Circumcision

Circumcision is a surgical procedure that removes the foreskin (the fold of skin that covers the tip of the penis).

During the operation, the surgeon carefully cuts away the foreskin and closes the edges with stitches or a special adhesive. This exposes the glans (the rounded head of the penis) permanently. The procedure is performed for medical, cultural, or religious reasons and can be done at any age, although it is most commonly carried out in newborns, young boys, or adults who develop a medical need later in life.

Circumcision is recommended in several medical situations, and doctors may also perform it when a family or patient requests it for cultural or religious reasons. Below are the most common medical indications.

• Phimosis — a condition where the foreskin is too tight to be pulled back over the glans, causing pain or difficulty urinating.
• Paraphimosis — an emergency where the retracted foreskin becomes stuck behind the glans and cannot return to its normal position, cutting off blood flow.
• Balanitis (inflammation of the glans) or balanoposthitis (inflammation of both the glans and foreskin) that keeps coming back despite other treatments.
• Recurrent urinary tract infections (UTIs) in male infants who are at high risk.
• Lichen sclerosus (a skin condition that causes the foreskin to scar and harden over time), when it does not respond to other treatments.
• Penile cancer that involves the foreskin, in some cases.
• Religious or cultural reasons, or personal preference in adults.

Circumcision is generally not performed in certain situations. Your doctor will review these carefully before any decision is made.

• Newborns with certain genital abnormalities, such as hypospadias (where the urinary opening is not at the tip of the penis), because the foreskin tissue may be needed for reconstructive surgery.
• Patients with bleeding disorders (conditions that prevent blood from clotting normally) that have not been treated or stabilised.
• Newborns who are premature or medically unstable.
• Active local infection at the surgical site — the procedure is usually postponed until the infection clears.

Circumcision is a well-established procedure, but like any surgery it carries some risks; serious complications are uncommon, and your surgical team will take steps to minimise them.

• Pain and discomfort in the days following the procedure — this is expected and is managed with pain relief.
• Bleeding at the wound site, which usually stops with gentle pressure but occasionally requires further treatment.
• Infection of the wound, recognised by increasing redness, swelling, warmth, or discharge.
• Swelling and bruising around the penis in the first few days.
• Meatal stenosis (narrowing of the urinary opening) — a longer-term complication that can affect the urine stream.
• Removing too little or too much foreskin, which may require a follow-up procedure in rare cases.
• Scarring or skin adhesions (areas where healing skin sticks together) on or around the glans.
• Rarely, injury to the glans or urethra (the tube that carries urine out of the body) during the operation.
• Reactions to anaesthesia (the medication used to prevent pain), which are rare but possible.

Preparation depends on the patient's age and whether local or general anaesthesia is planned. Your surgical team will give specific instructions, but the following reflects common practice.

Before the procedure, patients are usually asked to:

• Fast (avoid eating and drinking) for several hours beforehand if general anaesthesia is to be used. The exact fasting period will be specified by the team — it is different for infants, children, and adults.
• Stop blood-thinning medications (medicines that reduce the blood's ability to clot) for a period recommended by the doctor, to reduce bleeding risk.
• Avoid smoking in the days leading up to surgery, as smoking slows wound healing.
• Avoid alcohol for at least a day or two before the procedure.
• Arrange for a responsible adult to accompany the patient home if sedation or general anaesthesia is used.

The doctor will usually request some pre-operative tests. These may include:

• A blood test to check for clotting function and general health.
• Urine tests if a urinary infection is suspected.
• In adults, a brief physical examination of the genital area to confirm the indication and plan the surgical approach.

On the day of the procedure, the steps typically follow this order:

• 1. The patient is checked in and identification and consent documents are confirmed.
• 2. The genital area is cleaned and, in older patients, any hair may be trimmed.
• 3. Anaesthesia is given — this may be a local anaesthetic injection (numbing just the penis), a penile nerve block (numbing the nerves that supply the penis), or general anaesthesia (the patient is fully asleep), depending on age and clinical judgement.
• 4. The surgeon carefully separates and removes the foreskin using a scalpel, surgical clamp, or one of several specialised devices. The method chosen depends on the patient's age and the surgeon's training.
• 5. Bleeding is controlled, and the wound edges are closed with dissolvable stitches or surgical adhesive.
• 6. A light dressing or petroleum-based gauze is applied to protect the wound.
• 7. The patient is moved to a recovery area where vital signs are monitored until the anaesthesia wears off.

Most patients recover at home within a few days to a couple of weeks, depending on age and individual healing. Newborns and young children typically heal faster than adults. Your medical team will advise on the exact timeline and what to watch for.

• Pain management: Mild pain and swelling in the first several days is normal. The doctor will recommend appropriate pain relief; do not give a child any pain medication not specifically approved for their age by the treating team.
• Wound care: The wound should be kept clean and dry. In infants, the nappy (diaper) should be changed frequently and petroleum-based gauze may need to be applied at each change to prevent sticking, as directed by the team.
• Bathing: Gentle washing of the area is usually allowed after a short waiting period. Soaking in a bath for extended periods is often discouraged in the early healing phase.
• Activity restrictions: Adults are usually advised to avoid strenuous physical activity, cycling, and sexual intercourse for several weeks while the wound heals. Children should avoid rough play that could injure the area.
• Clothing: Loose-fitting underwear and trousers help reduce friction and discomfort during healing.
• Dissolvable stitches: If used, these dissolve on their own — no removal is needed. The team will confirm which type was used.
• Follow-up appointment: A check-up is usually scheduled within a week or two to confirm the wound is healing properly. If meatal stenosis or other concerns arise later, further review will be arranged.
• Warning signs to report promptly: Heavy or non-stop bleeding, signs of infection (increasing redness, pus, fever), difficulty or inability to urinate, or the wound reopening should all be reported to the medical team without delay.