Circumcision is the removal of the foreskin attached to the male penis and is a medical procedure that can be performed on male children or adults. Certain cultures, such as that of Jewish and Islamic tradition, require males to be circumcised for religious reasons. However, some males can experience tight or non-retracting foreskin and this requires circumcision or foreskin adjustment on medical grounds.
What is Circumcision?
Children may be circumcised between 18 months and 16 years of age where the developing foreskin sleeve is removed through surgery or circumcision from the penis head. Similarly in adult males the fully developed penis foreskin is removed.
When a male child is born the foreskin attaches to the penis head or glans. By the age of 4 the foreskin sleeve should naturally detach. Irregular conditions such as foreskin tightness or phimosis may prevent the foreskin from being able to slide over the penis head. Phimosis can cause swelling and painful urination with recurring infection and psychological distress. Paraphimosis is when the foreskin becomes trapped and is unable to retract, in which case circumcision is necessary to correct this problem.
When infection and pus set in between the foreskin and penis head, acute balanoposthitis or foreskin inflammation occurs. Such infections can happen again so circumcision is necessary to prevent infection.
After surgery the penis may feel sore and tender, in which case painkillers can be prescribed to prevent discomfort. Where necessary a course of antibiotics is given to reduce the risk of infection. The moist dressing is usually removed a day after surgery and care should be taken when cleansing the site.
Aftercare guidance will be provided and normal activities can generally be resumed within 10 day. However, it is recommended to wait four weeks until attempting any kind of sporting activity. Healing rates and recovery duration may differ between children and adults.
Older children and adults may feel more traumatised at the thought of having circumcision and may need to be psychologically prepared for the treatment. Risks of surgery are bleeding, infection and surgical error, but surgeons are trained to reduce the risk of such difficulties. It is normal for some swelling and bruising to be present and temporary scarring may occur.
Results of Circumcision
The expected result from circumcision surgery is complete removal of the foreskin covering the end of the penis. In families this may have religious significance and be part of a rite of passage. For others, where the foreskin develops irregularly, the operation may provide relief and a sense of psychological well-being. In certain cultures circumcision is favoured for cleanliness and health reasons.
Generally parents make the decision to have their child circumcised for reasons of religion or health and provide consent for treatment. A team of medical professionals trained in paediatrics are involved in the circumcision process for children.
Adults make their own choice to be circumcised for religious or health reasons, providing their own consent. In men where the foreskin develops too tightly or does not retract properly, circumcision is often recommended to correct this irregularity.
The consultation process involves a team of medical professionals, such as a dermatologist, urologist, anaesthetist and plastic surgeon. Diagnostic tests are performed first, such as MRI scans or X-rays, and in all cases the individual’s medical history, prior operations, medication use and reasons for having the surgery are assessed.
Children may be provided with a local anaesthetic but it is usually recommended that adults have a general anaesthetic for pain-free treatment during sleep. During the operation the foreskin is surgically trimmed away. Dissolving sutures are used to fuse remaining skin and a moist dressing is placed around the penis. Elastic net pants may be provided to keep the dressing in place for a day or two.
The patient, whether child or adult, may require an overnight hospital stay depending on their health condition or may return home on the same day as surgery. Post-operative aftercare instructions are provided for healthy recovery, and where children are concerned parents may need to assist with aftercare.