Circumcision: Everything You Need To Know

Circumcision is the surgical removal of the foreskin of the penis. The foreskin if the layer of skin that covers the head of the penis. This procedure can be performed in newborns, older children, and/or adults. Circumcision is the most common surgery among males.

infant

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What Is Circumcision Surgery?

A circumcision procedure is performed by a trained medical physician under aseptic technique. Circumcisions may be performed due to religious, cultural, and/or medical reasons.

Currently, the world's highest circumcision rates are in:

  • United States
  • Middle East
  • South Korea

Circumcision is embedded in the Muslim and Jewish faith. In the Jewish faith, circumcisions are performed on the eighth day of life by a mohel, a person trained in circumcision and performed during a ceremony called a bris.

Medical reasons for circumcision include:

  • Phimosis: Stricture of foreskins that narrows the opening and prevents it from being retracted to uncover the glans
  • Paraphimosis: Foreskin trapped behind the corona and forming a tight band of constricting tissue, causing swelling of the glans and foreskin
  • Balanoposthitis: Inflammation of the foreskin and glans
  • Balanitis xerotica obliterans: Chronic sclerosis and atrophic process of the glans penis and foreskin
  • Preputial neoplasms
  • Excessive skin
  • Tears in the frenulum

Health benefits for circumcision include:

  • Reduces bacteria under the foreskin
  • Decreases risk of urinary tract infection
  • Decreases risk of sexually transmitted infections (in adults)
  • May decrease the risk of HIV
  • Potentially decreases risk of penile cancer
  • Decreases the risk of cervical cancer and some infections in female partners
  • Promotes good genital hygiene

Contraindications

Contraindications for a circumcision procedure are grouped into four areas. These include:

  • Bleeding disorders: Family history including bleeding disorders such as hemophilia and thrombocytopenia should be fully screened for prior to circumcision.
  • Congenital malformations: Infants born with abnormalities such as hypospadias, chordee, webbed or buried penis, are not eligible for neonatal circumcision.
  • Insufficient size: Premature infants often have smaller size penis' in diameter and/or length. A micropenis is a contraindication.
  • Inadequate age/health of infant: Infants must be at least 12 hours of age and at least one significant void.

Potential Risks

As with any surgical procedure, there several potential risks associated with undergoing a circumcision procedure. While most are relatively minor and treatable, early complications are:

  • Pain
  • Bleeding
  • Swelling
  • Inadequate skin removal

Late post-operative risks include:

  • Wound infection
  • Pain
  • Urinary retention
  • Meatal stenosis
  • Meatal ulcer
  • Fistulas
  • Sexual dysfunction
  • Edema of glans penis
  • Loss of penile sensitivity
  • Hematoma formation
  • Poor cosmesis
  • Tearing of the sutures

While a circumcision procedure is relatively minor, serious complications can occur during the procedure including excessive bleeding and possible amputation of the glans penis.

Purpose of Circumcision

The purpose of a circumcision is to surgically remove the foreskin of the penis. The foreskin is the layer of skin that covers the head of the penis. Generally, circumcisions are performed during the newborn period but can be performed at any time during a person's lifetime.

How to Prepare

Preparing for surgery is never easy. It can be a scary and uncertain time for the patient and their families. After initial appointments the surgeon will give the patient a list of instructions that need to be followed and/or studies that need to be completed.

If this is an outpatient adult circumcision, the night before the surgery, a preoperative registered nurse will call the patient to go over the scheduled arrival time and any last-minute instructions. These instructions will include what medications should be held prior to the procedure as well as what time to become NPO (nothing by mouth).

Location

Circumcisions are often done while a newborn is still in the hospital. Adult circumcisions are performed in a hospital as an outpatient procedure or a same-day surgery center.

What to Wear

Newborns will be in a hospital gown and diaper prior to the procedure. These will be removed once the patient is placed onto the surgical table. Adult circumcision patients should arrive in loose-fitting clothing and will be instructed to change into a hospital gown.

Food and Drink

Adult patients will be required to stop eating and drinking prior to surgery. This is called being NPO, which means nothing by mouth. Adult patients undergo general anesthesia which is why NPO status is increasingly important.

Instructions on a specific time will vary for all patients and are determined by the surgical team. You will be given this information at a pre-operative appointment and then a follow-up reminder call is done the day before the procedure.

Newborns will generally not be feed immediately prior to the procedure. Often feedings can help comfort a newborn after the circumcision.

Medications

The surgeon will discuss all medications with you before the surgery. Make sure to bring a list of the medications to pre-operative appointments including the dosage, how often the medication is taken, and when it was last taken.

Also include all vitamins and supplements in the list of medications. These are just as important as prescribed medications as they may have side effects with the anesthesia and medications used during and after the procedure.

Take only the medications your health care provider tells you to take on the morning of your surgery. Take them with just enough water to swallow comfortably. Make sure to confirm the medications with your surgeon and only take with water.

