NHS Forth Valley – Circumcision

Circumcision is an operation to remove the foreskin – the sleeve of skin that surrounds the head of the penis.

Medical reasons: Circumcision may be recommended if your foreskin is too tight (phimosis), often due to recurrent infections. A tight foreskin can make erections or sexual intercourse painful. Forcing a tight foreskin over the head of the penis can cause it to get stuck (paraphimosis), which requires urgent medical attention.
Other reasons: Circumcision may also be performed for cosmetic, religious, or social reasons. When done for reasons other than medical need, it is called non-therapeutic (or ritual) circumcision.
Potential benefits: Circumcision may help reduce the risk of sexually transmitted infections and cervical cancer in female partners, but practising safer sex is considered more important.

Creams: There are creams that may help thin and soften the foreskin, making it easier to pull back. However, there is no scientific proof that these work permanently.
Other procedures: Your surgeon may suggest a preputioplasty or frenuloplasty (small slits in the foreskin to help it stretch). These preserve the foreskin but may not be permanent solutions, and circumcision may still be needed later.

Consultation: Your surgeon will explain how to prepare. If you smoke, you may be asked to stop, as smoking increases the risk of infection and slows recovery.
Shaving: You do not need to shave or trim your pubic hair before the operation.
Day case: Most circumcisions are performed as day cases, meaning you will not stay overnight.
Anaesthetic: Most are done under local anaesthetic (penile block), which numbs the penis but keeps you awake. This avoids the small risks of general anaesthetic and allows faster recovery. Some may be done under general anaesthetic (you are asleep).
Eating and drinking: If you are having general anaesthetic, you must follow fasting instructions (typically no food or drink for six hours before).
Pre-op checks: At the hospital, your nurse will explain your care and may check your heart rate and blood pressure. Tell your nurse about any allergies or family history of bleeding problems.
Consent: Your surgeon will discuss the operation and ask you to sign a consent form, confirming you understand the risks, benefits, and alternatives.

Duration: The operation takes 30 – 40 minutes.
Procedure: The foreskin is pulled forward and trimmed away. The skin edges are closed with dissolvable stitches.
Dressings: Your penis may be wrapped in a paraffin-based dressing to protect it from rubbing. Once removed, no further dressings are needed.
Anaesthetic: Your penis will feel numb for a few hours after the operation.

Discharge: If you have local anaesthetic, you can usually go home soon after. If you have general anaesthetic, you must rest until the effects wear off.
Transport: You must arrange for someone to drive you home. Failure to do so could result in your operation being postponed.
Pain relief: The local anaesthetic lasts up to eight hours. After this, use over-the-counter painkillers (paracetamol or ibuprofen) as advised.
General anaesthetic: This can affect your coordination and reasoning for 48 hours. Do not drink alcohol, operate machinery, or sign legal documents during this time.
Driving: Only drive when you can perform an emergency stop without discomfort.
Clothing: Wear loose clothing and boxer shorts until healed. Tight clothes may rub and cause soreness. Petroleum jelly (e.g., Vaseline) on the tip of the penis can prevent sticking and ease pain when passing urine.
Hygiene: Keep the area dry for at least 24 hours. After this, shower daily (avoid scented soaps). Let the penis dry naturally.
Stitches: Dissolvable stitches disappear in 7 – 10 days. The wound may bleed slightly until all stitches dissolve. If bleeding occurs, apply pressure for 20 minutes.
Sexual activity: Refrain from sexual activity for 6 weeks to allow healing and prevent infection. Erections may be painful for a few days after the operation.

Follow-up: A return appointment is only arranged if the surgeon feels it is necessary.
Symptoms to watch for: Contact your GP or the hospital if you experience:
- Difficulty passing urine
- Severe swelling or redness (swelling can take up to 6 weeks to resolve)
- Yellow or white discharge from the penis
- High temperature
- Pain not controlled with painkillers
- Increasing bleeding from the wound

Circumcision is commonly performed and generally safe, but you should be aware of possible side effects and complications:

Side effects: Temporary pain, swelling, and bruising (may last several weeks).
Complications: Rare, but can include:
- Unexpected reaction to anaesthetic
- Excessive bleeding (may require overnight stay)
- Infection (usually mild, treated with antibiotics)
- Blood clot (deep vein thrombosis, DVT)
- Removal of too little or too much foreskin
- Abnormal scar tissue (may need further surgery)
- Damage to the penis or urethra (very rare, may need further surgery)
- Change in sensation (penis may feel more or less sensitive)
Individual risks: Ask your surgeon how these risks apply to you.