The reason for a circumcision is often because the opening at the end of the penis is too tight, associated with scarring. This can interfere with the passing of water, can cause infection and may make intercourse uncomfortable. Sometimes the reason is due to chronic inflammation or pre-cancerous conditions of the foreskin or head of the penis which can usually be cured by circumcision. Very rarely, men with hypersensitivity of the head of the penis may benefit from circumcision but non surgical methods will usually be preferable. In nearly all cases, simple tightness of the foreskin without scarring or other problems does not need circumcision.
Some men wish to be circumcised for religious reasons: I am happy to offer religious circumcision to adults but do not do so for children until they have attained their majority, as circumcision brings no medical benefits for the vast majority of men with a normal foreskin, and may be harmful.
Are there different types of Circumcision?
The amount of foreskin removed during a circumcision will affect both the cosmetic and functional result. For some men with severe scarring or pre-malignancy of the foreskin it may be necessary to remove as much tissue as possible: this gives an appearance similar to that commonly carried out in North America, giving what men refer to as the “high tight style.”
However, I usually prefer to conserve at least some of the internal layer of the foreskin and as much as possible of the shaft skin, with preservation of the frenulum if it is not daaged. This prevents uncomfortable pulling on the shaft and pubic or scrotal skin during erection, and may allow some partial coverage of the glans penis during flaccidity. It is also possible to carry out a partial circumcision where only the tight ring is removed, although this may not be an option in men with scarring of the foreskin.
What sort of anaesthetic is required?
While most UK surgeons carry out the procedure under a general anaesthetic, I recommend a locoregional anaesthetic for the procedure. This gives excellent pain control after the procedure and avoids the small risk of a general anaesthetic. In hundreds of circumcisions done under local anaesthesia so far I have had only one patient who regretted the choice of anaesthetic. Men can safely leave the clinic within an hour or so of the operation.
However if patients prefer a general anaesthetic this can of course be arranged.
How is the operation done?
The patient lies comfortably on his back and two anaesthetic injections are given to the base of the penis – this is a mixture of a short acting and long acting anaesthetic. While the injection is very similar to that given by the dentist, most men perceive it as being given to a more precious area!
After letting the anaesthetic take effect, the penis is cleaned and sterile drapes out on. A skin marking pen is used to accurately mark the correct incision on the penis and then the skin is incised. Bipolar diathermy is used to dissect all the blood vessels and tissue in order to remove the foreskin. This technique avoids the use of sutures or ties to stop bleeding.
Stitches and/or tissue glue are then used to hold the remaining skin edges together whilst they heal. I have found tissue glue to give an excellent cosmetic result with low post-operative pain and now use it whenever technically possible in preference to external sutures.
All operations can have some side effects such as infection or bleeding: these occur in less then 5% of elective cicumcisions and do not usually cause any long term trouble. None of my patients have required to return to the operating theatre in the last ten years of using the bipolar diathermy technique. Some men may find that the penis is rather less sensitive following a circumcision then beforehand, although it may take a few months for the head of the penis to adapt to the loss of protection of the foreskin.
In about ten percent of men who have a partial circumcision scarring may occur requiring revision surgery later.
Very occasionally, meatal stenosis may occur, where the opening of the penis becomes scarred and narrowed requiring a second small operation: in adults this is usually a side effect of the inflammation which was present before the procedure.
Some discomfort and swelling is normal after the operation. This usually responds well to simple analgesics; Diclofenacol is usually prescribed for the first few days. It is common to wake up with a sore penis at night for a few days: this is due to the natural process of having erections during sleep, so the tablet is usually taken at bed time, and may be helpful during the day also. Most men will find that tight underwear such as lycra sports shorts will be the most comfortable option in the first few weeks..
The dissolving internal stitches will usually be dissolved by about 14 days. The tissue glue on the surface of the skin will usually fall off after five or six days.
You can wash the penis from the second day following your operation in order to keep the wound clean, but do not rub it or use any creams, ointments, soaps or bubble bath. As long as there is no bleeding, showering is quite safe from this time on.
The main limitation to working after the procedure is the discomfort due to the exposed head of the penis rubbing against clothes.
You will require approximately 2-3 days off work if you work in an office and a week off if you are a manual worker. Intercourse should be avoided for at least 3 weeks following the operation.
For men who have had a partial circumcision there will usually be a degree of swelling in the residual foreskin for several months, with the result that overall healing is usually a bit slower.
Infection is rare, but always be aware of signs:
* Weeping, oozing wound
* Red, hot wound to touch
* Temperature over 38 degrees
* Bruising or swelling at incision site
If you think that swelling is excessive or the wound begins to bleed and does not stop with gentle pressure after 5 minutes, please contact us.
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