Circumcision

The procedure involves complete removal of the foreskin. It is usually performed for one or more of the following reasons:

• a tight, non-retractile foreskin – known as phimosis;
• recurrent infections under the foreskin – known as balanitis;
• skin disease on the foreskin and glans (head of penis) – such as chronic inflammation;
• large warty lesions of the foreskin; or
• cancerous or pre-cancerous lesions of the foreskin. 

Topical creams and washes (including short-term use of a steroid cream) – for phimosis, these may decrease inflammation and relieve some tightness but symptoms often return once the treatment is stopped. They are not suitable, or effective, in all patients and your specialist will be able to advise you accordingly. Circumcision is usually necessary if topical agents fail. 

• Dorsal slit of the foreskin – this involves incising (cutting) the tip of your foreskin to relieve the tightness which is preventing retraction. 
• Frenuloplasty – a surgical procedure used when the frenulum is tight, causing pain and may tear during intercourse 
• Preputioplasty – a surgical procedure used to widen the foreskin at its point of maximum tightness. 

Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent. If you are having a local anaesthetic, this will also be explained to you at this stage. 

An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you. 

We usually provide you with a pair of TED stockings to wear, and we may give you a heparin injection to thin your blood after the operation, if you remain in hospital. These help to prevent blood clots from developing and passing into your lungs. 

• we usually carry out the procedure under a general anaesthetic, but local or spinal anaesthetic may be used instead 
• we use local anaesthetic nerve blocks, regardless of the type of anaesthetic, to provide post-operative pain relief 
• we may give you an injection of antibiotics before the procedure, after you have been checked for any allergies (but this is not common)
• we make a circular incision in your foreskin at a level just below the head of the penis and remove the whole foreskin; this leaves the glans (head of the penis) completely exposed 
• we use dissolvable stitches to attach the skin of your penis to below your glans (see right); these stitches usually disappear within two to three weeks 

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual: 

Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. Individual hospitals may have different rates, and the medical staff can tell you the risk for your hospital. You have a higher risk if you have had: 

• long-term drainage tubes (e.g. catheters); 
• bladder removal; 
• long hospital stays; or 
• multiple hospital admissions. 

• you will get some swelling and bruising of the penis which may last up to 7-14 days 
• it can take up to six weeks before the penis returns to its final cosmetic appearance 
• the exposed glans penis will feel very sensitive for the first 2-3 weeks, although a few patients describe this lasting longer 
• once the hypersensitivity has settled, your penis may feel a little less sensitive than before the operation 
• the exposed glans may dry out and scab over; applying a little vaseline will help this and can also help decrease the sensitivity after the operation