Circumcision

What Is A Circumcision?

A circumcision is an operation to remove your foreskin (the skin that covers the sensitive tip of your penis). You may have asked Dr Vasudevan to perform a circumcision for cultural or religious reasons. This document will give you information about the benefits and risks to help you to be sure you want to go ahead with the operation.

If Dr Vasudevan has recommended a circumcision for medical reasons, this document will give you information about the benefits and risks to help you make an informed decision. If you have any questions that this document does not answer, ask Dr Vasudevan.

Why Is A Circumcision Performed?

Worldwide, circumcisions are most commonly performed for religious or cultural reasons. Circumcisions are usually recommended only for the following medical reasons:

Tightening of the foreskin (phimosis), where you are unable to pull back the foreskin despite advice and treatment from your doctor.

Balanitis xerotica obliterans (BXO), which is an uncommon condition where the foreskin becomes thickened and white, making it difficult to pull back. BXO can cause the opening of your urethra (tube that carries urine and semen to the tip of your penis) to narrow.

Pain during sex. This is often caused by a tight or non-retractile foreskin.

Infections of the foreskin that keep coming back despite good hygiene and treatment with antibiotics.

Are There Any Alternatives To A Circumcision?

If BXO is suspected, a circumcision is the only dependable way to cure the condition. For other conditions, a dorsal slit operation or a preputioplasty may be recommended. These operations involve widening the foreskin but not removing it. However, they give a poorer cosmetic appearance.

What Will Happen If I Decide Not To Have The Operation?

If you do not have a circumcision, your symptoms will continue. If you have BXO, it can spread onto the end of your penis but even after surgery this may still happen.

What Does The Operation Involve?

The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to Dr Vasudevan and the healthcare team your name and the operation you are having.
The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you. You may also have injections of local anaesthetic to help with the pain after the operation.
You may be given antibiotics during the operation to reduce the risk of infection. The operation usually takes about 30 minutes.
Dr Vasudevan will remove the foreskin and seal off any small blood vessels. They will stitch the two edges of skin together (see figure 1). You may be able to see these stitches but they will dissolve after a few weeks.


What Should I Do About Medication?

Let Dr Vasudevan know about all the medication you take and follow his advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.

What Can I Do To Help Make The Operation A Success?

If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complication and will improve your long-term health. Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health.

You can reduce your risk of infection in a surgical wound.

In the week before the operation, do not shave or wax the area where a cut is likely to be made.

Try to have a bath or shower either the day before or on the day of the operation.

Keep warm around the time of the operation.

What Complications Can Happen?

Dr Vasudevan will try to make the operation as safe as possible but complications can happen. Some of these can be serious and can even cause death (risk: 1 in 400). You should ask Dr Vasudevan if there is anything you do not understand. Dr Vasudevan may be able to tell you if the risk of a complication is higher or lower for you.

Complications of anaesthesia

Your anaesthetist will be able to discuss with you the possible complication of having an anaesthetic.

General complications of any operation

Pain- The hospital healthcare team will give you medication to control the pain and it is important that you take it as you are told so you can move about as advised.

Bleeding during or after the operation (risk: 3 in 50)-You may need another operation.

Infection of the surgical site (wound) (risk: 1 in 10)- Infection is most common within the first two weeks. It is usually safe to shower after two days but you should check with the healthcare team. Let Dr Vasudevan know if you get a high temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may need another operation.

Unsightly scarring of your skin.

Specific complications of this operation?

Not enough foreskin is removed. You may need another operation (risk:1 in 100).

Too much foreskin is removed. This is uncommon and usually gets better without another operation.

Difficulty passing urine. You may need a catheter (tube) in your bladder for one to two days.

Developing an ulcer at the tip of your penis (Meatal ulceration) caused by your penis rubbing against underwear. This usually gets better.

Narrowing of the opening of your urethra (meatal stenosis) caused by injury during the circumcision or inflammation afterwards (risk: less than 1 in 100). This leads to difficulty passing urine. You may need another operation.

Damage to your urethra (urethral fistula). This is rare and you will need another operation.

Reduced pleasure from sex. Some men report an improvement. If the circumcision is performed because of pain during sex, it is likely that pleasure from sex should improve.

Injury to the end of your penis. This is serious but rare and needs specialist treatment.

How Soon Will I Recover?

In hospital

After the operation you will be transferred to the recovery area and then to the ward. You should be able to go home the same day or the day after. However, Dr Vasudevan may recommend that you stay a little longer. If you do go home the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency.
Your penis will usually look swollen and bruised, and may feel sore for the first week. This is a normal reaction to the operation.
If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours.
To start with, rest and wear loose underwear. A lukewarm bath may reduce the pain and also help you to pass urine. For the first few days take simple painkillers such as paracetamol and drink plenty of fluid.
Do not have sex for three weeks.
You should be able to return to work after a week to 10 days. Do not swim for three weeks.
Regular exercise should help you to return to normal activities as soon as possible.

Summary

A circumcision is an operation to remove the foreskin. Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.