Welcome to Toronto Safe Circumcision and Vasectomy Clinic!
At our clinic we provide fast and almost painless circumcision techniques. Circumcision is a surgical procedure by which the foreskin, the skin covering the head of the penis is removed. The procedure is often done as a religious tradition or for cultural reasons.
Though male circumcision could be done at any age, it is commonly done within the first two months of birth. It can also be a medical treatment for problems with the foreskin.
Toronto Circumcision Clinic
Circumcision is the surgical removal of the removal of the foreskin, the fold of skin that covers the head of the penis.
The benefits of male circumcision include a reduced risk of urinary tract infections in childhood, a reduced risk of ulcerative sexually transmitted diseases in adulthood, protection against penile cancer, a reduced risk of cervical cancer in female sex partners, and prevention of balanitis ( inflammation of the glands), posthitis (inflammation of the foreskin) and paraphimosis (inability to return the retracted foreskin to its original location).Call us today and schedule an appointment
Normally, a local anesthetic is given by injection through the skin near the base of the penis. During a circumcision, the foreskin is removed from the head of the penis (glans). Even though the person having the procedure will be awake, there will be no pain while it is being done. After the procedure, some discomfort is expected when the local anesthetic wears off. There are pain-killers that relieve any pain or discomfort. For newborn babies, circumcision is easier and faster that it is with adolescents and adults. The healing period is much shorter for newborns and infants.
Circumcision is a procedure that is surrounded by controversy. It is sometimes required for medical reasons, but many make the decision themselves or for theirs sons to be circumcised based on religion, culture, or the belief that it is more hygienic and likely to protect against various health problems. We are prepared to provide you with the information you need to make an informed decision on whether or not circumcision is the right choice for you or your son(s).
Benefits of Circumcision
Circumcision may provide the following benefits;
. Make it easier to keep the penis clean . Reduce the risk of urinary tract infections especially in childhood
prevents: - Inflammation of the glans (balanitis) and the foreskin (posthitis) - The potential for scar tissue on the foreskin, which may also lead to phimosis (inability to retract the foreskin) - Paraphimosis (swelling of the retracted foreskin resulting in inability to return the foreskin to its normal position) - Provide a reduced risk of HIV, penile cancer, cancer of the cervix in female sex partners and some sexually transmitted infections (STIs), especially ulcerative disease such as chancroid and syphilis
There are risks associated with circumcision. However, they are rare when performed in a well-equipped clinic by a well-qualified doctor with specialized training and experience in circumcision. These risks include:
- Pain - Bleeding - Hematoma (formation of a clot under the skin) - Infection at the site of circumcision - Increased sensitivity of the glans penis for the first few months after procedure - Irritation of the glands - Meatitis ( inflammation of the opening of the urethra) - Injury to the penis - Adverse reaction to the anesthetic used during the circumcision
These complications are rare when circumcision is performed by well trained, adequately equipped, experienced health care personnel, and are easily and rapidly resolved
The healing process usually takes about one week. The baby should be brought back to the clinic if any of the following occur in the child:
Distressed or pain
Failure to wake for feeding as he usually does
Feparation of the skin edges
Unusual swelling or bleeding
Difficulties with urination
If the parents have any concerns about healing process
Frenulectomy, or Frenectomy, is quite a non-invasive, brief, outpatient procedure that takes only about 20 minutes, and is virtually pain free with local anesthetic. Essentially, it is the removal the tight or short bit of elastic skin called the frenulum, between the shaft of the penis
Vasectomy is a surgical procedure for male sterilization or permanent contraception. During the procedure, the male vas deferens are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse
Circumcision is the surgical removal of the removal of the foreskin, the fold of skin that covers the head of the penis.
The benefits of male circumcision include a reduced risk of urinary tract infections in childhood, a reduced risk of ulcerative sexually transmitted diseases in adulthood, protection against penile cancer, a reduced risk of cervical cancer in female sex partners, and prevention of balanitis ( inflammation of the glands), posthitis (inflammation of the foreskin) and paraphimosis (inability to return the retracted foreskin to its original location).
