Frequently Asked Questions

What is a Circumcision?

Circumcision is a simple operation which removes the foreskin. The foreskin is the sleeve of skin around the tip of the penis.

What does the Procedure Involve?

Circumcisions are carried out as a day case, so that your child can return home on the day of the procedure.

Firstly the doctor will inspect the penis and ask you a few questions to make sure that there are no contra-indications to carrying out the procedure. A local anaesthetic will be injected all around the penis to numb the foreskin.

The doctor will then test the area to ensure it is totally numb before proceeding with the circumcision. He will then mark the foreskin to give an estimation of how much skin should be removed. He will clean the area between the foreskin and the glans penis, removing adhesions and stretching and pulling back the foreskin. This will allow him to judge the size of the plastibell (plastic ring) that will be required for your child. It may be necessary at this stage to carry out a dorsal slit (cutting a little of the foreskin at the top) to allow the placement of the plastic ring. Once the ring is correctly positioned, it will be kept in place by a thread, tied with very tight knots. The plastic ring remains in place and falls off by itself a few days after the procedure.

Finally the excess foreskin will be cut off, leaving behind a very small amount of skin which will turn black and fall off with the plastic ring.

Once the procedure is finished it is advisable that you give your child paracetamol for pain relief. Before you are allowed to leave, the doctor will make sure that there is no bleeding. He will also ensure that the child has the ability to pass urine by visualising the urethral meatus (the opening at the end of the penis) and advise you to give the child plenty to drink. If he has not passed urine within four to six hours of discharge or if there are any signs of bleeding then you are to contact the doctor

In certain situations, after the local anaesthetic has been injected, the adhesions have been removed and the foreskin has been pulled back, the glans penis is sometimes bigger than expected. In these situations the ring is too small for the plastibell method. The doctor may at this stage abandon the procedure or proceed with a formal circumcision where the foreskin is cut and stitches are required to control any bleeding.

How to book an appointment?

To book an appointment for circumcision please call the circumcision center and speak to a member of our administration team. You also have the option to leave a voice message or send us an e-mail to request a call back at a time that is convenient for you. Please see our contact us details for more information.

What information is provided before the appointment?

After booking the appointment you will be sent detailed information about the circumcision procedure and aftercare service. This will allow you to read through all the necessary details and prepare any questions you may want to ask the doctor. You will also be sent directions to the clinic.

What are your fees?

   Age GroupDepositBalanceTotal Fee
   Under 12 Weeks£80£80£160
  Infants 13 Weeks to 1 Year£100£100£200
  Infants Sleeve 13 Weeks to 1 Year £200£200£400
  Toddlers 1 Year to 2 Years£150£150£300
  Children 2 Years to 15 Years£200£200£400

  Adults 16+

£400£400£800

What documents will need to be brought on the day of the appointment?

For children under the age of 16 years old, you are required to bring along the child’s red book, birth certificate (if issued) and photographic ID (e.g. passport or driving license) for both parents. You will also need to bring along the information pack that will be sent to you after making the appointment.

Do both parents need to be present?

For children under the age of 16 years we require both parents to be present and sign the consent form. Exceptions to this rule apply to single parents and other similar cases. Please speak to one of our administration staff if both parents are not able to attend for the appointment and we will be able to advise you accordingly.

What will happen on the day of circumcision?

On arrival at the clinic please report to the front desk. You will take a seat in our waiting area and when the doctor is ready you will be called into the private operating room.

The information pack that you will receive prior to the appointment will contain details of the appointment, the consent forms and our refund and restraint policy. Please read these documents carefully.

Before the procedure you will have an initial consultation, during which you will have the opportunity to ask any questions you may have. Once you are happy, you will need to sign the consent form.

The patient will be examined by the doctor to make sure he is healthy and that the circumcision can proceed safely.

What type of anaesthetic is used and will my child feel any pain?

Before the circumcision, the penis is made numb by injecting a medicine around the base of the penis. This is called a local anaesthetic and ensures that there is no pain during the circumcision procedure. After the injection, the doctor will wait a few minutes for the anaesthetic to take effect, test the foreskin, and only when he is certain that the child is unable to feel localised pain, he will begin the circumcision. The type of anaesthetic we use can last for up to six hours.

Will my child cry?

Every baby and child is different. We have had babies and children who have not cried for the injection and have remained quiet during the entire circumcision procedure. Other babies and children start crying as soon as they are undressed and put on the bed.

One way to calm and settle babies and very young children is to give them a bottle of sugary water to drink during the injection and the circumcision procedure. We strongly advise this for all babies, infants and toddlers, even if they are breast-fed.

Will my child be awake?

We use a local anaesthetic to numb the penis. This means that the patient is not put to sleep. However some babies and young children find it soothing to suck the bottle of sweet water and can slowly fall off to sleep naturally.

