Circumcision

Why is circumcision performed?

Medical reasons

1. Tight foreskin (phimosis) that won’t pull back easily that is causing painful intercourse, difficulty in passing urine properly (ballooning of the foreskin, splashing of urine), and poor hygiene.
2. Recurrent infections and inflammation of the foreskin and head of penis  (medically referred to as balanitis/ or balanoposthitis
3. When the pulled foreskin cannot be returned back to its starting position leading to the head of the penis to swell (like a ring around the swollen finger. Medically this is known as paraphimosis
4. Certain foreskin (dermatological) conditions like Balanitis xerotica obliterans (BXO) including suspicious changes or cancer.
5. HIV prevention. Trials in Africa have shown that circumcised men have a lower risk of acquiring HIV. The benefit is seen in young age group. This does not apply to other sexually transmitted diseases (STDs).

Non-medical reasons

1. Cultural or religious (Jewish, Islamic and many African communities) .

Is there an option to avoid surgery?

In the absolute majority circumcision will only be recommended when other less invasive venues have been tried and did not work.

Initially a topical steroid is prescribed, which softens the skin facilitating pulling back the foreskin. If this does not work then surgery will be recommended.

If there is an infection of the foreskin / head of the penis these are addressed with an ointment  that depending on the cause can be a combination of corticosteroid / antifungal / antibiotic. The situation is reassessed once there is complete resolution of the acute event.

My foreskin retracts easily but my doctor is still recommending a circumcision. Why?

If you are suffering from repeated balanitis (infections of the head of the penis) these can be decreased by removing the foreskin as the wet urine rich environment that typically triggers it is eliminated. This typically leads to a major improvement.

In some men, when the penis is asleep (flaccid) the foreskin retracts easily but when the penis gets erect the foreskin is tight leading to discomfort.

Can you guide me through the procedure?

Most circumcision are done under local anaesthetic and as a day case procedures. These avoid the complications of a general anaesthetic (put completely to sleep) and minimise stay at hospital so the chances of infections from hospital environment is minimised.

The Doctor will see you in the morning and go through the consent process. This means that the doctor will explain the operation steps, its risks and complications, your recovery, and warning signs to seek medical attention.

In a nutshell steps of the procedure include the following;

A local anaesthetic is infiltrated at the bottom  (base) of the penis. Checks are made to ensure that it is working. You will feel the movement but you should not feel pain.

The section of the foreskin removed is marked and cut.

The edges of the wound are sutured with an absorbable suture.

An ointment and dressings are applied.

What are the risks of the surgery?

Most men don't have any significant problems. Even though this is a common procedure there is no such surgical procedure where complications do not arise.

1. Swelling and bruising
2. Increased sensitivity
3. Wound healing issues
4. Infection
5. Change in sensation of the shaft or head of penis
6. Change in orgasm sensation
7. Return back to theatre
8. Scarring
9. May need further removal of skin
10. Not happy with the cosmetic result
11. Extremely rarely injury to water pipe (urethra)
12. Local anaesthetic issues.
13. If you have general anaesthetic then you are at increased risk of heart, chest and clot issues. Extremely rarely death.

Recovering after circumcision

Will I be given any ointment?

Most surgeons will ask you to apply an ointment (antibiotic based like chloramphenicol or simple Vaseline) so that the exposed head does not dry out, avoids the wound to attach to your garments/underwear and it may help to offset the increased sensitivity of the head.

How will my penis look?

The penis initially will look swollen and bruised. Typically it will take between 10 to 21 days to settle down.

Will I have sutures? Do I need to have these removed?

The sutures used are typically dissolvable and will fall off by themselves. There is no need to have them cut.

Will I be in pain?

Your penis especially the head may be sensitive in the beginning as it is adapting to being exposed. This will resolve in the first 48 to 72 hours. Many men have good pain control by simple paracetamol or ibuprofen if not contraindicated.

I always recommend wearing light, loose-fitting clothing for the first few days this will minimise the irritation.

Can I wash?

For the first 3 days just let saline drip down over the penis. After you can wash with normal soap. It is always advised that you pad dry.

Will I be able to go to work and exercise?

Take at least 1 week off work to recover and avoid long walks.

When can I go behind the wheel?

It's your duty to ensure you're able to drive after surgery. The recommendation is that if you can press the brake without thinking about the soreness of discomfort down in the operated area you can drive.

When can I have sex? Will my pleasure change

Avoid having sex for at least 3 to 4 weeks after your operation.

Some men report that their feeling of orgasm has changed.

When to seek medical attention after surgery?

If you have one or more of the following;

1. excessive swelling,
2. spreading redness,
3. pain not controlled by simple pain relief medication,
4. difficulty in emptying the bladder
5. bleeding  that does not stop
6. Fever including chills and rigors.