Complication rates following male circumcision are very low when it is performed by well equipped and trained heath care providers. Numerous regional and global studies since the 1980s have noted a lower risk of HIV infection in circumcised men, as well as lower HIV prevalence in populations where male circumcision is common. Several randomized controlled trials in Africa demonstrated that male circumcision reduce the risk of acquiring HIV infection by 50- 60%. Lower prevalence of human papillomavirus (HPV) infection in circumcised man than in uncircumcised men. The incidence of invasive penile cancer is significantly lower in circumcised man than in uncircumcised man, though this condition is extremely rare.
Frenulectomy, or Frenectomy, is quite a non-invasive, brief, outpatient procedure that takes only about 20 minutes, and is virtually pain free with local anesthetic. Essentially, it is the removal the tight or short bit of elastic skin called the frenulum, between the shaft of the penis, under where the foreskin would be in both circumcised and uncircumcised adult males. A frenulectomy can be combined with an adult circumcision as well if desired. It can also be done to fix abnormalities such as Frenulum Breve, which causes pain and often bleeding during sexual activity. For other men, if the frenulum is wide and firm, it doesn’t break, but causes a sensation od painful grip when erect, resulting at times to premature ejaculations, which is more rare but also treated with a frenulectomy. Frenulum Breve
If the frenulum is too tight or short, it tugs on the glans (head of the penis) and can restrict the foreskin from stretching fully. This can cause pain, bleeding, or both during intercourse. Such a bleed calls for immediate tentativeness to control and prohibit the bleeding with usually dissolvable stitches, although not all frenulectomies require stitches. If the frenulum is abnormally wide, it constitutes absorbable stiches. Frenulectomy Vs Circumcision
It is important to note that the correction is a short frenulum or Frenulum Breve, is even more of a minor surgery than an adult circumcision, and not to be nervous about, especially considering its health benefits. An uncorrected short frenulum, causes pain and uncontrollable bleeding during coitus, and even sometimes morning erections. The bleeding would be deemed as a need to stop what you are in the middle of, and get to an Urgent Care immediately, which would be often and unpleasant. The Surgical Procedure
There are several terms to describe this procedure, including frenulum lengthening, plasty of the frenulum, and frenulumectomy. The technique is quite straight forward and brief. Simply the frenulum is cut out and dissolvable stitches may be applied. A dressing is applied for the first few days and special care instructions will be provided. The surgery occurs under local anesthesia via syringe. As a results, it is virtually pain free. The following days after the procedure, if at all pain is experienced, you will be given a brief as-needed only non-addictive medication regimen such as Tylenol extra strength. The surgery fixes the problem conclusively. Complimentary Consultation
At our clinic, we offer a complimentary no-obligation consultation with Dr. Tahmoures Bahrami to consult about frenulectomy procedures for those who are medically cleared and in good health for small surgery. If you have any questions or wish to get a second opinion with us, please don’t hesitate to call. In fact, feel free to call us at 905-475-2506 Monday to Friday 9am -5 pm or leave us an after hour message to return your call shortly. Dr. Bahrami, CCFP is a board certified Family Physician of Ontario with years of experience in vasectomies, pediatric and adult circumcision, as well as adult frenulectomies. He successfully manages Toronto Safe Circumcision with 20 years of continued expertise in this field (www.torontosafecircumcision.com). What is the Frenulum of the Penis?
Frenulum of the penis connects the foreskin to the glans penis and the long shaft region. Generally speaking, the frenulum is located on the ventral or underneath portion of the penis. Some men are born with a hereditary or naturally occurring congenitally short and tight frenulum, causing pain and often bleeding when their penis is erect or during intercourse. What Could Happen If Left Untreated?
When the frenulum is tight and short, an erection can cause tension of the frenulum leading to pain and bleeding, as blood pools into the penis with high pressure at this time. Not only is it a destructive situation when the bleeding and pain doesn’t stop on its own, but over time, pressure on a tight frenulum leads to an overcompensated, bent penis. Thus, a Frenulum Breve could turn into a penis with a permanent curvature to the right, left or downward. What Are The Risks of A Frenulectomy?
Bleeding (usually mild, treatable): 1 / 100
Scarring at the site of the operation (minimal, lessens): 1 / 100
Swelling and bruising at the site of the procedure (time heals this): 1 / 100
Suboptimal cosmetic or functional effect requiring a second procedure: 1 / 100
Vasovagal reaction causing light-headedness after the procedure (treatable): 1 / 200
Meatal Stenosis due to injury to the Frenular Artery requiring a Meatotomy (treatable, rare): 1- /500
Chronic pain at the site of the surgery (treatable) 1 / 500
Infection requiring antibiotics (treatable): 1 / 500 Treatment Options for Short Frenulum
A number of treatment options are available for short frenulum. These include:
Circumcision plus a Frenulectomy (all done at one time) Just Frenulectomy (other names: Frenuloplasty or Frenectomy)
How Long Does The Frenulectomy Take?
