A circumcision is an operation to remove the skin covering the top of the penis (the glans). This skin is called the foreskin. Circumcision is mostly done in babies and young children but can be done at any age. The operation is 15,000 years old and was performed in Ancient Egypt. It is done for medical and religious reasons.
If it is not needed for medical reasons, there is an increasing trend for parents to weigh up the risks and benefits before getting the procedure done. Some parents are postponing the operation until their child can be involved in the discussion.
Circumcision is only available on the NHS for medical reasons. If you want to have the procedure done for religious/cultural reasons or for the sake of appearance you will need to have it done privately. Clinics and private individuals who offer this service may do so hygienically and safely but they are not subject to the same controls and regulations as NHS facilities.
Why is circumcision done?
There are several medical conditions affecting the foreskin for which circumcision is the best treatment. These include:
- Phimosis: this occurs when your foreskin becomes too tight to pull over the head of the penis (the glans). If the foreskin is not too tight you may want to try other types of treatment such as a steroid cream or an operation to loosen or refashion the foreskin rather than remove it.
- Paraphimosis: if your foreskin is pulled back for cleaning or to insert a tube (a catheter) to drain the bladder and is not replaced in its normal position, the glans can start to swell, trapping the foreskin at its base.
- Balanitis and posthitis: balanitis is infection of the glans. Posthitis is infection of the foreskin. Both can be caused by poor hygiene. However, there can be other causes such as allergies and sexually transmitted infections. If either condition persists, you may require circumcision.
- Balanitis xerotica obliterans: this is a skin condition which can affect your foreskin, the skin of your glans and the channel through which urine is passed (the urethra). It can cause white lumps on the affected skin and thinning and scarring of the urethra. Medicines are usually used to treat the condition but circumcision can often help, especially if the urethra is not involved.
What does the operation involve?
The operation is usually done using anaesthetic gel or a local anaesthetic injection in babies. In older children and adults a general anaesthetic is usually given so you will be asleep for the procedure. If you are given a general anaesthetic you are usually advised not to eat or drink anything for six hours beforehand.
The classic operation involves cutting off the foreskin and stitching back the remaining skin. In recent years, various plastic clamps have been used such as the Gomco®, Plastibell® and Shang Ring®. These make the operation easier and quicker, result in a neater scar and reduce the need for stitches.
You should be able to leave hospital as soon as you are ready. However, if you have had a general anaesthetic you may feel drowsy and should wait until you are fully awake. You should not drive and should make sure someone is there to accompany you when you go home..You should not drink alcohol, operate machinery or sign legal documents for 24 hours after the procedure.
You can do any activity you feel comfortable with and should be able to return to work after seven to ten days. The same period of time applies to children returning to playschool or school. If your job involves heavy physical work you may need to take a couple of weeks off. You should also avoid sex (intercourse) or masturbation for about four weeks, as this can lead to pain and bleeding.
What are the benefits of surgery?
If you have had discomfort or inflammation because of one of the medical conditions described above, circumcision will relieve the symptoms. If you keep getting urine infections, the operation may prevent you from getting any more. You will also be less likely to get a sexually transmitted infection such as HIV, herpes simplex or human papillomavirus. Circumcision also reduces the risk of you getting some types of cancer of the penis. There is much debate on whether circumcision should be offered routinely. Recent American CDC guidelines have found in favour of circumcision - but this remains an area of debate.
What are the risks?
As with any operation, you may have a reaction to a general anaesthetic, bleeding from the wound, or infection. Bleeding can usually be stopped by applying pressure but some people need to be taken back to theatre to have stitches put in.
Other complications can include:
- Removal of too much or too little foreskin.
- Scarring of the urethra (meatal stenosis), leading to problems passing urine.
- Damage to the end of the penis.
- Scar tissue (adhesions) between the glans and the shaft - ie between the end and main body of the penis.
Are there any alternatives to surgery?
Steroid creams can sometimes thin the foreskin so it is loose enough to be pulled below the head of the penis (the glans). You can also have an operation called a preputioplasty which involves cutting and stretching the foreskin rather than removing it altogether.
Further reading and references
; Circumcision indecision: the ongoing saga of the world's most popular surgery. CMAJ. 2011 Nov 22183(17):1961-2. doi: 10.1503/cmaj.109-4021. Epub 2011 Oct 17.
; British Association of Paediatric Urologists (2013)
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