is desirable to trim it fairly short. This aids asepsis 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. Routine shaving should be stopped at least two days before your surgery on areas such as your upper legs and pubic areas. This is to prevent any skin irritation or damage which could lead to an infection. Continue to wash/shower or bathe with your regular products at home.
There will be a period of up to six weeks after circumcision when you will not be able to indulge in sex.
Alcohol
Do not take any alcohol, whether with or without a meal, prior to the operation 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 operation empty your bowels and bladder.
Aftercare
After the operation your whole 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 boxer shorts 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 the procedure only the immediate area of the cut will be bandaged. 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.
1-2 days after the operation is generally regarded as the most opportune time to change the dressing in the case of a glue circumcision. In a stitch circumcision it is advisable to try and keep the dressing on for 3-4 days. The bandage will, most likely, be well caked in blood (particularly the inner layers) and will need to be soaked off in the bath to avoid tearing the healing wound. If the dressings fall off earlier then do not be concerned as long as there is no bleeding.
Only put enough lukewarm water in a bath as needed to cover your groin completely. Throw in a couple of handfuls of salt to promote healing. DO NOT add any form of antiseptic solution. Sterilize a pair of small scissors by dipping in an antiseptic solution followed by a quick rinse in clear water (they will not actually touch your wound, so need not be absolutely aseptic). After soaking, cut the Elastoplast in the direction towards the tip of the penis. This reveals the gauze which detaches from the penis. Avoid cutting the other stitches.
The dressing should now be peeled off the wound. (Having a small plastic bag available to throw the used bandage into is a good idea.) Slowly unwind the bandage, stopping whenever you start to need to use any force to release it let the water soak the clotted blood off and then continue. Be sure to remove ALL of the bandage, including any odd strands of gauze which might otherwise become embedded in the wound. Do not peel off the glue.
Once the bandage is off, swill away the bloody water and replace with more lukewarm water and salt. Allow the exposed penis to soak for a few minutes (not too long, but enough to remove caked blood) and then pat dry with a gauze pad followed by applying a fresh bandage to protect the wound as it continues to heal in the case of stich circumcision. A thin coating of a bland ointment, e.g. Vaseline, before applying the bandage will reduce the possibility of blood making it stick to the skin. Repeat the process every 48 hours or so until the middle of the second week, after which the light bandage can be left on or off as you wish. If you choose not to use a bandage, then a gauze pad may be useful to prevent the stitches from catching in your underwear.
There is no need to put the bandages for glue circumcision if there is no oozing of blood.
Promoting Healing
Do not apply any antiseptic cream to your penis, nor add any antiseptic to bathwater. 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.
It can be beneficial and very soothing to soak the wound for 10 to 15 minutes a couple of times a day in a cupful of cooled, boiled water to which has been added a teaspoon of salt.
Pain Killers
Everyone reacts differently in respect of pain. For most people circumcision will not be very painful, but a degree of discomfort is to be expected during the first few days.
If you choose to take painkillers, 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 combining medications.
Do not take Aspirin or any Aspirin based product since these thin the blood and have an anti-clotting action which can increase bleeding from a wound. Please liaise with the doctors first if you take aspirin regularly for heart-related problems.
The Stitches
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 1 and 2 weeks. Leaving them longer increases the risk of small holes (or ‘stitch tunnels’) remaining in the skin.
Although the doctor will normally use soluble (or self-dissolving) stitches they should still be removed after 2 weeks if not already dissolved by then. You can go to your own doctor to have the stitches removed or can do it yourself (even easier, get your partner or a friend to do it for you).
Sterilise a pair of fine-pointed scissors and a pair of flat-bladed tweezers. Wash your hands and penis thoroughly. Carefully cut through a stitch near the knot and pull it out by grasping the knot in the tweezers. Do not be surprised if the location bleeds a bit. Remove alternate stitches, stopping if the two edges of the circumcision line separate this indicates that healing is not far enough advanced. If all is well then you can remove the remaining stitches, or you may choose to leave them a couple of days more if you wish.
Erections
To reduce the effect of night erections pulling on the stitches during the first few days, 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
Do not be over eager to have sex until your circumcision has healed, which will normally take up to six weeks.
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
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 energetic or contact sports, cycling and swimming until your circumcision has fully healed.
Your staff were very professional, the clinic clean and welcoming. You were very reassuring both before the procedure and on Day 6 when I called with a concern. The Plastibell did fall off the very next day.
