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Circumcision

Last updated April 15, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Circumcision is the surgical removal of skin around the tip of the penis, which is also known as the foreskin or prepuce.


Background Information:

What are the other Names for the Procedure?

  • Male Circumcision
  • Prepucectomy

What is the Circumcision surgical procedure?

Circumcision is the surgical removal of skin around the tip of the penis, which is also known as the foreskin or prepuce.

What part of the Body does the Procedure involve?

A Circumcision procedure involves the penis and the foreskin of the penis.

Why is the Circumcision surgical procedure Performed?

A Circumcision is performed for the following purposes:

  • When there is a difficulty in retracting the foreskin (phimosis)
  • To treat infection of the penis (balanitis)
  • Infection of the urinary tract
  • Religious purposes

What are some Alternative Choices for the Procedure?

For any problems arising due to the foreskin of the penis, a Circumcision remains the gold standard technique.

What are the Recent Advances in the Procedure?

Circumcision is an assured procedure; hence, there are currently no advances in performing this surgery.

What is the Cost of performing the Circumcision surgical procedure?

The cost of Circumcision procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Circumcision procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician.
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayoclinic.com/health/circumcision/MY01023/DSECTION=how-you-prepare (accessed on 16th July, 2012)

Prior to Circumcision surgical procedure:

How is the Circumcision surgical procedure Performed?

  • During the surgery, the foreskin of the penis is pulled or retracted
  • The surgeon next makes two superficial incisions on the foreskin, one above and the other below
  • The skin between the two incisions is removed. The remaining part of the foreskin (mucous membrane) is folded and closed with soluble sutures, with the skin of the penis
  • Finally, the surgeon puts a bandage after applying petroleum jelly.

Where is the Procedure Performed?

A Circumcision is performed in a hospital or an outpatient facility. The individual is admitted, undergoes the procedure and discharged, as per the instruction of the physician.

Who Performs the Procedure?

The Circumcision surgical procedure is performed either by an urologist, a general surgeon, or a family doctor, along with an anesthesiologist.

How long will the Procedure take?

The procedure may take anywhere between 20 minutes to an hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any deodorant or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Circumcision procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Circumcision surgical procedure?

Before the procedure, the individual may be asked to do a routine blood and urine analysis.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Circumcision?
  • Why is this procedure necessary?
  • What does the procedure involve?
  • How will this procedure help?
  • How soon should I get it done? Is there an emergency?
  • Where is the procedure performed?
  • Can oral medications solve the problem?
  • Does the procedure require anesthesia to be administered?
  • What are the risks while performing the procedure?
  • What are the complications that might take place while recovering?
  • After recovering from the procedure, are there any follow ups tests? If yes, how often?
  • How long will it take to recover? When can I resume normal work?
  • Who are the medical personnel involved in this procedure?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Circumcision surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia, either with or without sedation. However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

Since Circumcision is a less invasive procedure, there is little blood loss involved.

What are the possible Risks and Complications during the Circumcision surgical procedure?

The possible risks or complications that may arise during the surgery are as follows:

  • Excessive bleeding
  • Surgical wound infection
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Circumcision surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Circumcision surgical procedure:

What are the possible Risks and Complications after the Circumcision surgical procedure?

Post Circumcision surgical procedure, the following complications may arise:

  • Pain
  • Swelling
  • Redness
  • Drainage
  • Bleeding in the surgical area

What is the Prognosis after the Surgery?

The individual can expect complete healing without any complications. The prognosis, post-surgery is good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Pain, swelling, and redness, around the incision site
  • Bleeding and drainage
  • Signs of infection
  • Dizziness
  • Fever
  • If any new symptom is observed

What Post-Operative Care is needed at Home after the Circumcision surgical procedure?

At home, the following post-operative care is recommended, post Circumcision procedure:

  • In case of bleeding, in the first 24 hours after the surgery, press a tissue or clean cloth for about 10 minutes, on the area
  • Use ice packs to ease pain in the surgical area for the first 24 hours after the surgery
  • Use a heating pad, to relieve surgical wound pain
  • Wear comfortable clothing
  • Use mild soap while bathing
  • Keep the wound dry and clean for the first few days
  • Use mild soap while bathing
  • Do not apply any non-prescription antibiotic ointment to the wound
  • Avoid sex or conditions that may be sexually-arousing

How long does it normally take to fully recover, from the Procedure?

It may take about 3-4 weeks to completely recover from the surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue may be taken for further examination and later disposed, as per the standard medical procedure. However, this is not necessary.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Circumcision surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or hospital
  • The family doctor or general surgeon or urologist
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Circumcision procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 4, 2013
Last updated: April 15, 2018