Circumcision

Circumcision is an operation to remove the foreskin from the penis. The foreskin is the sleeve of skin that surrounds the head of the penis.
 
This factsheet is relevant for both adults who are having circumcision and parents of children who are having the procedure. However, for simplicity we will refer to ‘you’ throughout.
 
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
About circumcision
What are the alternatives?
Preparing for a circumcision
What happens during a circumcision
What to expect afterwards
Recovering from a circumcision
What are the risks?
 

About circumcision

Circumcision is a simple operation to remove the foreskin from the penis. The foreskin is always stuck to the head of the penis at birth, but it gradually separates and can usually be pulled back by the age of about three. Although circumcision is done more often on babies and young boys, it can be performed on men of any age.
Circumcision may be done for medical reasons such as if your foreskin is too tight and difficult to pull back over the head of your penis. This is called phimosis and it’s most common in boys around puberty.
If you have a tight foreskin and you force it over the head of his penis, there is a risk it will get stuck there. This condition is called paraphimosis and it usually needs urgent medical attention.
Circumcision may be done for cosmetic, religious or social reasons. This is called non-therapeutic (or ritual) circumcision. It's thought that circumcision may help reduce the risk of sexually transmitted infections and cervical cancer in female partners. However, having safer sex is considered more important.

What are the alternatives?

Your surgeon may suggest a procedure called preputioplasty. This involves making one or two small slits in the foreskin to help it stretch.

Preparing for a circumcision

Babies are likely be given a local anaesthetic, either by injection or by gel applied to the area. This is thought to be safer than a general anaesthetic in newborns. In older children and adults, circumcision is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
 
At the hospital a nurse will ask you questions about your general health. He or she will also measure your heart rate and blood pressure. You must tell the nurse if you have any allergies or if there is any history of bleeding problems in the family.
Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
In some circumstances a child can sign their own consent form independently, providing he or she understands what they are asked to do.

Non-therapeutic circumcision

Both parents must give consent for non-therapeutic circumcision in children. Boys who are old enough to express how they feel about having the operation may say that they don’t want to be circumcised. Their wishes are important and the surgeon will take them into account.
The risk of complications is greater than any advantages.
If you do want circumcision you should speak to your GP who may refer you to a private clinic.

What happens during a circumcision

The operation takes 20 to 30 minutes.
The foreskin is pulled forward and trimmed away. The skin edges are closed using dissolvable stitches and/or special glue.
Your penis may be wrapped in a paraffin-based dressing to protect it from rubbing against clothing. The dressing is usually removed after 24 to 48 hours.
If you have a general anaesthetic, you may also be given a local anaesthetic before you wake up. This means that you will feel less pain immediately after the operation.

What to expect afterwards

After a general anaesthetic you will need to rest until the effects of the anaesthesia have passed.
You will be able to go home when you have passed urine. However, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds and a date for a follow-up appointment before you go home.

Recovering from a circumcision

The local anaesthetic will keep you free of pain for up to eight hours. You may need pain relief to help with any discomfort as the anaesthetic wears off. If needed, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
 

Bathing

It's important to keep the tip of your penis clean. The area should be kept dry for 48 hours after the operation. After this, take warm baths or showers once or twice a day. Don't use bubble bath or scented soaps, as these may irritate your healing wound. Leave the penis to dry naturally after having a bath or shower.
You should wear loose underwear and clothing until the wound is fully healed. Babies still in nappies will need them changed frequently.
You may find it painful when passing urine for the first few days. Applying petroleum jelly (for example, Vaseline) to the tip of your penis after you have passed urine may help to ease this and stop clothes from sticking to it.
Dissolvable stitches will disappear on their own in seven to 10 days. The wound may bleed slightly until all the stitches have dissolved. Contact your GP or the hospital if the healing wound bleeds heavily or starts to weep yellow or white discharge.
Follow your surgeon's advice about sexual activity. Having an erection will be painful for a few days after the operation, so you should not get into situations that could cause arousal.
You should not have sexual intercourse until the wound has fully healed. This can take four to six weeks. If you have sexual intercourse too soon, the wound could re-open and you may need another operation.
Children can usually return to school or playgroup from seven to 10 days. Full recovery can take two or three weeks.

What are the risks?

Circumcision is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

 Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling, sick as a result of the general anaesthetic. Common side-effects include pain, swelling and bruising of the skin around the penis, which may last several weeks.

Complications

This is when problems occur during or after the operation. Most men aren’t affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection.
Bleeding is usually stopped by applying pressure. Very rarely, heat (diathermy) or fine stitches are used to seal the blood vessels. You may need to stay in hospital overnight for observation. Infection is usually mild and treated with antibiotics.
Specific complications of circumcision are rare, but can include:

• removal of too little or too much of the foreskin
• abnormal scar tissue formation – it may be possible to correct this with further surgery
• damage to the penis or urethra (the tube which carries urine out of the body) – this is very rare but if it happens another operation may be necessary

It's possible that circumcision may affect future sexual sensation (although this is impossible to measure).
The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your surgeon to explain how these risks apply to you.