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Circumcision

What is circumcision?

This surgical procedure involves removing some or all the foreskin of the penis.

Why would you need a circumcision?

It is performed for different reasons:

  • 1.Phimosis (tight foreskin). The patient is unable to full the foreskin back over the head (glans) of the penis. This makes cleaning difficult, can make sexual activity uncomfortable for the man, and in severe cases, can interfere with urination.
  • 2.BXO – Balanitis xerotica obliterans. This is an ongoing inflammation of the foreskin (and sometimes head of the penis) that can cause scarring and a tight foreskin. It can also affect the head of the penis, and the opening. Steroid creams can be tried early on in this process, but often circumcision is needed.
  • 3.A tight frenulum, which makes it difficult to pull the foreskin over the head of the penis. Circumcision is the best way to treat this in the long term, but there are other options; see frenuloplasty and other foreskin sparing procedures.
  • 4.Penile cancer is very rare, but if it is present, it is more common that not to need the foreskin removed.

The operation for circumcision

Circumcision is mostly performed under general anaesthetic, but can be done under local anaesthetic if necessary. It takes less than an hour. In some cases, just the very end of the foreskin is affected, and this can be removed, leaving some foreskin behind. However, most of the time, the entire foreskin is removed by cutting the skin at the level of the ridge of the glans. Small blood vessels are controlled with ties or diathermy, and dissolvable stitches are placed. Even if you have a general anaesthetic, you will be given long lasting local anaesthetic in the area of the operation while you are asleep, so that you should wake up with no discomfort. This local wears off over 12 hours or so.

What are the risks of this operation?

All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.

Risks of the anaesthetic need be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand. 

There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:

Common

  • Swelling of the penis, lasting several days

Occasional

  • Bleeding that requires a further minor procedure
  • Infection of the incision requiring antibiotics
  • Reduced sensation of the glans of the penis

Rare

  • Failure to be satisfied with the cosmetic result
  • A large bruise in the area that becomes infected, requiring a further procedure

Very rare

  • If the foreskin is very badly affected by BXO, there may be an abrasion to the glans when separating the foreskin. This heals over time.
  • Narrowing of the urethra at the opening, requiring further procedures.

After the operation

You will be given specific instructions before you leave the hospital.

If you have any of the complications above, or you feel unwell, return to your nearest emergency department. Most people will have some swelling and bruising, but if this is worrying, do ask for help. Likewise, some discomfort is usual. Often, this is because the glans of the penis is not used to rubbing against your clothes, as the foreskin has protected it. This discomfort will soon improve.

If the pain is worrying, ask for help.

Generally, avoid work for 48 hours, longer of you have a strenuous job. Avoid sexual activity for 6 weeks, as the stitches can tear. You can shower the day after your operation, but avoid a bath for three days. Do not swim for a week.


Disclaimer

This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your urologist. The information does not apply to all patients.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.

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