Can parents stay in the room during the circumcision?

We encourage parents to stay in the operating room during the entire circumcision procedure. However some parents feel more comfortable to wait outside the operating room whilst the circumcision is being carried out. Sometimes other family members, like grandparents and aunts, remain with the child whilst the parents wait outside. We appreciate this can be an anxious time for parents and will try to accommodate whatever they are comfortable with.

Can we bring toys, computer games and other forms of distraction?

For some children it helps for them to watch or listen to something on an electronic device such as an iPad or mobile phone. Some children are distracted during the circumcision procedure by a song or cartoon that is playing on an electronic device. Older children may like to play electronic games whilst the doctor carries out the circumcision.

What aftercare is provided?

Once the procedure is finished you will be taken to a separate recovery room. The doctor will go through the aftercare in more detail, you will also have the aftercare written guide to take home with you, this is so that you know exactly what to expect and how to take care of the wound. The Modality Circumcision Service provides comprehensive aftercare service. Detailed written circumcision aftercare information will also be provided so that our parents and patients know exactly what to expect and do.

Parents and patients are encouraged to contact us with any questions or queries relating to the circumcision.

What are your infection control policies?

Our circumcision clinic operating theatres are modern and of a high standard. They are equipped with electro-hydraulic operating beds and overhead theatre lights. This ensures a safe operating environment.

We have strict infection control procedures that meet all Care Quality Commission standards. We use only sterile single use equipment and instruments for the circumcision. This means we do not reuse any surgical instruments.

After the circumcision we dispose of all used materials. This ensures that we comply with the highest level of infection control and reduce the risk of our patients acquiring any type of infection. Because of this we do not use certain circumcision methods that require the same equipment to be reused on other patients.

What are the Risks of Male Circumcision?

1. Lack of informed consent. An infant cannot consent to the procedure. The decision must be made by the family/legal guardians. The procedure is considered permanent and there is a risk that when the child is older he will be unhappy he was circumcised as an infant.

2. Pain. The child may experience some pain whilst the local anaesthetic is being injected and also after the procedure, once the effect of the anaesthetic has worn off.

3. Surgical risk. Complications during male circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.

4. Change in sexual satisfaction. Some people believe that circumcision leads to decreased sexual pleasure later in life. Data recently collected from a large group of adult males who underwent circumcision later in life suggest that there is no change in sexual satisfaction between circumcised and uncircumcised men and their partners. However, some patients may be unhappy that they were circumcised.

If the procedure is abandoned then there is likely to be some swelling to the foreskin, causing some discomfort to the child for a couple of days.

The decision as to whether to totally abandon the procedure or proceed with a formal circumcision will be made by the doctor. This will depend on:
  1. Whether the child can be restrained long enough
  2. Whether the local anaesthetic is still effective
  3. Whether a formal circumcision at this stage may result in undue pain or harm to the child.

What are the steps to be taken care after the circumcision for 0-2 years ?

When your child goes home, he may not be his normal self for a few days.

1. He may feel unwell for some hours and experience some discomfort. The site will be sore after the procedure. Paracetamol (CALPOL) will help to relieve this discomfort and can be given every four to six hours.

2. Please give your child plenty of fluids to drink over the next few hours and make sure he has passed urine within 6 hours of the operation.

3. As with any procedure/operation, there is a chance of infection. A way to reduce the risk of infection is to ensure that the area is bathed at least once a day. You should start bathing him the day after the operation. To the bath water you should add:

2 tablespoons of salt, any salt is suitable.
2 caps of TCP antiseptic liquid.
You may also add normal baby wash or shampoo.
The bath should be deep enough to ensure the penis is submerged. Your child should sit in the water for 5-10 minutes. Afterwards you may leave the penis to dry on its own or dab it with a towel. You should stop the bathing once the plastic ring has fallen off.

4. During regular nappy changes you can clean the bum and penis area with wipes or water.

5. The plastic ring, usually drops off within ten days after the circumcision. Apply vaseline around the area as shown by the doctor. Once the plastic ring has fallen off, continue with the vaseline for another 3 days.

6. It is normal for the skin to be dark brown or black in colour around the plastic ring, this will disappear when the ring drops off. It is normal for some bruising and swelling to occur around the site.

7. When the ring is starting to fall off, and once it has fallen off, the penis will look red and swollen, and may have a yellow rim around the area where the ring was sitting. This is normal and will settle over the next few weeks.

8. If any of the following should occur, then please seek advice immediately:

Bleeding.
If the child has drank plenty of fluids and still not passed urine six hours after discharge.
The plastic ring has not fallen off within 10 days.
The plastic ring has slipped onto the shaft of the penis.
If the child develops a temperature or is unwell in any other way.

9. After the circumcision, the glans penis (the exposed part of the penis) may look, pale, pink, purple or bluish, the colour differs from child to child. This is absolutely normal.

