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Circumcision in men

Published by Bupa's health information team, January 2008.

This factsheet is for men considering having a 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. Although circumcision is done more often on babies and young boys, it can be performed on men of any age.

There is a separate factsheet available for parents who are considering having their son circumcised - Your son's circumcision.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About circumcision
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from your circumcision
What are the risks?
Questions and answers
Related topics
Sources

About circumcision

Circumcision may be done for medical reasons; such as if your foreskin is too tight and difficult to slide over the head of your penis (phimosis). This is usually caused by recurrent infections under the foreskin. A tight foreskin can make it painful for you to have an erection or sexual intercourse.

If you have a tight foreskin and you force it over the head of your penis, there's a risk it will get stuck there. This condition is called paraphimosis and it usually needs urgent medical attention.

Circumcision may also be done for cosmetic, religious or social reasons. Circumcision that is done for any reason other than medical need 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?

If you have a tight foreskin there are creams that may help thin and soften the foreskin so that it's easier to pull back. But there is no scientific proof that they work permanently.

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

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example if you smoke, you may be asked to quit, as smoking increases your risk of getting a chest or wound infection and slows your recovery.

You don't need to shave or trim your pubic hair before the operation.

Circumcision is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure.

The procedure can be done under local anaesthesia using an injection called a penile block. This means that your penis will be completely numb but you stay awake. You may be offered a sedative to help you relax during the operation.

Your surgeon will advise which type of anaesthesia is most suitable for you.

If you are having general anaesthesia you will be asked to follow fasting instructions. 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.

If you are having local anaesthesia you can eat and drink as usual on the day of your operation.

At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine. Tell your nurse if you have any allergies or a history of bleeding problems in the family.

Your surgeon will usually visit you to discuss the operation and 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.

About the operation

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 the operation is done under general anaesthesia, your surgeon may numb your penis with a local anaesthetic so that you don't feel any pain for a few hours 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 your circumcision

The local anaesthetic will keep you free of pain for up to eight hours. After this, 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.

General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. This is usually five days after the operation.

Wear loose clothing and boxer shorts until the wound has healed. Tight-fitting clothes may rub the wound and make it sore. Putting petroleum jelly, for example Vaseline, on the tip of your penis can stop clothes sticking to the healing wound and help ease pain when passing urine.

It's very important to keep your penis clean. The area should be kept dry for at least 48 hours. 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.

Dissolvable stitches will disappear on their own in seven to ten days. The wound may bleed slightly until all the stitches have dissolved. If the bleeding gets worse contact the hospital.

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.

Contact your GP or the hospital if you develop any of the following symptoms:

difficulty in passing urine
severe swelling or redness
yellow or white discharge from the penis
high temperature
pain that can't be controlled with painkillers
increasing bleeding from the wound

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 are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

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 your body) - this is very rare but if it happens another operation may be necessary
change in sensation - your penis may feel more or less sensitive after the operation

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.