Circumcision
Figure 1: Circumcision procedure
What are the indications for a circumcision?
Circumcision may be indicated for
Tight foreskin (Phimosis)
Complications from a tight foreskin such as recurrent infections, pain or trouble urinating
Scarring / chronic inflammation (Lichen Sclerosis)
Cancer of the penile foreskin
What pre-operative work up is needed?
In most cases, no significant work-up is needed. Your urologist will organise any necessary urine and blood tests at your consultation prior to your procedure.
If you take any blood thinning medication, you should discuss with your urologist if these need to be stopped before your procedure. In general, aspirin can be continued in most cases but other medications such warfarin, plavix (clopidogrel) and anticoagulants may need to be stopped temporarily.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the anaesthetic (either general or spinal) before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does the procedure involve?
A circumcision is a surgical removal of the foreskin. Local anaesthetic is injected into the base of the penis to relieve discomfort after the operation. After the foreskin is removed with an incision behind the head of the penis, the remaining skin is sutured back behind the head of the penis, leaving the head of the penis exposed. An antiseptic solution and a dressing are used to cover the wound. This is done as a day case and you will be discharged later that day
Are there any risks or side‑effects of a circumcision?
Mild itchiness and swelling around the surgical site lasting a few days. 40-50%
Minor ooze of the wound 20-30%
Minor infection of the incision requiring antibiotics 5-10%
Severe bleeding or infection needing further surgery 1-2%
Permanent altered or reduced sensation in the head of the penis 20-30%
Persistent tenderness at the surgical site 3-5%
Failure to be completely satisfied with the cosmetic result 3-5%
Need for removal of excessive skin later 2-3%
Need for revision surgery due to accidental removal of excess skin <1%
Unexpected finding of cancer on biopsy <1%
What should I expect on discharge when I get home?
You will experience some swelling, discomfort and sensitivity at the operative site for a couple of weeks, which should settle with time and with paracetamol and/or ibuprofen. Keep the dressing on for 2-3 days during which time you should avoid getting the area wet. After 3 days, you can soak the area in water and remove the dressing. You will be given a tube of topical antiseptic gel on discharge, which you should apply to the incision site daily for a week after the dressing comes off. The sutures are self-dissolving (takes 2-4 weeks) and do not need to be removed.
After 2-3 days, you can begin normal activities again, such as work and light exercise. You should only return to strenuous activity and driving when you are completely pain free and when your GP is happy with your progress (at least 2 weeks). You should refrain from sexual intercourse for a minimum of four weeks.
If you develop swelling, fevers or significant pain and redness at the circumcision site you should contact your GP.
What follow-up will I need?
Your urologist will see you in the clinic in 3-4 weeks to check everything has healed well and no further follow-up is needed after this.