What is a circumcision?

A circumcision is an operation to remove the foreskin. This operation is usually performed for a narrowing of the foreskin called a phimosis. Not all phimoses are abnormal, especially in children. The operation can also be performed if the foreskin is abnormal in some way.

What are the symptoms of phimosis?

  • You may not be able to retract the foreskin over the head of the penis.
  • You may not be able to clean underneath the foreskin (in adults).
  • You may get the foreskin stuck underneath the head of the penis.
  • You may find the head of the penis gets infected – red, hot, sore, discharging pus.
  • You may find you cannot pass urine. This is rare and is more likely to happen to older men.

What causes phimosis?

In children – a phimosis is usually completely normal there are occasions where a type of scarring has formed, or the child gets recurrent infections. This is not normal, and a circumcision may be offered.

In adults – a phimosis is usually abnormal, but may not necessarily need treatment. The foreskin may split during sex, and the scar formed may constrict the skin in a band. A special type of scarring may affect the foreskin called BXO. This makes it thickened and stops it retracting. This condition can be very disfiguring and affect the top of the water pipe (meatus) as well. Very rarely a cancer can present this way.

What are the treatments?

In children – treatment is often not required as most children will grow out of a physiological phimosis. Performing a circumcision is reasonable if the foreskin is scarred or the child is missing significant amounts of school, then there is a relative indication for circumcision.

In adults – creams containing antibiotics and antifungal medication, with or without steroid may be helpful to settle infections and aid pliability. They tend to treat symptoms rather than causes, however, and if the problem keeps returning, surgery may be the only option.

It is reasonable to check for medical conditions associated phimosis, including diabetes, urinary tract infections and to take a swab of the foreskin to look for fungal infections.

What are the surgical procedures available?

  • Prepucioplasty – this involves cutting the bad that is causing the phimosis in several places. It allows a patient to keep the foreskin, which is extremely sensitive and therefore useful in lovemaking. It may leave ‘dog-ears’ which may be unsightly, and may fail – this area scars easily and the band may recur.
  • Frenuloplasty – the band connecting the foreskin to the head of the penis is cut across ways and repaired in the line of the band. This lengthens it and is a useful operation if the foreskin is healthy but the tight frenulum is holding the foreskin in an abnormal position and causing pain. It has the advantage of keeping the sensitive foreskin, but may fail if it scars back up.
  • Circumcision – the foreskin is removed and the remaining skin attached underneath the head of the penis. If severe BXO is present an operation to open the end of the water pipe may be required. This removes the problem skin completely, but there can be issues with sensitivity, especially during lovemaking, and occasionally patients can be unhappy with the cosmetic result. The operation can, however be revised.

Author: Mr Stuart Graham BSc MBBS FRCSEd FRCS(Urol)

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