Circumcision is the procedure of removing foreskin that surrounds the end of the penis and is done for a variety of reasons that include medical, religious, cultural, and family. In some cultures and religions it is customary to undergo circumcision as a child, however due to the medical benefits, adults often have this procedure done by choice. The procedure is performed on an outpatient basis, and takes about 30-45 and can be done under local anesthetic or light sedation. The most common procedure for the adult circumcision is the Free Hand Method (Sleeve Resection). First, the foreskin is pushed back along the shaft and a freehand cut is made around the shaft where the scar-line is desired. The foreskin is pushed forward towards the glans and another incision is made at the same position as the first. A longitudinal cut is made spanning the two circumferential cuts in order to remove the strip of foreskin. Finally, the edges of the skin are pulled together and sutured. If there is associated significant bending of the tip, the frenulum can be incised during the circumcision or separately. Tightness and scar-line can be variable depending on the anatomy and the desires of the patient.

Adult circumcision comes with numerous advantages that include:

Decrease risk of STD (Sexually Transmitted Diseases):

Specifically, circumcision is known to reduce three types of STD’s, HIV, Syphilis, and chancroid. Research in Africa shows that circumcised heterosexual men reduce their risk of HIV by 38-66% compared to uncircumcised heterosexual men. It is believed that within the foreskin there are special cells that attract the HIV virus. As for syphilis and chancroid, it is believed that the foreskin provides a warm and moist environment for bacterial growth. Uncircumcised men are twice as likely to get syphilis and ten times more likely to get chancroid. While circumcision is shown to reduce the risk for STD’s, condoms are still the best method for prevention of STD’s.

Decrease risk of UTI (Urinary Tract Infection)

Statistics show that about 4% of boys will have a UTI at least once in their life before reaching the age of 16. However, circumcision is known to reduce the risk of UTI by 10-14%. UTI’s are thought to proliferate by bacteria that gather inside the foreskin, which then spread into the urinary system.

Prevention of Paraphimosis

Paraphimosis occurs when the foreskin is trapped underneath the tip of the penis. It causes swelling around the penis which can block the blood supply, ultimately leading to death of penile tissue. Paraphimosis can be the result of normal examination of the penis, cystoscopy, or urinary catheterization.

Prevention of Balanoposthitis

Balanoposthtis is caused by a bacterial infection that causes inflammation of the foreskin. The swelling can cause pain when urinating and discharge of pus from the penis. Balanoposthitis can be treated with antibiotics but can be further prevented by circumcision.

Penile Cancer

Even though penile cancer is very rare, research has shown that circumcised men are 3-4 times less likely to develop penile cancer. Penile cancer tends to develop in the foreskin of the penis and is therefore a risk factor for uncircumcised men. Penile cancer is very rare, however men with a family history of penile cancer are recommended to undergo circumcision as a preventative measure.

Preoperative preparations:

Pubic Hair

It is recommended to trim pubic hair fairly short to aid asepsis and prevent trapping of hair in the bandaging afterwards.

Alcohol and Drugs

No alcohol 24 hours prior to operation (may cause dehydration and reduce effectiveness of anesthetic). No drugs 24 hours prior to operation, unless it is a prescribed drug approved by the operating physician.

Sex

Sexual intercourse/masturbation can take place up to to surgery to because sexual acts cannot be performed for six weeks post-surgery.

Food

If under local anesthetic, it is recommended to eat a light meal to prevent fainting. General anesthesia requires fasting the night before the procedure.

Sanitation

Shower and clean the genital area while retracting foreskin and cleaning under it. Make sure to empty bladder and bowels prior to operation.

After-care/Follow-up-care:

The local anesthetic and surgery may cause the penis to become swollen and bruised which will gradually reduce over a two week span.

Clothing

It may be more comfortable to wear boxer briefs, as they hold the penis in place and reduce friction and irritation. It is also helpful to orient the penis upward to help lymphatic drainage and reduce swelling.

Urination

The swelling may cause urine to spray for first few days.

Pain Management

Do not take Aspirin (or Aspirin based medication) because of their blood thinning and anti-coagulating capabilities as this may cause increased bleeding.

Tylenol is recommended.

Erections and Sex

To prevent nocturnal erections from pulling on the stitching during the first few nights, empty your bladder before going to sleep, sleep on your side, and draw your knees up into the fetal position. Do not conduct sexual activity for approximately six weeks. After six weeks, to avoid unnecessary irritation and friction on the healing scar, it is recommended to use a condom during sexual intercourse until scar is completely healed.

Bandage

A tight bandage will be placed on the penis to serve two functions, to protect the wound and reduce swelling. The first dressing change is done at a time that maximizes the compression to reduce the swelling while preventing the bandage from sticking to the healing skin. This is usually done two or three days after the operation. To remove the bandage, the penis should be soaked in the bath with lukewarm water and a few handfuls of salt or Epsom Salts to promote healing (DO NOT add any antiseptic to the bath because this will slow down healing). Sterilize a small pair of scissors in antiseptic solution and then rinse in water. Then use the scissors to cut the bandage into small lengths to ease the unwinding process. Slowly unwind the bandage while soaking whenever resistance is felt. Make sure ALL the bandage is removed, and be aware of odd strands of gauze that might be embedded in the wound. Once the entire bandage is removed, clean the penis with more lukewarm salt water for a few minutes and reapply gauze with a fresh set of bandages. If desired, Vaseline or sudocrem can be applied before the bandage is applied to reduce the sticking of bandage to skin.

Stitches

Stitches usually remain on the penis between one and two weeks in order to heal the wound without allowing the skin around to fully heal. We always use self-dissolving stitches, however if they don’t dissolve within four weeks medical attention to remove the stitches is advised.

• Principal Methods of Male Circumcision
• The Surgical Procedure
• Circumcision – Why it is necessary
• Preparation and After-care for Your Teen or Adult Circumcision