Circumcision

Circumcision is an operation which is performed to remove the foreskin.

Who needs a circumcision?

The medical indications for performing a circumcision include a tight foreskin or phimosis with associated scarring that prevents the foreskin from being completely pulled back, or recurrent, severe infections of the penis and foreskin. Circumcisions may also be performed for social and religious reasons.

When should this be performed?

If possible, circumcision is performed when the child is over one year of age. Circumcision of the newborn should be avoided, as there is a significantly increased risk of complications in this age group. These complications include narrowing of the urinary opening due to scarring.

Circumcision is usually performed as a daycase operation. Under a general anaesthetic, the foreskin is removed using either scissors or a scalpel. The edges of the skin are then stitched together using stitches that dissolve of their own accord after 1-2 weeks. Whilst the child is asleep, the anaesthetist will block the nerves to the penis with an injection of local anaesthetic. After the child has woken, he should not be in significant pain but may be distressed at waking in a strange place, and feeling hungry. The anaesthetic injection tends to last for about 6-8 hours and after this time the boy may require oral pain killers for 1-2 days. If it is comfortable to do so, the boy can bath or shower normally, even on the first day.

Can there be complications after the operation?

The two main side effects of the operation are bleeding and infection. If bleeding from the edges of the cut become a trickle, then the Paediatric Surgeon will need to review the child again and occasionally may need to return the child to the operating theatre to stop the bleeding. If infection occurs, it is usually 2-3 days after the operation and the penis will become more swollen, more red and more painful rather than less so. If this occurs, the boy may require a course of antibiotics. Sometimes the edges of the cut will stick to the head of the penis and will require gentle separation in the clinic some weeks after the operation.

If a child has a slightly abnormal penis and foreskin, a Paediatric Surgeon must exclude the possibility of hypospadias before a circumcision is performed. Hypospadias is a congenital abnormality of the penis in which the opening for the urine is not located at the tip of the penis. There is an associated hooding of the foreskin, there may be curvature of the penis and sometimes the urinary opening is smaller than it should be. As the foreskin is useful in the correction of Hypospadias, it should be preserved in the boys with this abnormality.

It is important that circumcision achieves a cosmetically and functionally appropriate result with the correct amount of foreskin removed during the operation.