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Dr Hammad Malik (MBBS BSc, MRCGP)

Circumcision London

Welcome to London Circumcision for circumcision London. Please email hammadmalik10@gmail.com or TEXT only to 07951 726 844

Dr Malik has a private practice based in Harley Street, London.

The circumcision surgery is offered as a visiting service in London and Greater London for children from 7 days to 4 years of age.

Dr Malik believes that it is extremely important that no child should feel any pain either during or after a circumcision. Initially we go through an information sheet explaining the procedure and aftercare to the parents. It is always performed as a painless procedure under local anesthetic. All instruments used are sterile, single use and disposable only. This greatly reduces any risk of blood borne infections eg HIV and Hepatitis. Following the circumcision, parents may contact Dr Malik at any time.

Dr Malik recently featured in a video regarding Circumcision on the NHS on Channel 4. If you would like to watch this video, please click here.

Circumcision appointments at home in London

Appointments are available evenings and weekends. Please feel free to give Dr Malik a call for more information or to make a booking. References can be provided should you wish to speak directly to other parents who have used our service.


cqc circumcision londonThis is to certify the following service provider Dr Hammad Malik has been registered by the Care Quality Commission under the Health and Social Care Act 2008

Certificate number:CRT1-579954264   Provider ID:1-544491491


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What is a circumcision?

 

Circumcision is a surgical operation where there is removal of the foreskin  (the skin covering the head or glans of the penis). My preferred method is the Plastibell technique as I believe it is safer, less painful and generally produces a neater cosmetic result.

 

So how is this Plastibell method done ?

 

Using a local anaesthetic injection the penis is made totally numb. Modern techniques mean that we no longer inject into the penis but just under the pubic bone. This allows me to access the nerves more rapidly so that the anaesthetic starts working within seconds. As some babies may cry because they have had their nappy removed I always demonstrate that the anaesthetic is working properly. By gently squeezing the end of the foreskin with a pair of forceps we check to see that he does not react by moving his hips – in other words the anaesthetic block is working perfectly and he is not in ANY pain whatsoever. The parents watch this check so there is no doubt in their minds that their boy is feeling any pain. Unfortunately there are still boys in the UK who are circumcised without any anaesthetic – please note that anaesthetic sprays and creams DO NOT work properly and are not licensed for use in surgery. The anaesthetic will last on average 1.5-2 hours the procedure takes 4-5 minutes. Within 10 minutes of the procedure ending and another 1-1.5 hours of anaesthetic time I give all children a weight adjusted dose of analgesic painkillers. So way before the anaesthetic starts wearing off the painkillers are already on board and working.

 

The foreskin is gently retracted back and the Plastibell is positioned on the head of the penis. We then carefully roll the foreskin back over the ring. Using the sterile ligature (string) which comes in the pack we tie the ring in place. The ligature is secured in place with 3 surgical knots and the string ends and excess foreskin at the edge of the Plastibell is trimmed leaving behind a 2mm margin.

 

Because of the ligature cutting off the blood supply to the remaining 2mm margin of foreskin, this tissue starts to die off. Just like the umbilical cord clamp and cord the 2mm edge changes colour from white to brown to black as its dies. Usually within 6-12 hours the 2mm margin has died off and therefore feels no pain. As it is dead and dry like the umbilical cord it feels no pain and does not stick to the nappy. Your baby wears a nappy and babygrow. He can be held normally, put in a car seat and taken out. With methods using stitches and bandages there is an open wound that is painful for the child when they pass urine and often sticks to the nappy. So here the advice given is no nappy or a loose nappy to let the open wound air dry, or use vaseline/olive oil to stop the penis sticking to the nappy. NONE of these apply to the Plastibell method – if it sticking then something odd is occurring which needs assessing.

 

Slowly and automatically the ligature will cut through the remaining 2mm margin and then the Plastibell, 2mm foreskin margin and ligature will all slide off the end of the penis in 1 piece. Just like the cord this process is painless. He will wee and sleep normally. Once the ring has fully detached behind it will be the beautiful clean and neat result. It is the string cutting through with the Plastibell acting as a template that produces the lovely straight edge. Trimming the excess foreskin to the 2mm margin ensures the tissue dies off quicker and hence he is potentially in pain for less time and reduces the risk of infection with less dead tissue near the head.

 

History of circumcision

 

There are many techniques which have been used over the years. These have ranged from simply cutting the foreskin with a blade followed by a bandage dressing or stiches  (sutures) through to various clamp devices (Mogen or Gomco ) and disposable clips ( Plastibell or PrePex ).

 

The first documented description of circumcisions are seen in ancient Egyptian wall paintings hieroglyphs of young boys undergoing ritual circumcision. These date from before 2300 BC though it was known to be practised in the Middle East following the tradition started by Abraham. Hence Jewish boys and later Muslims with some orthodox Christian groups embraced this practice. Elsewhere in the world ranging from Africa to South America circumcision had been seen in a varied mix of cultures and religions – often seen as a rite of passage into adulthood.

 

Disease prevention was also a consideration for why we believe some cultures started circumcising their males. In the United States many soldiers were circumcised to reduce penile infection risks when stationed in regions where there would be poor sanitation and humidity. In the western world, circumcision became widespread in the UK, Australia, New Zealand and Canada though Europe recorded very low rates.

 

Worldwide nearly 1 man in 3 is circumcised, generally done as newborns. It is the most common paediatric surgery in the world - far above tonsillectomy or appendicectomy. Cultural and religious variations dictate regional rates with almost universality for predominantly Muslim countries in the Middle East, Indian Subcontinent and North Africa. The Far East and South/Central America are seeing increasing rates. Currently in the US many babies are circumcised the following day after the delivery with parents having to opt out as this is considered the norm irrespective of the parents religion.  

 

Benefits of circumcision

 

 

Throughout the latter half of this century there have been many arguments questioning the benefits versus harm for circumcision. Then in 2012 the American Academy of Paediatrics ( AAP ) published a revised policy statement. They undertook an extensive review of all the current trials data. This showed there were health benefits which outweighed the risks but it should be always a considered parental choice.

 

Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections including HIV.

 

http://pediatrics.aappublications.org/content/103/3/686.full

 

Evidence has been shown in other studies that cervical cancer rates are lower in communities where the males have been circumcised. This is thought in part to relate to the reduced transmission of human papilloma virus (HPV) – a well documented trigger for cervical cancer. Currently in the USA, UK, Australia and Europe teenage girls are vaccinated against HPV (the so called cervical cancer vaccine Cervarix or Gardasil)

 

HIV reduction programmes were initiated in Sub-Saharan Africa in light of a study in 2007 from the World Health Organization and UNAIDS proving that circumcised men reduce their risk of HIV infection by approximately 60% in high risk areas.