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 Circumcision (N3030)

A circumcision is an operation to cut away the foreskin of your penis.  The foreskin is the sleeve of loose skin that covers the end (head) of your penis.

Why this procedure
A circumcision may relieve problems such as:

•    Tight foreskin (phimosis) – where the foreskin is too tight to be pulled back over the head of the penis (glans); this can sometimes cause pain when the penis is erect and, in rare cases, passing urine may be difficult

•    Recurrent balanitis – where the foreskin and head of the penis become inflamed and infected

•    Paraphimosis – where the foreskin can’t be returned to its original position after being pulled back, causing the head of the penis to become swollen and painful; immediate treatment is needed to avoid serious complications, such as restricted blood flow to the penis

•    Balanitis xerotica obliterans – a condition that causes phimosis and, in some cases, also affects the head of the penis, which can become scarred and inflamed

•    Cancer of the penis – a very rare type of cancer

Under some circumstances, other treatments may be considered, but circumcision remains the most commom treatment options to relieve your symptoms.

  Alternative to a circumcision include:

•    Frenuloplasty – this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis.  If the frenulum is short or torn, you may have problems pulling your foreskin back.

•    Doral slit – in this procedure the foreskin is cut to wide and loosen it, so it can be pulled back more easily.

•    Prepuceplasty – this is a more minor procedure than a circumcision.  The foreskin is cut and stitched to widen it.

What is the procedure
A full general anaesthetic is normally used and you will be asleep throughout the procedure.  A spinal anaesthetic (where you are unable to feel anything from the waist down) or a local anaesthetic injection around the penis may also be used.  

Local anaesthetic is injected into the base of the penis to relieve discomfort after the operation.  This can be used as the sole form of anaesthesia in some patients.  All methods minimise post-operative plan.

The entire foreskin will be removed using an incision just behind the head of the penis; this leaves the head of the penis completely exposed with no redundant skin.  Dissolvable stitches may also be used to attach the skin of the penis to below the glans, they will usually disappear after 2-3 weeks.

Before, during and afterwards
There are risks associated with any operation.
•    Heavy bleeding during or after the operation – this can cause bruising which may go away by itself or you may need another operation to drain the blood away.
•    An infection at the operation site.
•    Scaring and narrowing at the opening of the tip of the penis.
•    Dissatisfaction with the appearance of the circumcised penis.
•    With the removal of your foreskin, the end of the penis feels different.  You may have less sensitivity at the tip of your penis.

The operation takes about 20 to 30 minutes and you should be able to go home on the say, although your consultant will discuss this with you at your consultation.  

You may feel some pain after the procedure however this can be controlled with pain killers, any medicine given to you will be explained before you leave the hospital.

How soon will I recover?
You might feel dizzy and tired when you go home after the operation if you have had a general anaesthetic.  Please rest for the remainder of the day and following day to help recovery.  You may also have:

•    Swelling – you can expect a little swelling and bruising at the wound site.  There may also be a bit of oozing yellow coloured fluid.

•    Stitches – these will dissolve of fall out on their own about 14 to 21 days after the operation.  Some parts of the stitches may take up to 6 weeks to dissolve.  They do not need to be removed.

•    A dressing over the wound – this will fall of on its own and does not normally need to be replaced.  If the dressing does no fall off on its own you may remove it in the bath or shower the day after your operation.

It is possible you may have some bleeding from the foreskin, although this is unusual.  If cleaning does occur, use a clean cloth and press firmly on the area for 15 minutes.  If it doesn’t stop you will need to go to your nearest A&E department.
Sexual Intercourse

Please do not have sexual intercourse for six weeks after the operation.  This will:
•    Help your wound to heal
•    Help to avoid infection
•    Help to lower the risk of bleeding


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