It can take six weeks or more for complete healing to take place.

If you feel that your child needs emergency treatment, please go to the nearest A&E department.

What are the steps to be taken care after the circumcision for 2-16 years ?

Introduction

After the operation the penis will be swollen and look 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 boxers you may find that they give insufficient support. You may wish to consider some form of briefs which will hold the penis in position and thus reduce the frictional stimulation which it would otherwise receive if allowed to swing freely. Pointing the penis upwards in the tighter underwear helps drain away lymph and thus reduce the swelling.

Urination

Do not be surprised if the urine tends to spray instead of forming a neat stream for the first few days. This is a natural result of the swelling and will correct itself as the swelling subsides.

The Bandage

The bandage helps to protect the wound and also to contain and reduce the swelling. It is best to remove the bandage 48 hours after the operation. 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.

Put only enough lukewarm water in a bath as needed to just cover the groin completely. Throw in a couple of handfuls of salt or Epsom Salts to promote healing. DO NOT add any form of antiseptic solution. Soak the penis in the water for 5-10 minutes and 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.

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 followed by applying a fresh bandage to protect the wound as it continues to heal. A thin coating of a bland ointment, e.g. Vaseline or Sudocrem, before applying the bandage will reduce the possibility of blood making it stick to the skin. If you choose not to use a bandage then a gauze pad or even paper tissue may be useful to prevent the stitches catching in the underwear.

Promoting Healing

Do not apply any antiseptic cream to the penis, nor add any antiseptic to bath water. Whilst they do help to kill germs, most are corrosive to new skin and actually slow down healing. 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 or Epsom Salts.

In the rare cases where an infection develops, please contact us or your own doctor as soon as possible.

Pain Killers

Everyone reacts differently in respect of pain. For most people circumcision will not be truly painful, but a degree of discomfort is to be expected during the first few days.

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. Paracetamol or Ibuprofen based products are to be preferred.

Do not take more than the recommended maximum dose of painkillers.

The Stitches

We have used soluble (or self-dissolving) stitches. In theory these should dissolve by themselves but if they are still present after 6 weeks please contact us or your own doctor to have them removed. Leaving them longer increases the risk of small holes (‘stitch tunnels’) remaining in the skin.

Erections

To reduce the effect of nocturnal erections pulling on the stitches during the first few days, empty the bladder before going to bed and any time you wake during the night. Do not lie on your back, but on your side.

Time off School or Work

Make sure the young boy does not ride a bike or use other sit-on toys until the swelling has completely gone down. He should be able to return to school about a week after being circumcised. However, let his teacher know that he has had the operation.

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. You should naturally avoid fast-moving or contact sports, cycling and swimming until your circumcision has fully healed.

 If you have any queries after discharge, please contact the service on 0121 250 0386 or circumcision.bham@nhs.net and we will arrange for a clinician to call you back.

 If you feel that your child needs emergency treatment please go to the nearest A&E department.

 

What is your restraint and refund policy?

The Modality Circumcision Service operates a very strict restraining policy. For clarity we have explained the policy below. Please take your time to read and understand the policy and then judge whether your child will allow for the procedure to go ahead.

The doctor will only restrain the legs of a child during the administration of the local anaesthetic, which involves injecting a needle around the base of the penis.

Where a child shows signs of extreme distress or resistance and the doctor feels it would be harmful to restrain and administer the anaesthetic, the procedure will be cancelled.

Once the anaesthetic has been injected, only children aged two years and under will be restrained during the procedure. However, where children of this age group show signs of distress or resistance and the doctor feels it would be too harmful to continue, the circumcision will not be carried out.

For children above the age of two years, we will not allow any form of restraint, either by the doctor or parents. After the anaesthetic has been administered, if your child refuses to lie still on the operating bed, it will be dangerous to carry out the circumcision and the procedure will be cancelled.

Irrespective of the age of your child, if after the anaesthetic has been injected, the doctor observes signs of extreme distress or resistance, then it would be harmful to continue with the circumcision.

In certain situations where there is a clinical contra-indication (such as a buried penis or other anatomical abnormalities) the procedure will be cancelled.

The Modality Circumcision Clinic is an award winning clinic, that has an excellent reputation and while the majority of procedures go ahead with no problems, in certain cases children do get extremely distressed and the procedure has had to be cancelled.

In all of the above circumstances where the procedure has been cancelled, the booking deposit will be considered a consultation fee and is therefore non-refundable.

All deposits are fully refundable only if we are given a minimum of three working days notice.

What is the vital information based on ages?

Babies

There is no minimum age limit before a baby can be circumcised. Our youngest patient has been 4 days old.

We follow the World Health Organisation guideline that states that the baby must weigh more than 2.5kg (5.5 pounds) in order for the circumcision to be carried out. So as long as your baby weighs more than 2.5kg and has no contra-indications for circumcision, then it is safe for him to undergo the procedure.

