Circumcision

Circumcision is the removal of the foreskin of the penis, rejoining the skin to the mucosa behind the glans. The procedure has been performed since the early Egyptian civilisation, in many population groups, for medical, cultural and social reasons and at various ages. Recently, there has been a trend away from routine circumcision of the newborn in Western populations. Medical indications for circumcision include:

• narrowing of the opening, causing difficulties with erection and voiding
• skin disease affecting the foreskin
• recurrent urinary infections or inflammation affecting the glans

Although much has been written about the importance of the foreskin, there is no good evidence of functional disturbance following circumcision. Nor is there evidence that uncircumcised men achieve better sexual function than circumcised men, or vice versa.

Most circumcision in adults and adolescents can be performed under local anaesthetic only, on a day-visit basis. The local anaesthetic is injected into the base of the penis, providing temporary numbness. The injection itself stings. The cut skin edges are stitched with dissolving sutures. Some patients prefer general or spinal anaesthesia for circumcision.

For local anaesthetic circumcision:
Pre-operatively:

• discontinue aspirin one week prior to procedure
• normal diet on day of procedure

Post-operatively:

• stay 1 hour post-procedure until voided urine
• some burning may occur with voiding, but this settles rapidly
• regular Panadol 4 hourly to prevent pain, for 24 hours
• keep dressings dry for 12 hours; remove dressing day after surgery in the shower or bath, or earlier if the dressing becomes soiled with urine
• avoid swimming in the sea for 2 days
• there is no restriction on driving nor on other activities, but sexual intercourse should be postponed for 2 weeks

For general anaesthetic circumcision, in addition to the above:
Pre-operatively:

• nil by mouth for 6 hours prior to surgery

Post-operatively:

• stay 4 hours post-procedure
• driving and normal activities are permitted from the day following surgery

Although most cases proceed without particular difficulty, bleeding or infection occur in 2% of patients overall. Some swelling is expected and altered (usually temporarily) sensation can occur over the glans. The glans mucosa changes over time to become more like skin. Urinary retention requiring catheterisation rarely occurs secondary to pain. Other complications are considered rare and extraordinary.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.