What is circumcision?

Circumcision is the surgical removal of the foreskin. The foreskin covers the head of a flaccid penis. When the penis is erect, the foreskin pulls back to reveal the penis.

Why is it done?

Many adult men and teens seek circumcision for medical, health, sexual, cultural, religious and cosmetic reasons.

Circumcision is also performed for medical reasons:

• Phimosis: a condition in which the foreskin is too tight to be pulled back over the head or glans of the penis
• Paraphimosis: a urologic emergency in which the retracted foreskin of an uncircumcised male cannot be returned to its normal anatomic position, causing a restriction behind the glans which may slow or stop the flow of blood to the tip of the penis. The condition can lead to serious complications if it isn’t treated
• Repeated episodes of infection:
  • Balanitis is infection of the glans (head) of the penis
  • Posthitis is infection of the foreskin
• Balanitis xerotica obliterans: this is a skin condition which can affect the foreskin
• Recurrent tearing of the frenulum.

What happens during the operation?

The operation is done as a day case.

While in babies the operation is usually done using anaesthetic gel or a local anaesthetic injection, in older children and adults, a general anaesthetic is usually given so you will be asleep for the procedure, however spinal anaesthetic may be used instead, you will be able to discuss options with your anaesthetist.

Your urologist will make a circular incision in your foreskin at a level just below the head of the penis and remove the whole foreskin; this leaves the glans (head of the penis) completely exposed, then will use dissolvable stitches to attach the skin of your penis to below your glans; these stitches usually disappear within 2 to 4 weeks.

The operation takes about 30 minutes.

What to expect after the operation?

You should be able to leave the hospital as soon as you are ready. However, if you have had a general anaesthetic, you should not drive and should make sure someone is there to accompany you when you go home. You should not drink alcohol, operate machinery or sign legal documents for 24 hours after the procedure.

Recovery from adult circumcision typically takes 2 to 3 weeks but it can take up to 6 weeks before the penis returns to its final cosmetic appearance.

After the surgery, you may experience some swelling and bruising of the penis which may last a few days. You may experience pain or discomfort when passing urine or when the wound is touched, simple painkillers such as paracetamol are helpful if you have any discomfort. Minor bleeding can occur initially.

Avoid wearing tight clothing for the first few days.

All your stitches will dissolve, usually within 2-4 weeks. Any dressing should fall off within 24 hours; if it does not, or if it becomes soaked with urine, you should remove it. Try to keep the area dry for 24 to 48 hours; do not take a bath before 48 hours after the procedure.

The exposed glans will feel very sensitive for the first 2-3 weeks, although a few patients describe this lasting longer. Once the hypersensitivity has settled, your penis may feel a little less sensitive than before the operation.

You will continue to get erections as normal after the procedure, but you should refrain from any sexual activity (intercourse or masturbation) for 4 weeks. When you first get erections, you may feel some tightness and discomfort around the scar tissue; this will regain its normal elasticity within a few months. The procedure will have no effect on your ejaculation and fertility.

Are there any risks?

Adult circumcision is a relatively simple procedure, but as with any medical procedure there are some risks and complications that can arise.

As with any operation, you may have a reaction to a general anaesthetic, bleeding from the wound, or infection. Bleeding can usually be stopped by applying pressure but some people need to be taken back to the operating theatre to have stitches put in.

Other complications are rare and include:

• Removal of too much or too little foreskin
• Scar tissue (adhesions) between the glans and the shaft – i.e. between the end and the main body of the penis
• Scarring of the urethra (meatal stenosis), leading to problems passing urine.

You should call your doctor if:

• The wound becomes very red, swollen or tender after at least 4 This may indicate infection
• You have any excessive bleeding
• You have difficulty in passing urine
• You have increasing pain or pain that cannot be controlled with pain killers
• You have a high temperature.