This education series aims to answer your questions about having a circumcision. It explains the benefits, risks and alternatives, as well as what you can expect when you come to hospital. If you have any further questions, please speak to a doctor or nurse caring for you.

What is a Circumcision?

A circumcision is an operation to cut away the foreskin of the penis. The foreskin is the sleeve of loose skin that covers the end (head) of the penis.

What are the benefits?

• A circumcision may relieve problems such as a tight foreskin that:
• is causing problems with passing urine and / or causing infections.
• is causing pain during sexual intercourse.
• If you decide not to have a circumcision or alternative treatment, you will continue to have symptoms such as those outlined above.

Are there any alternative treatments?

Under some circumstances, other treatments may be considered but circumcision remains the most common treatment option to relieve your symptoms. Alternatives to a circumcision include:

• Frenuloplasty - this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis. If the frenulum is short or torn, you may have problems pulling your foreskin back.
• Dorsal slit - in this procedure the foreskin is cut to widen and loosen it, so it can be pulled back more easily.
• Prepuceplasty - this is a more minor procedure than a circumcision. The foreskin is cut and stitched to widen it.
• Your surgeon can explain these treatments if they are suitable for you.

Giving my consent (permission)

The staff caring for you may need to ask your permission to perform a particular treatment or investigation. You will be asked to sign a consent form that says you have agreed to the treatment and that you understand the benefits, risks and alternatives.

What are the risks?

There are risks associated with any operation. Your doctor will explain the specific risks for a circumcision to you before asking you to sign the consent form. Please ask questions if you are uncertain. Possible problems from a circumcision include:

Bleeding during or after the operation - this can cause bruising which may go away by itself or you may need another operation to drain the blood away.

An infection at the operation site.

What do I need to do before my surgery?

Prior to surgery we will assess your suitability for a general or local anaesthesia. It is important that you stop smoking for at least 24 hours before your operation to reduce the risk of chest problems. Smoking can also delay wound healing because it reduces the amount of oxygen that goes to the tissues.

What happens during a circumcision?

Your operation takes about 20 to 30 minutes. You should be able to go home on the same day, although your doctor will confirm this with you at your consultation.

A circumcision is usually performed using a local anaesthetic. This is medicine that ‘freezes’ a specific area of your body so it is pain free. Sometimes you are also given a general anaesthetic, which puts you to sleep for the entire procedure.

The foreskin can be removed in several different ways. Your surgeon will talk to you about how he will do the surgery and what type of anaesthetic will be used before you sign the consent form. The aim is to cut away enough of the foreskin to leave the head of the penis uncovered but keep the skin that covers the length of the penis.

Will I feel any pain?

Before your surgery, you will be given an injection of local anaesthetic at the base of your penis. This will make your penis numb and pain free for eight to 10 hours after the operation. You can expect some discomfort after the anaesthetic wears off and we will give you pain relief for this. It is important that you take this medicine on a regular basis for the first few days. When taken regularly, it is kept at a constant level in your body and will control your pain better. After a few days, you can gradually reduce the medicine until you do not need it any longer. Please contact PACE Hospitals if you find the pain difficult to control. Any medicine given to you will be explained before you leave the hospital. It is important that you do not exceed the recommended daily dose of any medicine you are given.

After your surgery

If you go home on the day of your surgery, a responsible adult must help you home and be with you for 24 hours after the procedure. You might feel dizzy and tired when you go home after the operation if you have had a general anaesthetic. Please rest for the remainder of the day and the following day to help you recover from the general anaesthetic. It will take 24 to 48 hours to wear off completely but you do not need to stay in bed for the whole of this period. Gently moving around your home will help your blood circulation and help to prevent blood clots.

You may also have:

• Swelling - you can expect a little swelling and bruising at the wound site. There may also be a bit of oozing yellow coloured fluid. This is normal and nothing to worry about, although it may take about three to four weeks for your wound to heal completely.
• Stitches - these will dissolve or fall out on their own about 14 to 21 days after the operation. Some of the last pieces may take four to six weeks to dissolve or disappear. They do not need to be removed.
• Wound dressing - you will have a dressing on the penis when you return to the ward following your operation. However this will be removed before you go home or you will be instructed to remove it later that day if there has been no bleeding form the wound site. You should not require a dressing after that.
• It is possible you may have some bleeding from the foreskin, although this is unusual. If bleeding does occur, use a clean cloth and press firmly on the area that is bleeding for 15 minutes. If the bleeding does not stop after 15 minutes you will need to go straight to pace emergency department.
• Glans sensitivity - the glans (head of your penis) will feel extra sensitive for the first two weeks after the operation and this will settle down over a period of time.
• Wound appearance - in the initial six weeks after the operation, the head of the penis and the skin around the wound site may appear swollen but this will settle down and by six months post operation will have returned to normal.
• Sexual activity - you should refrain from all sexual activity for four weeks after the operation.

Can I eat and drink as normal after the operation?

You can eat and drink as normal, but please avoid alcohol for two days after your surgery, because of the anaesthetic. You should not drink alcohol while taking certain medicines.

When can I return to work?

Every patient reacts differently to anaesthetic and there is no definite rule as to when you should return to work. Most people take a week off work, although this will depend on your recovery and the type of work that you do. If you work in an office, you should take at least two to three days off after your operation. If your job involves manual labour, please do not work for a week after your operation. Have some rest to help you to heal and to let the anaesthetic wear off properly. Please do not return to work until you feel ready to do so. Please do not play any sports for two weeks after the operation.

When can I have sexual intercourse?

Please do not have sexual intercourse for four weeks after the operation. This will:

• help your wound to heal.
• help to avoid infection.
• help to lower the risk of bleeding.

When can I have a bath or shower?

It is important to keep your wound clean and dry – pat the wound gently when drying. Do not put creams or ointments on your penis until it has fully healed. This will help prevent any delay in the healing of your wound. Sometimes the head of the penis can be dry – you could use a small amount of Vaseline to keep it moisturised.

You can have a bath or shower as often as you wish, from the day after your procedure.

Will I have a follow-up appointment?

You might need a follow-up appointment in the outpatient clinic after 5 days of surgery for wound check.

What if I have a problem at home?

Please contact PACE Hospitals emergency or consult your urologist if you have:

• Excessive pain
• Persistent bleeding
• A high temperature (38°C/100.4F or above)
• Difficulty passing urine
• A large amount of swelling
• Redness, inflammation and pain at the wound site
• An abnormal colour at or around your wound site
• Pus coming from your wound