|Information for the patients and parents.|
When the foreskin won’t retract
Phimosis, or preputial stenosis, is a term that usually means any condition where the foreskin of the penis cannot be retracted.
· Most infants are born with a foreskin that cannot be retracted and the prepuce may be tight until after puberty.
· A fully retractable foreskin occurs in 50% of ten year olds, 90% of 16 year olds and 98 to 99% of 18 year olds.
Causes of Phimosis
Symptoms of Phimosis
A very tight foreskin can cause problems during intercourse, urination.
Inflammation Affecting Head of the Penis and Foreskin
Balanitis is an inflammation that affects the head of the penis and/or the foreskin.
Most common in men over 40 years old, Balanitis is a condition affecting about 11% of adult men and 3% of children. Balanitis is characterized by shiny red to orange plaque (area). It can also present as a yellow hue with red pinpoint spotting.
Signs Symptoms of Balanitis
· Discharge from the penis
· Difficulty with passing urine
· Inability to retract the foreskin
Causes of Balanitis
· Poor hygiene
· Response to infection.
Various viruses and organisms can cause balanitis. These include HPV (human papilloma virus)
· Chemical irritants (ie condoms) an allergic reaction
· In overweight and obese men
· Penis cancer
Complications of Balanitis
The Circumcision Operation
A straight forward circumcision will take about 5 to 10 minutes. When a circumcision is performed for medical conditions the procedure will take longer. we use a special medical glue to join the edges of the cut foreskin.In adults 3-4 desolvable stitches are are used in addition.
The type of anesthesia used for circumcision will depend on the procedure being performed and on the patients age. Babies will often only have a numbing medicine along with a very short GA .
How to Care for Your Wound After a circumcision procedure
it is important to take good care
of the surgical site to minimise
the risk of infection and
72 hours after the operation, gently wash the
area with warm water each day to prevent
infection. After washing, pat the area dry with a
Tight clothing or underwear can rub against the
surgical site causing irritation and discomfort.
Loose clothing allows the area to breathe and
You should avoid strenuous physical activity,
such as sports or heavy lifting for at least 3
week after the procedure.
Over-the-counter pain medication,
paracetamol/Ibuprofen can help to relieve any
discomfort or pain.
Watch for signs of infection, such as redness,
swelling, fever or pus drainage from the surgical
site. If you notice any of these symptoms,
contact your healthcare provider.
It is important to follow your healthcare
provider’s instructions for post-operative
care and attend any follow-up appointments
Side effects of circumcision requiring
medical attention include:
BLEEDING: Blood loss in a small infant is potentially
dangerous, slight bleeding including staining of
the cloths/nappies is ok. If the child or adult is
continuously bleeding, apply pressure over the wound
site as you hold a stick in your hand and contact the
hospital where he had the circumcision.
· If a child fails to pass urine after 6 to 8 hours after the
operation contact the hospital or Mr Jaffry’s offi ce.
There may be a scab blocking the meatus. This is
usual in some cases as the raw area over the meatus
will form a scab which causes inability to pass urine.
· If swelling and redness around the top of the penis
does not go or becomes worse after 3 to 5 days,
contact Mr Jaffry’s offi ce (091 720065). An Important
factor here to remember is progression of symptoms,
if the symptoms are not progressing you can wait.
· A yellow discharge (not staining of clothes) around the
penis tip may indicate an infection (if it persists after
3-5 days). It is very unusual to get a post operative
infection and if it does, this usually settles with
frequent washing and keeping it clean and dry.
· Antibiotics are not usually necessary but if the GP or
your physician feels it’s necessary then you have to
· Calpol (Paracetamol) and/or Neurofen (Ibuprofen) is
usually effective alternately until any swelling and
· You may remove the dressing after 72 hours of
the operation. This will include removal of a ribbon
gauze wrapped around the penile would , this
has to be unrolled. A net dressing called mepitel
dressing will be found underneath it and has to be
peeled off. Usually its easy to peel it off the wound.
· You may start washing the wound after the
dressing is removed ie: 72 hours after the
operation, with clean water and cotton wool.
· Do not apply any type of creams/gels or soaps after
washing, until you are advised by Mr Jaffry.
· The wound can separate and that usually settles
itself, however a regular visit with Mr Jaffry may be
necessary in some cases to make sure the wound
is healing well. This is mainly due early morning/
nocturnal tumescence in both adults and children.
· Post operative pain in adults may take number of
weeks (6-8) to settle.
· For adult patients refrain from sexual intercourse
until your fi nal review at the rooms.
· Please note that in patients who have a pubic fat
pad, they may have additional cosmetic problems
initially, which would have been discussed at initial
consultation, just to reiterate, a circumcision
procedure does not effect the overall size of the
penis however the appearance may look small
and there could be delayed healing/infection and
webbing of the skin post operatively.
· In patients with BXO and other chronic
infl ammatory conditions the recovery may be
extended and can cause prolonged side effects
and complications like infection, bleeding, scab
formation, meatal closure, altered/hyper sensation
around penile skin, discolouration of penis and skin
fi brosis at closure site. This is the usual course in
some patients, which requires close monitoring
and regular follow up with Mr Jaffry to achieve an
Mr Syed Jaffrey