It can be performed in an outpatient clinic setting under local anesthesia. The procedure takes about 20 minutes to perform. Anesthesia is injected about 20 minutes prior to beginning. Please expect to reserve an hour for the entire process of filling out medical paperwork and so on. When Can I Resume Sex?
After a frenulectomy, you are advised to refrain from sexual activity for a minimum of 3 weeks until the tissue heals completely. Can It Go Away On Its Own?
Unfortunately, a short frenulum does not get better on its own. It either stays about the same or worsens, as described in details above. Usually fernulectomy is necessary to remove it. Can we detect this problem in children?
This abnormality can sometime be detected in children during spontaneous erections. It is possible to treat it preventively before puberty. Otherwise, it is up to the teenager or young adult to refer to a specialist. Although it may be embarrassing to do so at that age, we prefer to talk about its advantages than its disadvantages. Do not hesitate to refer to a specialist. It is common urological problem and the treatment is rather simple.
The procedure requires simply braking the frenulum with the aid of a surgical knife. Sometimes, excision of the edges of the frenulum is necessary for a more aesthetically pleasing result. Otherwise, there may be a slight undesirable growth on the glans and the foreskin. Post – Operative Care
Apply polysporine ointment (green label) four times a day for 3 weeks in order to reduce the risk of sticking. Postoperative bleeding may occasionally occur within one week after surgery, especially after a strong erection. In which case, obtain and use a compressive bandage in those instances.
Are The Risks of Frenulectomies the Same as Other Surgical Procedures? Yes
Bleeding (rare) Infection (rare) Scarring (minimal, if any)
We advise that you first discuss the procedure with you primary physician who should send a referral to our office. Also, you should follow up by either calling us or booking your registration online to reserve an appointment with Dr. Tahmoures Bahrami.
For those who utilize our internet booking option, you save a visit to our office, and only have to attend your actual vasectomy day if you so choose. Most patients prefer an in-office consultation beforehand however.
Dr. Bahrami is ready to discuss any questions or concerns you may have and the procedure should only occur when you are ready.
We perform the latest Vasectomy technique that requires no needles, no incision, no stitches, and virtually no pain or downtime.
or call our office at 905-475-2506.
No-Scalpel No Needle Vasectomy
Fully covered by OHIP
A quick and virtually painless procedure
Optional online appointment registration
How can I be sure vasectomy is right for me?
You don’t want to father any (more) children under any future circumstances
You want to enjoy sex without worrying about pregnancy
You want to save your partner from invasive surgery which carries higher risk and failure rate, like tubal ligation, or unwanted abortion
A vasectomy might not be right for you if:
You are planning on reversing the procedure later on
You are under a lot of stress
You are very young
Your current relationship is not stable
You’re having a vasectomy just to please your partner
Eight reasons to have a No Scalpel Vasectomy:
Less chance of bleeding and other complications
Just as effective as more invasive vasectomy methods
Common Questions About No-Scalpel Vasectomy
Hoes does vasectomy prevent pregnancy?
Sperm are made in a man’s testes. During sexual climax, the sperm travels through two tubes (the right vas and the left vas) in the scrotum, mix with semen, and come out of the penis. In a vasectomy, these tubes are blocked so the sperm cannot reach the semen. As a result, you will ejaculate semen without sperm. A man cannot makes his partner pregnant without sperm.
Will I be sterile right away?
No, after vasectomy, there are always some active sperm left in you system. It usually takes 3 months plus 20 ejaculations to clear them. You and your partner should use some form of birth control until two semen tests confirm that your semen is sperm free.
Does No-Scalpel Vasectomy work?
Success rate has been better than 99.9%.So, to be safe, you must use other forms of contraception for two months post-procedure, or until Dr. Bahrami has examined two separate semen specimens and found them to be sperm free. If both tests are negative, it is very likely you will have permanent success as it is exceedingly rare for the tubes to ever grow back together if they have not done so by two months.
How soon can I go back to work?
