A circumcision is an operation to remove the foreskin of the penis. Circumcision is only necessary for medical reasons. For the first four to five years of a boy’s life, it is normal for the foreskin to be attached to the head of the penis and not pull back.
As the foreskin starts to separate from the head of the penis, it is usual to see the foreskin ‘ballooning out’ when your child passes urine. This can occasionally lead to infection (balanitis) but this usually settles down with time.
If the foreskin is damaged, usually by severe infection, and it will not slide back over the head of the penis (true phimosis), 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 may narrow making it more difficult to pass urine.
What happens before the operation?
The operation is usually carried out as a day case, which means your child will have the operation and go home later the same day. You will have received information about how to prepare your child in your admission letter.
Your child should not have had anything to eat or drink beforehand, from the time set out in the letter. It is important to follow these instructions – otherwise your child’s operation may need to be delayed or even cancelled.
On the day your child comes into hospital for the circumcision, the doctor will explain about the operation in more detail, discuss any worries you might have and ask you to give your permission for the operation by signing a consent form. An anaesthetist will also see you to explain about your child’s anaesthetic in more detail. If your child has any medical problems, such as allergies, please tell the doctors.
What does the operation involve?
Your child will have a general anaesthetic and will be fully asleep and unaware of what is happening. During the operation, your child’s surgeon will carefully remove the foreskin and stitch up the wound. The stitches will dissolve and you will not need to visit the doctor to have them removed. Your child’s penis will take up to six weeks to fully heal.
Are there any risks with this operation?
The main risk with this operation is bleeding, both during and after the operation. During the circumcision, the surgeon will minimise any bleeding by sealing off the blood vessels affected. Occasionally when your child wakes from the anaesthetic, he may have some further light bleeding 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 when you return home, you should visit your local hospital Accident and Emergency (A&E) department.
Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic, your child may feel sick. He may also have a headache, sore throat or feel dizzy. These side effects are usually short-lived. There is a very small risk of infection.
Following the circumcision, your child should not suffer after effects in later life, although very occasionally the hole where the urine comes out of becomes tight. This can easily be corrected but requires a further small operation.
What happens after the operation?
When your child returns from the operation, his penis may be covered with a small dressing. This will protect the area and absorb any slight bleeding. It will be removed before your child goes home. He will be able to go home once he has passed urine. This may be uncomfortable at first.
Your child’s penis will look sore and inflamed for a week or so, and may look worse a few days after the operation than it did immediately afterwards. The surgeon may prescribe some ointment to put on the area for a few days to help it heal. Your child may be more comfortable with loose clothing or without clothes on his bottom half for a few days. Peeing will be more comfortable while the penis is sore if your son pees in the bath or shower.
Your child will have been given painrelieving medicine during the operation, but this will begin to wear off. He will need to have regular pain relief for at least three days, usually paracetamol or ibuprofen, so please make sure you have enough at home.
The day after the operation, your child will be able to have a bath. He should not ride a bicycle or other sit-on toy until any discomfort or swelling has completely gone. He should be well enough to go back to school or nursery a week after the operation. When he returns to school or nursery, please pass on this information to his teacher.
Usually no follow-up is required unless the foreskin has been sent for examination in our laboratory, for instance, if BXO is suspected.
You should call your family doctor (GP) or the ward if:
There is any bleeding from your child’s penis
Your child’s penis stays swollen after two weeks
Your child still finds passing urine painful a few days after the operation
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.