Circumcision is a procedure performed in men to completely remove the foreskin, leaving the head of the penis exposed.
WHY IS CIRCUMCISION REQUIRED?
Circumcision in adolescent and adult males may be performed to treat:
- Scaring around the opening of the foreskin which prevents the foreskin from being pulled back over the head of the penis (phimosis).
- Skin diseases affecting the foreskin, such as Balanitis xerotica obliterans (BXO) / Lichen sclerosis (LS) which causes scaring and hardening of the foreskin.
- Recurrent Urinary tract infection and infections under the foreskin (balanitis).
- Abnormal growths (including cancers) on the foreskin or head of the penis.
WHAT DOES CIRCUMCISION INVOLVE?
Circumcision is usually performed under general anaesthetic (completely asleep), but spinal anaesthetic (numb from the waist down), or local anaesthetic (numbing injection) can be used instead.
Regardless of the type of anaesthetic, we also use local anaesthetic which will provide pain relief for several hours after the procedure.
We make an incision below the head of the penis and remove the whole foreskin.
We use dissolvable stitches to join the skin beneath the head of the penis to the skin on the shaft of the penis.
The procedure is usually performed as day surgery – you can go home on the same day of the surgery as long as you are accompanied by a responsible adult.
WHAT IS THE RECOVERY AFTER CIRCUMCISION?
A dressing will be placed on the penis. It usually falls off within the first 24 hours. If it falls off it doesn’t need to be replaced. If it doesn’t fall off, your surgeon will tell you when it can be removed. If it becomes soaked with urine it needs to be removed.
The wound needs to stay dry for 48 hours after the operation. Do not soak in the bath or go swimming for at least two weeks after operation.
You will be given instructions for pain relief after the procedure. Usually regular paracetamol and/or ibuprofen for a few days is enough. The penis will be numb for the first several hours after the procedure.
You may be given an ointment to apply to the wound and the head of the penis after the dressing comes off.
There will be some swelling of the penis which will go away after a week or so. It may take up to six weeks for the penis to reach its final appearance.
The head of the penis will be very sensitive. This will go away after a few weeks. Long term, the sensation in the penis will often be different to what it felt like before circumcision.
The stitches are dissolvable and will fall out on their own after a few weeks.
You will continue to get erections after the procedure. Avoid sexual activity for four to six weeks. There should be no long-term changes to your erections, ejaculation or fertility.
It is usually safe to drive 24 hours after the procedure.
You can usually return to work one to two days after the procedure.
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WHAT ARE THE RISKS OF CIRCUMCISION?
Specific risks of the procedure (excluding risks from the anaesthetic include):
Common (1/2 – 1/10)
- • Change in penile sensation.
Occasional risks (1/10 – 1/50)
- Bleeding requiring further surgery.
- Wound infection requiring antibiotics.
- Wound splitting open and taking longer to heal.
Very rare risks (< 1/250)
- Scarring at the opening of the urethra blocking the flow of urine and requiring further surgery.
WHAT ARE THE ALTERNATIVE TREATMENT OPTIONS?
Topical steroid creams applied to the foreskin can sometimes soften the skin, allowing the foreskin to be retracted.
A dorsal slit is a more minor procedure which can be used to treat phimosis. The cosmetic appearance of the penis after a dorsal slit is not as good as after circumcision.
Preputioplasty is a procedure which can sometimes be used to treat phimosis without removing the foreskin.
WHERE CAN I FIND MORE INFORMATION ABOUT CIRCUMCISION?
British Association of Urological Surgeons (BAUS): Circumcision leaflet