Infants

The Modality Circumcision Service carries out circumcisions on boys of all ages, including infants aged 3 months to 1 year.

Some parents prefer to have their sons circumcised within a few days or weeks after birth whilst others choose to wait until the age of infancy. Our clinic has carried out thousands of circumcisions and our doctors on a routine basis circumcise boys of this age category.

Toddlers

At the Modality Circumcision Service, we carry out circumcisions on boys of all ages, including toddlers aged 1 year to less than 2 years. Parents may choose to delay the procedure until this age because of cultural reasons or simply because they needed time to research and make decisions about what would be in the best interest of their son.

We also have many parents traveling from different parts of the UK and Europe because they could not find a suitable clinic to have their son circumcised at an earlier age.

Whatever the reason for having your son circumcised, you can rest assured that at our clinic we will provide a high level of service and a safe standard of care.

Children

The Modality Circumcision Service carries out circumcisions on boys of all ages, including children from the age of two to less than 16 years old. There are certain cultures and religious opinions that prefer for boys to be circumcised when they are much older. We have had patients travelling from Italy, Finland, Iceland and many other parts of Europe and the UK to our circumcision clinic.

We have also had brothers and cousins, of different ages, all circumcised on the same day. Some families prefer to dress their children in traditional ceremonial clothing and treat the whole event as a celebration. Whatever the reasons for having your son circumcised at this age, our staff follow very strict policies and protocols to deliver safe, professional and high quality of care.

Before making a booking for children of this age category, we strongly advice that you read our restraining and refund policy. We operate a very strict policy to ensure the safety of our patients. Although the vast majority of children in this age group are circumcised without any problems, a small minority of cases are cancelled on the day in accordance with our policies and protocols.

Adults

Adults decide to get circumcised for numerous reasons. At our centre we have carried out adult circumcisions for cosmetic, personal hygiene, religious/cultural as well as medical reasons. The common medical conditions that have led to some of our adult patients seeking a circumcision are phimosis and BXO (Balanitis Xerotica Obliterans). We have also “re-done” previous circumcisions carried out at other clinics. Whatever the reason for circumcision, our doctors make every effort to ensure that the cosmetic outcome is satisfactory to the patient.

The most preferred method of adult circumcision at The Modality Circumcision Service is the “sleeve resection” method. According to the World Health Organisation manual on Adult Male Circumcision, the sleeve resection method requires good surgical skill and cosmetic results are better than the forceps guided and dorsal slit method. At our circumcision centre the surgeons have the skill to carry out all three methods and will at times, when necessary, combine or modify the methods. This is because every patient is different and the experienced and skilled surgeon will be able to choose and adjust the circumcision method that is suitable for a specific patient.

The style of circumcision is also important to adults who seek to have the procedure carried out for cosmetic reasons. The commonly known styles of circumcision are: Medium, Low & Loose, Low & Tight, High & Loose and High & Tight. These differing styles of circumcision are dependent on how much outer and inner skin is removed and where the scar line is placed. Some men also prefer for the frenulum to be removed (frenulectomy).

The angle of the scar line is also important to those adults who seek a cosmetic circumcision. Again, the sleeve resection method allows for the “V” scar to be placed on the ventral aspect of the penis. This style of scar follows the natural outline of the sulcus of the penis and cannot be achieved with the forceps guided method of circumcision.

Before the circumcision, the penis is made numb by injecting a local anaesthetic around the base of the penis. We use a combination of Dorsal Penile Nerve Block and a Ring Block. This ensures that there is no pain during the circumcision procedure and the anaesthetic effect can last up-to 6 hours. The patient remains fully awake during the circumcision procedure.

We use absorbable/dissolvable stiches (commonly 4.0 Vicryl Rapide) and thus there is no need to come back to the clinic to have them removed. They can take between 2-6 weeks to completely dissolve but some patients report that the stiches dissolve within 10 days.

Some patients prefer to have non-absorbable sutures. In these situations we would use 4.0 Ethilon and the patients can either come back to our clinic or make their own arrnagments with their GP to have them removed.

Our circumcision clinic operating theatres are modern and of a high standard. They are equipped with electro-hydraulic operating beds and overhead theatre lights. This ensures a safe operating environment.

We have strict infection control procedures that meet all Care Quality Commission standards. We use only sterile single use equipment and instruments for the circumcision. This means we do not reuse any surgical instruments.

After the circumcision we dispose of all used materials. This ensures that we comply with the highest level of infection control and reduce the risk of our patients acquiring any type of infection. Because of this we do not use certain circumcision methods that require the same equipment to be reused on other patients.

We will send out detailed written aftercare information, together with other important documents, once you make the booking. After the procedure you will be taken to a separate recovery room and the doctor will go through the aftercare in more detail.