Circumcision is the surgical removal of the skin covering the tip of the penis.
How is the procedure done?
- We usually carry out the procedure under a general anaesthetic, but local (we numb nerve to the penis with an injection at the base of the penis) or spinal anaesthetic may be used instead.
- We still use local anaesthetic nerve blocks even in general anaesthetic to provide post-operative pain relief.
- We give you an injection of antibiotics before the procedure after you have been checked for any allergies.
- An incision just below the head of the penis and remove the whole foreskin: this leaves the glans (head of the penis) completely exposed.
- Dissolvable stitches are used to attach the skin of your penis to the skin below your glans (see below). These stitches usually disappear within two-three weeks.
Why is the procedure done?
It is usually performed for one or more of the following reasons:
- Circumcision is a religious or cultural ritual for many Jewish and Islamic families, and groups in Africa and Australia. Circumcision can also be a matter of family tradition.
- A tight, non-retractile foreskin - known as phimosis.
- Recurrent infections under the foreskin – known as balanitis.
- Skin disease on the foreskin and glans (head of the penis) - such as chronic inflammation (balanitis xerotica obliterans).
- Large warty lesions of the foreskin - viral warts (HPV)
- Cancerous or pre-cancerous lesions of the foreskin
Risks of the procedure
Most common complications associated with circumcision are:
- Bleeding or accumulation of blood under the skin
This is because the skin of the penis is less tight than other parts of the body and has a very good blood supply. If a large blood clot forms, it is sometimes necessary to perform another small operation to remove it.
The wound can become infected, particularly in men with diabetes. The operation is performed in sterile conditions, but the penis is in an area that is not as clean as other parts of the body. The first signs of infection are increasing pain, redness and swelling at the site of the operation. If this happens, you should return to us for follow-up, as antibiotic treatment may be needed. Antibiotics are not given routinely.
- Side effects related to anaesthesia are possible as well.
- 1 in 250 patients will experience dissatisfaction with the cosmetic result even if the procedure is done correctly.
- Oedema (swelling) of excess skin and skin adhesions of remaining skin to glans may require further surgery and skin removal.
Before the procedure
- Please bring a pair of well-fitting clean underpants to wear after the operation.
- On the morning of the operation, wash the genital area and the penis carefully with water and mild soap, giving special attention to the area under the foreskin.
- There is no need to shave your pubic hair in advance of the operation.
- You will be more comfortable if you empty your bladder before the operation.
- Remember not to eat/drink from 22:00 the night before the procedure, irrespective of the type of anaesthetic used.
- Stop blood thinning medication prior to surgery. Discuss this prior to your surgery as the type of blood-thinning medication determines how long before the procedure it needs to be stopped.
- Ask us which of your chronic medication you should take on the day of the surgery.
After the procedure
- You will get some swelling and bruising of the penis which may last several days.
- It can take up to six weeks before the penis returns to its final cosmetic appearance.
- The exposed glans penis will feel very sensitive for the first two weeks. Once the hypersensitivity has settled, your penis will feel a little less sensitive than before the operation.
- The exposed glans may dry out and scab over.
- All your stitches will dissolve, usually within two-three weeks.
- Simple painkillers will be prescribed and will help with any discomfort.
- Remove the dressing after 5-7 days after the procedure.
- If the dressing becomes soaked with urine, remove it.
- After the dressing is removed, wash the penis with soap and water in the shower. Avoid soaking in a bath.
- You should not swim for two weeks.
- You will continue to get erections as normal after the procedure, but you should refrain from any sexual activity (intercourse or masturbation) for six weeks.
- When you first get erections, you may feel some tightness around the scar tissue; this will regain its normal elasticity within a few months.
- Avoid any sport or other strenuous activity for 4–6 weeks.
- The healing process will be well advanced after 7 days, but it takes 4–6 weeks for the wound to become strong. Full healing takes longer (3 to 6 months).
- Phone the rooms to arrange a routine follow-up appointment between 2-6 weeks postoperatively.
Phone us if any of the following occurs
- Continued bleeding from the wound or formation of a large blood clot under the skin near the site of the operation.
- Severe swelling (after the procedure swelling is normal and return to normal over the first few days. If the swelling gets worse, contact us.)
- Discharge of fluid or puss; this may indicate infection.
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