Circumcision: The Controversial Surgery Explained

In this video we will hear a consultation between Richard who is a 50-year-old patient and his urologist regarding his upcoming circumcision procedure.

Good morning, Richard.

Good morning, Doctor.

We are here to discuss your upcoming surgery of circumcision and I am happy to answer any questions.

Thank you doctor, what does the procedure involve?

This procedure involves completely removing the foreskin, this is the skin that covers the tip of the penis. It's done for several reasons, such as:
A tight foreskin that can't be pulled back, this is called phimosis.
Frequent infections under the foreskin, this is called balanitis.
Skin problems or chronic inflammation on the penis.
Large warty growths or signs of cancer on the foreskin.
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Thank you doctor, Are there other options?
Before considering surgery, other treatments might be tried:
1. Creams: Steroid creams can help loosen a tight foreskin, but the problem often comes back after stopping the treatment.
2. Small cuts: A small surgical cut can be made to loosen the foreskin, this is also called a dorsal slit as shown in this figure.
3. Frenulum surgery: If the small strip of skin under the penis which is called the frenulum, is too tight and painful, it can be adjusted with surgery.
4. Preputioplasty: This is a procedure to widen the foreskin without removing it entirely.
If these don't work or aren't suitable, removing the foreskin by circumcision is usually recommended.
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What happens on the day of surgery?
1. Before Surgery:
o Your doctor will review your medical history and confirm your consent.
o You'll meet with the anaesthetist to discuss whether you'll have either :
 A General anaesthetic where you're asleep or
 A Spinal anaesthetic where you're numb below the waist, or
 A Local anaesthetic where only the penis is numbed.
o You might be given special stockings to prevent blood clots, and possibly an injection to thin your blood.
What happens during surgery?
2. During Surgery:
o A local numbing injection is used, even if you're asleep, to help with pain after surgery.
o The foreskin is removed through a circular cut just below the head of the penis.
o The remaining skin is stitched into place using stitches that dissolve on their own within 2-3 weeks.
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What can I expect afterward?
Most people experience:
• Swelling: This lasts 1-2 weeks.
• Sensitivity: The tip of the penis feels extra sensitive for a couple of weeks.
• Permanent changes: The sensation on the head of the penis may feel different afterward.
Thank you doctor, are there any complications of the surgery?
Possible complications include:
• Infections: Rare (1-2% of cases) but may need antibiotics or additional treatment.
• Bleeding: Rare (1-2%) and sometimes needs further care.
• Appearance concerns: Some people (less than 2%) may feel unhappy with how it looks after healing.
• Other risks: Very rarely, there can be serious issues like blood clots, heart problems, or reactions to the anaesthetic.