What is a circumcision?

A circumcision is an operation to remove the foreskin.

What is the indication?

Circumcisions are usually recommended for the following medical conditions:

• Tightening of the foreskin (phimosis)
• Balanitis xerotica obliterans (BXO), a condition that causes the foreskin to become thickened and white. 
• Discomfort or pain during sex
• Infections of the foreskin 
• Cancer of the foreskin 

What does the surgery involve?

Circumcision can be carried out under general anaesthetic (when you are asleep) or local anaesthetic (you remain awake and the area is numbed by medication). The foreskin covering the head of the penis is gently cut away and the remaining skin is stitched back using dissolvable stitches. The procedure usually takes about 20-30 minutes. 

What are the benefits?

The main benefits are relief of pain, discomfort or inflammation, or to establish the precise diagnosis of the problem with the foreskin.

What are the risks? 

As with all surgery, complications do occasionally occur and may include:

• Bleeding – which sometimes may require further surgery
• Infection
• Altered sensation of the penis during sexual intercourse (rare)
• Increased sensitivity or discomfort or pain at the tip of the penis (rare)
• Narrowing of the urinary opening (meatal stenosis), which may impede urination and require corrective treatment (rare)
• Too much or not enough foreskin is removed 
• Displeasure with the cosmetic results 
• Injury to the end of the penis (rare, usually associated with severe BXO)

Are there any alternatives?

It depends on the underlying diagnosis. If BXO is suspected, a topical steroid sometimes helps, but a circumcision is the most reliable approach. 

What would happen if it’s not treated?

Phimosis can get worse, and the opening of the foreskin can completely close off and impede urination. 

If the foreskin should become stuck in a retracted position (where the foreskin cannot be brought back to its usual position) this is known as paraphimosis and may require urgent intervention. 

What to expect after your circumcision?

It is a day care procedure and you will be able to go home as soon as you feel comfortable. If you have a general anaesthetic, you will need to stay in the day care centre for a minimum of two hours after your surgery.

What happens before the operation?

Prior to admission, you will need a pre-operative assessment. This may be performed using a health questionnaire, over the telephone, or at a pre-assessment clinic. Before the date of your admission, please read the instructions given to you. 

What happens after the operation?

Some pain is to be expected around the wound site. The nurse will check how you are feeling and give you painkillers if necessary. A small amount of bleeding from the wound may also occur. Nurses will monitor the wound site and apply further dressings if necessary. You can usually go home when you are comfortable and the effects of the general anaesthetic have worn off. 

NOTE: a general anaesthetic can temporarily affect your coordination and reasoning skills, so you will need a responsible adult to take you home and stay with you for the first 24 hours. During this time, it is also important you do not operate machinery, drive or make important decisions. 

Before your discharge, the nurse will advise you about your post-operative care and will give you a supply of painkillers. 

Your GP will be notified of your treatment. After discharge, you are advised to see your GP for any follow-up requirements. 

If the surgeon does wish to see you again, you will be notified of this prior to discharge and an appointment card will be posted to you.

How much pain can I expect?

It is normal to experience some pain around the wound site over the first few days. It is therefore important for you to take painkillers regularly over the next three days (but remember that you should not exceed the stated maximum daily dose). If the level of pain is still not acceptable to you, your local pharmacist should be able to offer advice. If pain worsens, you should consult your GP. You may notice some discomfort for several weeks after the operation.

How do I care for my wound?

You can remove the wound dressing after two days. Try to keep the dressing dry for these two days. You should then shower or bathe daily. 

Over the first week or so, you may notice a sticky discharge around the wound that should be gently washed away. Soap and water is adequate and you may wash as often as you wish. Between washes it is important to keep the area clean and dry until healed. 

Most stitches are self-dissolving and will dissolve after a few weeks. Marked swelling and bruising of the penis is common after surgery and should subside over a couple of weeks. 

If your wound should become increasingly painful, swollen or mucky you should see your GP. Bleeding rarely occurs, but if it does this can happen several days after surgery. If this should occur, apply gentle pressure to the wound using a clean cloth. Any bleeding should subside after a few minutes. If bleeding continues or becomes very profuse, you should attend the nearest emergency department.

What activities will I be able to do after my surgery?

After your surgery you can return to normal physical activities when you feel comfortable, although it is wise to avoid heavy or strenuous activity for the first couple of weeks. It is important to avoid sexual activity for at least four weeks as this may cause pain and bleeding.

When can I return to work?

You can return to work as soon as you feel well enough, usually after a few days. If your work involves heavy lifting or strenuous activity, you may need about two weeks off work.

When should you contact us?

• If you have a fever above 38.5 ∞C, chills or shakes
• If you experience increasing pain, redness, swelling or discharge at the wound site
• If you have bleeding that soaks through dressings and onto clothes 
• If you are unable to urinate

Disclaimer: The information on this website is provided for your general information and is not a substitute for the specific advice of your treating doctor.