Circumcision

What is the foreskin?

The foreskin is the flap of skin that covers the head of your penis. This skin flap is usually loose enough to be pulled back over the top of the penis (the glans). The foreskin protects the head of your penis from damage.

If you're circumcised, the head of your penis is permanently exposed. Sensitivity will increase as your glans adjust to exposure, but once healed, should feel less sensitive than before the operation.

Is circumcision right for me?

Globally, circumcisions are most commonly performed for religious or cultural reasons. At Nuffield Health, this procedure is available to patients aged 3 and above, for medical purposes only. Your consultant may recommend a circumcision if:

• You keep getting foreskin infections, despite good hygiene and treatment
• You have balanitis xerotica obliterans (BXO) – an infection that causes the foreskin to become thickened, making it difficult to pull back
• You find sexual intercourse painful because you have a tight foreskin and can't pull the foreskin back when erect
• you have phimosis – a condition where the foreskin is very tight and cannot be pulled back over the head of the penis, either when flaccid or erect, and forcing it back may cause damage
• Non-surgical treatments, such as creams or medication, haven't improved your foreskin condition.

What happens during circumcision?

A circumcision procedure takes about 30 minutes. You may be worried about how painful an operation on your penis might be. Your anaesthetist will make sure you feel no pain during the procedure.

Circumcision is usually performed under general anaesthetic, but it can be done using a variety of anaesthetics. The anaesthetist will discuss what method will be used before your surgery.

Before the procedure

There are a few things you can do in the lead up to the procedure to make sure everything goes as smoothly as possible:

• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly
• In the week beforehand, don't 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
• If you're diabetic, keep your blood sugar levels under control around the time of your procedure.

During the procedure

1. Once you're under anaesthetic, your surgeon will make a cut behind the head of your penis and remove the entire foreskin, leaving the glans exposed
2. They'll seal off any small blood vessels
3. Finally, they'll stitch together the edges of the skin below the glans. In older patients, the skin may be stitched using dissolvable stitches. 

After the procedure

After the operation, you'll be taken to the recovery area where you'll wake up (if you had general anaesthetic). A nurse will be there to look after you.

Back in your room, you may feel some pain as the anaesthetic wears off, which you can take painkillers for.

Recovery from circumcision

Circumcisions in babies and young children usually heal in 7–10 days, school-aged children should be able to return to school in about 1 week, while teenagers and adults can take up to 4–6 weeks to heal. 

Circumcision will usually leave a fine scar line below the head of the penis where the stitches were.

Short-term recovery

Your penis will look swollen and bruised and may feel sore for the first week. This is a normal reaction to the operation. 

You should be able to go home the same day. If you had general anaesthetic or sedation, for the first 24 hours:

• You’ll need someone to take you home and stay with you overnight
• Don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and co-ordination
• You shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

You should get plenty of rest for the first 24 hours, but then it’s important to stay active to avoid blood clots. You should also follow the instructions from our healthcare team on medication or special compression stockings.

Here are a few things you can do to make sure you recover well:

• Take pain relief medication for the first few days 
• Wear loose underwear
• Drink plenty of fluid
• Try to keep the area dry for 24–48 hours and avoid soaking in a bath
  
• After this time, a lukewarm bath may reduce the pain as well as help you pass urine
• Exercise regularly 
• Children should avoid riding a bike or other sit-on toys until all swelling has disappeared
  
• Don't swim for 3 weeks.
• Adult patients shouldn't have sex for 4 weeks

If you're worried about anything, contact the healthcare team. 

Driving after circumcision

Don’t drive until you’re confident you can control your vehicle and always check your insurance policy and with your doctor first.

Time off work

You should be able to return to work after 7 to 10 days.

Complications of circumcision

Most patients make a good recovery from circumcision. As with any procedure, there could be complications such as:

• Bleeding
• Infection
• Allergic reaction to the equipment, materials or medication.

Specific complications of circumcision may include:

• Not enough foreskin is removed, meaning another procedure is needed
  
• Too much foreskin is removed
• Reduced pleasure during sex
• Difficulty passing urine
• Damage to the urethra (tube that carries urine from the bladder)
• Narrowing of the opening of the urethra
  
• Unsatisfactory appearance.

The healthcare team will do their best to minimise any risks. Make sure you discuss any concerns you have about these complications with your consultant.

Alternative treatment options

If BXO is suspected, circumcision is the only way to cure the condition. 

For other conditions, a dorsal slit operation or a preputioplasty may be recommended. These operations involve widening the foreskin, not removing it. However, they give a poorer cosmetic appearance.