What to Bring

Here is a list of some of the most important items to bring with you on the day of your scheduled adult circumcision:

  • Comfortable loose-fitting clothing, robe, and rubber-backed, non-skid slippers
  • Personal care products such as toothbrush and toothpaste
  • Storage containers for glasses, contact lenses, and/or dentures if you wear them
  • Insurance card and personal ID card
  • Emergency contact information
  • A copy of your legal paperwork pertaining to your health (such as your health care proxy or living will)
  • A complete list of all the medications you currently take including the dosages, how often you take them and when they were last taken
  • Any adaptive equipment for mobility including cane, walker, or wheelchair
  • Earplugs and eye mask
  • Reading material
  • Cell phone charger
  • Pillow or blanket

You should not bring:

  • Valuables
  • Jewelry
  • Watches
  • Credit cards
  • Cash
  • Laptop

What to Expect on the Day of Surgery

Newborns can expect to be brought to a separate room for the procedure while adult patients will report to the outpatient surgery department. Adult patients can expect to be discharged several hours after the procedure.

Patients report to the hospital at the prescheduled arrival time and will be instructed to change into a hospital gown. It is helpful to have someone at the hospital for support.

Before the Surgery

A hospital circumcision of a newborn only takes several minutes. The process of getting the patient ready can take longer. Prior to the procedure, the performing physician will speak to the parents and obtain consent while discussing the risks and benefits.

A circumcision may be performed by:

  • Pediatrician
  • Obstetrician
  • Family medicine doctor
  • Surgeon
  • Urologist

An adult patient can expect to meet with a member of the anesthesia team as well as the surgical team to go over the procedure as well as sign consent forms.

This photo contains content that some people may find graphic or disturbing.

circumcision surgery - stock photo


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During the Surgery/Procedure

The newborn is placed on a special table prior to the procedure. There are a variety of surgical techniques that are used to perform a circumcision and will vary depending on the healthcare provider. All following the same basic steps:

  • The penis and foreskin are cleaned.
  • A special clamp is attached to the penis and the foreskin is cut and removed.
  • After the procedure, gauze with petroleum jelly is placed over the wound to protect it from rubbing against the diaper.

The three major and most common surgical techniques include:

  • Gomco clamp
  • Plastibell device
  • Mogen clamp

Adult circumcisions are not common procedures but do occur. These procedures are generally done under general or local anesthesia and performed by a urologist. Adult circumcisions are done by one of two techniques:

  • Dorsal Slit technique
  • Sleeve technique

After the Surgery/Procedure

Immediately after an adult circumcision surgery the area is cleaned with sterile water and wrapped with either petroleum jelly and sterile gauze or Xeroform petrolatum gauze. The initial dressing should be removed 24 to 48 hours after surgery. Adult patients are instructed to wear loose-fitting briefs and should gently wash the surgical area daily with non-perfume soap.

After a newborn circumcision, there will be either a visible incision or a plastibell. Newborn circumcisions will be instructed to continue to place petroleum jelly on the tip of the penis after every diaper change in order to prevent the diaper from sticking to the healing area.

After a plastibell circumcision, the plastic rim is left on the penis as it heals. The plastibell will fall off by itself in five to eight days.

Recovery

Recovery after a circumcision is relatively easy. Most patients suffer minor if any complications. Tylenol is suggested for pain relief and patients should take it easier for several days following the procedure.

Healing

It's important for parents and patients to identify complications from the procedure, and to call the doctor right away:

  • Bleeding that is not stopping
  • More than a quarter-size amount of blood on the diaper
  • Redness getting worse or not going away after seven to 10 days
  • Fever
  • Other signs of infection, such as swelling or discharge getting worse, or pus-filled blisters
  • Not peeing normally within 12 hours after the circumcision
  • Dark of black discoloration
  • Consistent redness
  • Skin adhering to the glans

Coping With Recovery

Newborns often do not have any problems coping with recovery after surgery. Adults, on the other hand, should avoid intercourse and masturbation for four to six weeks after the procedure to avoid infection and skin breakdown.

Possible Future Surgeries

The need for future surgeries is rare. If there is an additional need it is often cosmetic. Circumcision revisions are performed by plastic surgeons.

A Word From Verywell

Circumcisions are often performed for religious and/or cultural reasons but also for medical and hygiene reasons. It's important for parents and patients to discuss the medical benefits and risks with the healthcare provider.

There are very minor risks associated with newborn and adult circumcisions but the benefits can be impactful. Consider the future health benefits, religious, and/or cultural beliefs as well as personal preferences or social concerns.

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Article Sources
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  3. The American College of Obstetricians and Gynecologists. Newborn male circumcision. Updated April 2019.

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  5. Weiss HA, Larke N, Halperin D. et al. Complications of circumcision in male neonates, infants and children: A systematic reviewBMC Urol. 2010;10,2. doi:0.1186/1471-2490-10-2

  6. Al-Marhoon MS, Jaboub SM. Plastibell circumcision: How safe is it?: Experience at Sultan Qaboos University Hospital. Sultan Qaboos Univ Med J. 2006 Jun;6(1):17-20. PMID: 21748122; PMCID: PMC3074910.

  7. University of Utah. Circumcision and frenuloplasty.

  8. Dayton Children's. Circumcision.

  9. New Jersey Urology. What to expect after adult circumcision.