Circumcision

Why is circumcision done?

Circumcision is usually performed for medical, religious and cultural reasons.

Medical reasons

There are several medical conditions affecting the foreskin for which circumcision is considered a treatment option. These include:

• Phimosis: this occurs when your foreskin becomes too tight to pull over the head of the penis (the glans). If the foreskin is not too tight, you may want to try other types of treatment, such as a steroid cream or an operation, to loosen or refashion the foreskin rather than remove it.

• Paraphimosis: if your foreskin is pulled back for cleaning or to insert a tube (a catheter) to drain the bladder and is not replaced in its normal position, the glans can start to swell, trapping the foreskin at its base.

• Balanitis and posthitis: balanitis is an infection of the glans. Posthitis is an infection of the foreskin. Both can be caused by poor hygiene. However, there can be other causes, such as allergies and sexually transmitted diseases. If either condition persists, you may require circumcision.

• Balanitis xerotica obliterans: a skin condition that can affect your foreskin, the skin of your glans and the channel through which urine is passed (the urethra). It can cause white lumps on the affected skin and thinning and scarring of the urethra. Medicines are usually used to treat the condition, but circumcision can often help, especially if the urethra is not involved.

The operation is usually done using anaesthetic gel or a local anaesthetic injection in babies. In older children and adults, a general anaesthetic is usually given so you will be asleep for the procedure. If you are given a general anaesthetic, you are usually advised not to eat or drink anything for six hours beforehand.

The classic operation involves cutting off the foreskin and stitching back the remaining skin. In recent years, various plastic clamps have been used, such as the Gomco®, Plastibell®, and Shang Ring®. These clamps make the operation easier and quicker, result in a neater scar, and reduce the need for stitches.

Circumcision

There is an alternative procedure called a preputioplasty which involves cutting and stretching the foreskin rather than removing it altogether.

How long does circumcision take?

The duration of the procedure may vary between babies and adults. In adults, it typically takes about 20 minutes. Additional time is usually needed for preparation and recovery before going home.

Is circumcision painful

Local or general anaesthesia is used to prevent pain during the procedure. Some soreness or discomfort afterwards is common and can be managed with pain relief. Pain may also occur if complications such as swelling or infection arise.

You should be able to leave hospital as soon as you are ready. However, if you have had a general anaesthetic, you may feel drowsy and should wait until you are fully awake.

You should not drive and should make sure someone is there to accompany you when you go home. You should refrain from drinking alcohol, operating machinery or signing legal documents for 24 hours after the procedure.

You can do any activity you feel comfortable with and should be able to return to work after seven to ten days. The same period applies to children returning to nursery or pre-school or school. If your job involves heavy physical work, you may need to take a couple of weeks off.

You should also avoid sex (intercourse) or masturbation for about four weeks, as this can lead to pain and bleeding.

Benefits of circumcision include:

• Relief from symptoms of any of the medical conditions described above.

• Prevention of urine infections.

• Reduces the risk of getting a sexually transmitted infection such as HIV, herpes simplex or human papillomavirus.

• Reduces the risk of you getting some types of cancer of the penis.

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

Other possible complications can include:

• Removal of too much or too little foreskin.

• Loss of sensation in the tip of the penis.

• Rare complications include scarring of the urethra (meatal stenosis), damage to the end of the penis and scar tissue (adhesions) between the glans and the shaft.