What is Circumcision?
Circumcision is a surgical procedure in which the skin covering the end of the penis is removed, thereby exposing the tip of the penis. The skin of the penis is a complex movable sheath with no clear indication of where it should be cut during a circumcision. This means that the amount of foreskin removed from one operation to the next can be very different, and no two circumcisions are the same. It is also possible to remove the foreskin in full or partially.
Why does this operation need to be done?
As the foreskin starts to separate from the head of the penis, it is usual to see the foreskin ‘ballooning out’ when your son passes urine. This can occasionally lead to infection (balanitis) but this usually settles down with time.
If the foreskin is scarred, usually by severe infection, and it will not slide back over the head of the penis circumcision is necessary. This is extremely rare before five years of age.
The most common reason for needing a circumcision is a condition called balanitis xerotica obliterans (BXO). This affects the tip of the penis, causing the foreskin to become scarred, sometimes following prior surgery, infection or an inflammatory condition. The urethra opening may also narrow making it more difficult to pass urine in this case a small procedure to enlarge it will also be required (meatoplasty). Circumcision is also done for abnormalities of the foreskin which are not going to improve with age and for religious and cultural reasons.
What would happen if nothing was done?
For a child experiencing problems, the problems would persist and in some cases get worse. If the foreskin becomes too tight and scarred it can lead to difficulty passing urine and potentially develop into an infection.
Reasons why you may decide to have your son circumcised
Medical Benefits:
What does the operation involve?
With your child under a general anaesthetic, the surgeon will make a cut to remove the foreskin on the penis. The underlying glans are exposed. The skin is then re-joined beneath the glans with dissolving stitches, which do not need to be removed. A gauze dressing will be placed over the operation site.
What complications can occur from the surgery?
The most common risk is bleeding from the site of the operation, both during and after. The surgeon will minimise any bleeding by sealing off the blood vessels affected. Occasionally, your son may have some further light bleeding after surgery but this usually stops when a dressing is applied to the area. If bleeding persists, a second shorter operation may be needed. If you are concerned about any bleeding at home, you should call the hospital PSP team.
There is also risk of infection which may require treatment with antibiotics.
Difficulty with passing urine after the operation due to narrowing the hole is unusual, it is more common when there is a scarring of the foreskin called BXO (Balanitis Xerotica Obliterans). With BXO some cream is prescribed after the operation to reduce the inflammation.
How long will the operation take?
This operation normally takes about 30 to 60 minutes. When the operation is finished your child will be taken to the recovery area, and once awake you will be able to see him.
Will my son have any pain?
During the operation some local anaesthetic will be injected around the base of your child’s penis or in his back by the anaesthetist or surgeon. This will make the operation site numb so your child will not feel pain when they wake up. Sometimes this is not effective and your son will be given a strong painkiller (morphine) to stop the pain. The local anaesthetic normally gives good pain relief for up to 6 hours. It is important for your child to start taking painkiller medicines by mouth before the numbness wears off for continued pain relief.
When can my child go home?
A nurse will check your son’s pulse rate and breathing rate. Once your son is ready then they will be given a drink and then something to eat. If your son has minimal/no pain, their temperature is normal and they do not feel sick they will be allowed to go home.
Will my child have any pain at home?
It is advisable to give your son regular painkiller medicine for the first 24-48 hours’ even if they do not complain or discomfort. Paracetamol and/or Ibuprofen can be used.
What will happen afterwards/ what will the recovery be like?
The penis often swells and bruises a little. A scab will form where the skin has been re-joined. Do not try and clean the scab off. There should be no problem passing urine (wee) afterwards. Nappies can be used as normal but older boys may prefer loose clothing until the area is less sore. Your son can have a bath or shower from the day after surgery. Bathing every day will help your son recover. Daily salt baths for up to 1 week are recommended to aid healing.
When can my son go swimming and school?
For swimming it is best to wait until the wound is fully healed. This is usually after 7 to 10 days.
Your son can return to school when they are comfortable, usually after 5-7 days.
Will I need to see the Surgeon again?
After a straightforward circumcision this is often not required any follow up. However, all boys with suspected Balanitis Xerotica Obliterans will usually be seen a few weeks after surgery in outpatients.
For further information, please contact:
Clinical Nurse Specialist, on 020 7580 4400, 10838 (09:00 – 17:00 Monday to Friday)
Out of hours: Contact our Paediatric Site Practitioner via the switchboard on:
02075804400 ext: 10843
