What are the indications for a circumcision?
Circumcision is usually recommended when non-surgical measures have not resolved a foreskin problem. Common medical reasons include:
- A tight foreskin that will not retract (phimosis)
- Repeated infection or inflammation under the foreskin (balanitis)
- Skin disease affecting the foreskin and glans (BXO/lichen sclerosus)
- Large warty lesions of the foreskin
- Pre-cancerous or cancerous changes in the foreskin
What are the alternatives?
- Topical steroid cream — A short course of steroid cream can ease inflammation and tightness, though symptoms often return.
- Dorsal slit — Cutting the tip of the foreskin to relieve tightness.
- Frenuloplasty — Performed for a tight frenulum without phimosis.
- Preputioplasty — An operation to widen and preserve the foreskin.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within 2 hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- Usually carried out under general anaesthetic, with a local anaesthetic penile block for comfort afterwards.
- A circular incision is made in the foreskin just below the head of the penis.
- The whole foreskin is removed, leaving the glans (head) exposed.
- The skin edges are closed with dissolvable stitches.
- The stitches usually disappear on their own within 3-4 weeks.
What are the side-effects?
- Swelling of the penis for up to 7–14 days (all patients).
- Increased sensitivity of the head of the penis for a couple of weeks (almost all patients).
- A permanent change in the sensation of the glans (almost all patients).
- Infection of the wound needing antibiotics or drainage (1-2%).
- Bleeding from the wound occasionally needing a further procedure (1-2%).
- Dissatisfaction with the cosmetic result (less than 1%).
What happens after surgery?
Most men wake up without pain due to the placement of a local anaesthetic block, which usually lasts for 6-8 hours post-op. After this you should take simple painkillers such as paracetamol if needed. Keep the area dry for the first day or two, following which you should shower and carefully dry the area, before applying Vaseline® or E45® cream to the wound and glans. You can expect swelling and bruising for one to two weeks, which will gradually settle to leave a final cosmetic result after 6-12 weeks. You should avoid sexual activity for at least 4 weeks until the wound has fully healed, and ensure plenty of lubrication is applied before sex.
A discharge letter will be shared with your GP and an outpatient review appointment will be made for 6-8 weeks.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Circumcision (complete removal of the foreskin).
View the BAUS leaflet