Circumcision is a surgical procedure that involves partial or complete removal of the foreskin (prepuce) of the penis. This is usually done under general anaesthetic as a day case procedure (ie: you will not need to stay overnight in hospital).
At Oxford Urology Associates we only see patients older than 16 years of age. In adults, the most common reason for a circumcision is a tight foreskin (phimosis). In this condition, the opening of the foreskin is narrowed, preventing retraction or making retraction painful. This may cause problems with intercourse or infections, and thus a circumcision is usually advised.
Steroid cream may be used to relieve inflammation and avoid circumcision. For some patients with a tight band a prepucioplasy may be performed. If the frenulum is tight, then a frenuloplasty may be performed instead.
Prepucioplasty is a procedure to treat a subset of men that have a tight band around their penis that makes retraction difficult or painful particularly when the penis is erect.
An incision is made through the band under general anaesthetic from A to B in the diagram. This is then closed horizontally (side to side). This procedure means that the foreskin is preserved. In about half of men with this problem this procedure works well. In the other half the problem can recur and a circumcision will be necessary.
In some men the foreskin is not tight, but there is a tight band of tissue from the underside of the tip of the penis to the underside of the foreskin. This can become torn during intercourse and bleed, or cause pain. In these patients, a small operation called a frenuloplasty can be performed. In this procedure the tight band is divided thus curing the problem. The procedure can be done under local or general anaesthetic.
You will usually be admitted on the same day as your surgery. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation.
A full general anaesthetic (where you will be asleep throughout the procedure), a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) or a local anaesthetic injection around the penis may be used.
Local anaesthetic is also injected into the base of the penis to aid pain control after the operation. For a circumcision. 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.
You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches used which do not require removal. Vaseline can be applied to the tip of the penis and around the stitch line to prevent the penis from adhering to your underclothes and it is advisable to wear light clothing for 2-3 days. Passing urine will be painless and will not be affected by the operation.
You should be reassured that the majority of patients do not suffer any problems after this procedure. Common side-effects include swelling of the penis lasting several days, oozing of small amounts of fluid between the stitches for a few days, and temporary increased sensitivity of the head of the penis. There is a small risk of infection so if your penis becomes more painful or red after the procedure you should see your GP. Rarely there can be some bleeding that needs a small additional procedure to correct.
It will be at least 10 days before healing occurs. You may return to work when you are comfortable. Most people require about a week off work. You should refrain from sexual intercourse for a minimum of 4 weeks.
There will be swelling of the penis for a few days. This will last up to 7 days and will then subside but do not be alarmed because this is expected. However, if you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your doctor.