You should not do any heavy physical labour for 7 days after your vasectomy. If your job does not involve this kind of work, you can go back sooner. Many men have their vasectomy on Thursday or Friday, so they can take it easy over the weekend and go back to work on Monday.
Is there any discomfort?
Before the vasectomy, you will not need any sedatives. No-Scalpel Vasectomy is virtually painless. Afterwards some people may be sore for a couple of days, and may want to take a mild painkiller. The discomfort is less with the no-scalpel technique, because there is minimal injury to the tissue.
What are some potential benefits of open-ended vasectomy?
Open-ended vasectomy is where, once the vas tube is cut, the end from the testicles is left open (ie. uncauterized), while the end of the tube leading to the penis closed. Studies have suggested that this could be the ideal way to block the vas end. There may be less post-operative discomfort because there is no sudden pressure back up to the testicles. Vasectomy reversal may also be easier to perform later, if required.
What is different about a No-Scalpel Vasectomy?
No-Scalpel Vasectomy is different from a conventional vasectomy in the way the doctors gets to the tubes, not in the way he blocks them. In addition, an improved method of local anesthesia, the No-Needle method, helps make the procedure virtually painless.
In a conventional vasectomy, after the scrotum has been numbed with a local anesthetic, the doctor makes two cuts in the skin and lifts out each tube in turn, cutting and blocking them. Then the doctor stitches the cuts closed.
In a no-scalpel vasectomy the doctor locates the tubes under the skin and holds them in place with a small clamp. Instead of making two incisions, the doctor makes one tiny puncture with a special instrument. The same instrument is used to gently stretch the opening so the tubes can be reached. This line accurately represents the actual size of the puncture. Through this tiny opening both tubes are temporarily lifted out and then blocked using heat cauterization. Then we carry out what many studies describe as a crucial step, called fascial interposition. This step involves tying the sheath or covering of the vas over one end of the cut tube with a tiny titanium clip or with dissolving thread, to create a natural barrier between the two cut ends.
The fine tubes are then gently places back into the scrotum and the tiny opening heals within days and soon becomes invisible. There is very little bleeding with the no-scalpel technique. No stiches are needed to close the tiny opening, which heals quickly, without a scar.
Will vasectomy change me sexually?
The only thing that will change is that you will not be able to make your partner pregnant. Your body will continue to produce hormones that make you a man. You will have the same amount of semen. Vasectomy won’t change voice, beard, muscles, your sex drive, you erections, or your climaxes. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before.
When can I start having sex again?
As soon as you are comfortable after a minimum of 7 days, but remember to use some kind of birth control until your semen analysis confirms you are sterile.
How long will a No-Scalpel Vasectomy take?
The vasectomy takes only a few minutes. It is so simple that it can be performed right here in our office (rather than the hospital). After the procedure there is no problem driving yourself home.
Can a No-Scalpel Vasectomy be reversed?
Yes, but reversal operations are expensive and not always successful. If you are thinking about reversal, perhaps vasectomy is not right for you. Pre-vasectomy Sperm Banking (cryopreservation) is a good idea for almost anyone considering a vasectomy. Ask our staff for details.
Is No-Scalpel Vasectomy Safe?
Most medical experts, including special panels convened by the National Institute of Heath and by the World Health Organization, have conducted that vasectomy is a safe and simple procedure. Vasectomy is surgery, and all surgery has some risks, such as bleeding, and infection. But serious problems are uncommon.
How much will a vasectomy cost?
OHIP covers vasectomy and the tray fee.
Please confirm you appointment at least two days prior by calling our office 905-475-2506.
One week before your scheduled surgery date do not take any anticoagulants (warfarin or aspirin) or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (ie. Advil, Naproxen, Aleve, Motrin, Ibuprofen) as they will thin your blood.
Avoid drinking alcohol three days before and after your vasectomy.
You may have your regular meals on the day of your surgery. There are no restrictions on your diet.
On the day before the surgery, you need to shave front wall of the scrotum and the underside of the penis.
On the day of your appointment please take a shower.
Upon arrival at the clinic you have to take 1 gram (2 tab of 500mg) of Tylenol.
You should wear light clothing, as the room will be warm.
When enter in the surgical room you need to lower your pants, lie down on the table and relax. The doctor will wash the scrotal area with iodine solution.
During the procedure, which takes about 10 minutes, you can bring listen to music, play games or watch videos on your phone or tablet.
