Circumcision and alternatives
 

Circumcision
 
Circumcision is removal of the foreskin, usually performed either under general anaesthetic, but it can also be done with a local anaesthetic if preferred.
The operation takes around 25 minutes, and can be carried out as a day-case procedure using special cauterising scissors and dissolvable stitches. A small dressing is placed over the suture-line, which can be removed later that day. Long-acting local anaesthetic is placed beneath the skin which minimises pain in the post-operative period.
 
General day-to-day activities can be resumed soon after circumcision, but you are advised to refrain from sexual activity for 4 weeks or so. It is common to get some swelling and bruising post-operatively, which can last up to 2 weeks, and uncommon complications include bleeding, infection, reduced sensation and cosmetic dissatisfaction.
 
Why is it done?
 
Common medical reasons for circumcision are:
  • Tight foreskin (phimosis)
  • Torn frenulum
  • Infections (Balanitis)
  • Inflammatory condisions (Balanitis Xerothica Obliterans / BXO / Zoon’s etc)
  • Growths (pre-cancerous or cancerous) of the foreskin (rare)
 
Circumcision is also performed for religious and cultural reasons.
           
 
Post-operative: 
Some discomfort and swelling is normal after the operation, which usually responds well to paracetamol. You may have a dressing around your penis, and  if this has not fallen then this can be removed the the following day.
You can resume most normal activities the following day. Showering is advised for the first week post-operatively, to avoid soaking the stitches, but baths are fine after that. . The skin around the stitches can become yellow/cream coloured – do not panic this is normal. The stitches will dissolve in time. Sexual intercourse can be resumed when the scar has healed (usually 4 + weeks).
 
Follow-up :
 
On discharge You will be given some contact numbers to call if there are any concerns in the post-operative period.
 
All being well, the typical follow-up is an appointment at 6 weeks as a final check.
 
For some general information and more detail regarding circumcision, please click here for the British Association of Urological Surgeons (BAUS) information sheet:

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Circumcision.pdf
Frenuloplasty
There is no really effective alternative to circumcision for the conditions described above.
 
Frenuloplasty can sometimes be performed when the problem is entirely confined to the frenulum. This may occur if it naturally tight, and has torn during intercourse - resulting in scarring and worsened tightness. In this case, dividing the frenulum (usually done under a local anaesthetic) and re-stitching it lengthways can elongate the frenulum and help reduce the tightness.
 
Despite this,   approximately 50% of men undergoing frenuloplasty find that there are ongoing issues in the long-term, and require circumcision later.
 
 
Prepucioplasty
Prepucioplasty is a procedure whereby the inner muscle and connective tissue fibres of the foreskin are divided to try and loosen the foreskin to allow retracability (see diagram). Although this is an option where there is no scarring per se, it is still not particularly successful in the mid-long term, with a high percentage returning requiring circumcision later.
 



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