Circumcision

What is circumcision?

Circumcision is an operation to remove the foreskin, which is the flap of skin that covers the head (end) of penis. The foreskin is cut away and the remaining skin edges stitched together.

Why is circumcision carried out?

Circumcision is carried out in the NHS for medical reasons only. The most common reason is lichen sclerosis or balanitis xerotic obliterans (BXO). Other conditions include phimosis, paraphimosis, Zoon’s balanitis or cancer of the penis (on the head of penis or under foreskin).

Circumcision is recommended when non-invasive treatments have been tried but failed.

Please tell your surgeon (before your surgery) if you have any of the following:

An artificial heart valve
A coronary artery stent
A heart pacemaker or defibrillator
An artificial joint
An artificial blood-vessel graft
A neurosurgical shunt
Any other implanted foreign body
A regular prescription for warfarin, aspirin or clopidogrel

How is circumcision carried out?

The procedure normally takes about 20 to 30 minutes and you will be able to go home on the same day.

A full general anaesthetic is normally used and you will be asleep throughout the procedure. It is sometimes done under spinal or local anaesthetic. This will be discussed with you when you see your surgeon or at the pre-assessment clinic. During the procedure the entire foreskin will be removed using an incision just behind the head of the penis. The remaining skin will be sutured to the skin on the length of penis. This leaves the head of the penis completely exposed with no redundant skin. The stitches that are placed are dissolvable and will start to fall out between one to two weeks after surgery.

What happens after the surgery?

From theatre you will go to a recovery area and then to the ward. The nurses on the ward will look for any bleeding before you go home. If you are in pain or discomfort let the nurse looking after you know and they may be able to give you some additional pain killers.

What are the complications after the procedure?

There can be some complications associated with the surgery.

Bleeding

You should expect to see some bleeding and swelling of the penis from the cut skin edges. Apply gentle pressure for 5 minutes and this should stop the bleeding. If the bleeding continues and penis becomes very swollen then you will have to come to A&E to see a urologist. This is very rare and only a very few patients will need to return to theatre to stop the bleeding.

Infection

Watch out for any signs of infection such as redness, pain, swelling and a high temperature. If you experience any of these you should contact your GP.

Loss of Sensation

A small percentage of patients may experience loss of sensation of the glans of the penis as this is now permanently exposed. This can have some effect on sexual intercourse and decreased sensation may delay orgasm. This could be due to psychological factors, due to the operation or underlying lichen sclerosis.

Narrowing of the tip of Urethra

If you notice that the tip of your penis has become narrowed and the flow of your urine is slower then please contact your GP.

Retention of Urine

Some patients may experience difficulty in passing urine after surgery. Please contact your GP or attend A&E if this happens.

Pain

You may experience some discomfort and pain for next few days. Take painkillers at regular intervals. If the pain continues please see your GP.

How much time should I stay off work?

You might have to take a week off as discomfort may remain until 5 to 7 days. Avoid heavy lifting for at least two weeks.

You should not drive, use machinery or make important decisions for 48 hours after your anaesthetic. Make sure you are comfortable driving, pain free and able to make an emergency stop before you start driving.

Do the stitches need to be removed?

The stitches dissolve between 1 to 3 weeks’ time. If they do not dissolve by 6 weeks then do please visit your GP.

How do I keep my penis clean after the operation?

The dressing will fall off either before you leave hospital or after you reach home. Do not apply any dressing too tight to interfere with the blood supply to the tip of the penis. During shower or bath, clean the area gently to wash away any blood or ooze from the wound. It is best to keep the wound uncovered or without dressing to. A clean dressing pad inside your underpants would be enough to keep the area clean and comfortable. There is no need to apply any creams or lotions.