Please bring a pair of well-fitting clean underpants to wear after the operation. They will hold the wound dressing in place for the first day or two. A day or two after the operation, once the dressing has been removed, it is better to wear loose underwear.
On the morning of the operation, wash the genital area and the penis carefully with water and mild soap, giving special attention to the area under the foreskin.
If you have long pubic hair, it is a good idea to clip this with scissors before the operation, so that is does not interfere with the dressing that will be put on after the circumcision. There is no need to shave you pubic hair in advance of the operation.
You will be more comfortable if you empty your bladder before the operation.
Problems and Complications after the operation
Some swelling and discomfort can be expected after the operation, but this normally gets better after the first day or two. No special treatment is needed.
One of the possible complications is bleeding or accumulation of blood under the skin. This is because the skin of the penis is less tight than other part of the body and has a very good blood supply. If a large blood clot forms, it is sometimes necessary to perform another small operation to remove it.
The wound can become infected, particularly in men with diabetes. The operation s performed in sterile conditions, but the penis is in an area that is not as clean as other parts of the body. The first signs of infection are increasing pain, redness and swelling at the site of the operation. If this happens, you should return to the clinic for follow up, as antibiotic treatment may be needed. Antibiotics are not given routinely and antibiotic ointment should not be used, as this may make things worse. The actual risk of having a complication, such as bleeding or infection, is about one for every fifty men who have the operation.
If you are unable to pass urine or have difficulty in doing so, you should return to the clinic for assessment.
Most men get erections during the night while sleeping. If this occurs after the circumcision operation, you may experience some minor discomfort because of pulling on the stitches. This is nothing to worry about and will settle down after 1-2 weeks.
Occasionally the head of the penis may remain very sensitive after the operation. This increased sensitivity will become less over the first few weeks, as the skin of the glans becomes slightly thicker.
Instructions to follow after the operation
In the first three days after the operation, it may help to rest at home. Lying on your back means that the penis is at its highest point in your body and this takes the pressure off the area. However, you should also walk about regularly, for example to get meals or visit the toilet. You should not ride a bicycle for the first five days after the operation.
Keep the area of the operation dry until the next day; keep the area clean; do not use any antiseptic cream, ointment or any other substances. Do not remove the bandage until told to do so by the clinic staff.
The circumcision wound is closed with absorbable stitches. These dissolve by themselves and it is not necessary to return to the clinic to have them removed.
You should return to the clinic if any of the following complications occur:
Continued bleeding from the wound
Formation of a large bleed clot under the skin near the site of the operation
Pain (you will feel some pain when the local anaesthetic wears off, but this should settle down over the first few hours. However, if the pain comes back, return to the clinic)
Swelling (after the procedure some swelling is normal and this will settle down over the first few days. If the swelling gets worse, return to the clinic)
Discharge of fluid or pus; this may indicate infection
Avoid any sport or other strenuous activity for 4-6 weeks. The healing process will be well advanced after 7 days, but it takes 4-6 weeks for the wound to become strong. Full healing takes longer (3 to 4 months). It is best to avoid sexual intercourse or masturbation for the first four to six weeks after circumcision. It is very important to use a condom during sexual intercourse to protect the healing wound for at least six months after the operation.
Postoperative Instructions for Adult Circumcision
After the operation, rest at home for three days. This will help the wound to heal
You may bathe on the day after surgery, but do not let the dressing get wet
Remove the dressing 24 – 48 hours after surgery
Do not pull or scratch the wound while its healing
Do not have sexual intercourse or masturbate for 4 – 6 weeks and use condoms to protect the wound for every act of sexual intercourse at least six months until the wound has healed completely. (Your health care provider will advise you about this during your follow up visit)
You may have a little pain or swelling around the wound. This is normal. Check occasionally to make sure that it does not get worse. Take any medications provided or recommended by the clinic. Be sure to follow the instructions given to you.
Return to the clinic of call:
If you notice increased bleeding from the surgical wound
If the pain or swelling a the surgical wound gets progressively worse
If you have difficulty passing urine
If you develop a fever within one week of surgery
If you have severe pain in the lower abdomen
If the wound is discharging pus
If you have any of these problems, call us to make an appointment immediately
Return to the clinic for a follow-up visit in 48 hours and 7 days after the operation, to see how the wound is healing