CIRCUMCISION

Introduction

Male Circumcision is the surgical removal of the foreskin. The foreskin is the hood of skin covering the end of the penis, which can be gently pulled back.

Circumcision may be performed for:

• Religious reasons – Circumcision is a common practice in the Jewish and Islamic faiths and is also practised by many African communities as a tribal or ethnic tradition
• Medical reasons - recurrent infections of the penis, difficulty when passing urine due to a tight foreskin
• Patient choice - a tight foreskin is making intercourse difficult

When Circumcision: may be necessary

This section describes only the medical reasons when Circumcision may be necessary.

Conditions that may benefit from Circumcision

Paraphimosis

Paraphimosis is a medical emergency. The foreskin is pulled back underneath the tip of the penis, becomes trapped and cannot be returned to its original position.

Paraphimosis sometimes happens as a complication of a medical procedure that involves pushing back the foreskin for a prolonged period of time. For example, during urethral catheter placement.

Paraphimosis causes a band of swelling to develop around the penis, which can block the blood supply. If paraphimosis is not treated, the lack of blood supply can damage the penis.

A paraphimosis can usually be reduced by pushing the foreskin back into its origional position. If there is a high risk of the problem occuring again a circumcision can be considered.

Balanitis

Balanitis is inflammation of the foreskin and penis,usually caused by a bacterial infection.

Symptoms of balanitis include:

• Pain when urinating
• A discharge of pus from the penis
• Inflammation of the shaft of the penis

Balanitis can be successfully treated using antibiotics. Most people do not have further infections. Circumcision is usually recommended only in adults in rare cases where someone has repeated infections (recurrent balanitis).

Balanitis Xerotica Obliterans (BXO)

This a skin condition that affects the foreskin and penis. It can respond to treatment with topical steroid creams though if this fails the next step would be Circumcision.

BXO can cause hardening and inflammation of the penis, usually affecting the foreskin and tip of the penis. It causes symptoms such as:

• Difficulties passing urine, pain when passing urine and difficulty retracting the foreskin.

In cases of BXO that primarily affect the foreskin, Circumcision is usually the most effective treatment and often results in a complete cure. In some cases, BXO can affect the urethra and treatment to widen the urethra may be necessary (a meatotomy).

Recovering from Circumcision

In general it takes approximately four to six weeks after the Circumcision is performed for the tissues to heal and the stitches to dissolve by themselves.

Self-care advice

As Circumcision is a painful procedure, painkillers such as Paracetamol or Ibuprofen will need to be taken for at least the first three days after the operation. I would suggest that they are taken regularly to start with. For approximately six hours after the procedure there is usually very little pain. This is due to a local anaesthetic that is injected around the penis during the operation. It is still sensible, however, to take pain killers so that they are working when the local anaesthetic wears off.

Circumcision exposes the sensitive skin at the tip of the penis (glans) which previously was covered. This can cause a lot of sensitivity especially when it rubs against clothing.

After Circumcision the penis will be red, swollen and bruised for several days. You may find it more comfortable to wear loose clothing for a while. Putting petroleum ointment directly on to the area can also reduce irritation.

Do not use scented products in the shower or bath and leave the penis to dry naturally.

Sex should be avoided until the wound has healed, to avoid it reopening or infection getting in.

When to contact me urgently

• If there is bleeding from the penis.
• The swelling and bruising of the penis starts to increase.
• It becomes red and inflammed.
• There are difficulties passing urine.

Risks of circumcision

As with all types of surgery, Circumcision has some risks.

Bleeding and infection are the most common problems associated with Circumcision.

• Bleeding requiring a return to theatre.
• Infection requiring antibiotics.
• Poor cosmetic result - scarring can occur especially if the foreskin was very adherent to the glans due to inflammation.
• Decrease / altered sensation of the penis, particularly during sex (the foreskin has many nerve endings within it which are lost during the operartion).
• Damage to the tube that carries urine inside the penis (urethra), causing it to narrow and making it hard to pass urine.
• Removal of too much / too little of the foreskin.
• Damage to the glans of the penis during the operation.