Understanding Pre - Operative Steps for Safe Cirumcision

What is Circumcision?

Circumcision is a surgical procedure performed to remove the skin that covers the tip of the penis. Circumcision does not affect fertility or sexual satisfaction.

Is the Circumcision procedure an elective or an emergency procedure?

Circumcision is an elective procedure.

Types

Circumcision is performed either in:

• A conventional method or
• A device-based method

In the conventional method, clamps such as Gomco clamp or Mogen clamp are attached to the penis and the excess foreskin is cut. In the device-based method, a plastic ring called a plastic bell device is placed on the penis to allow the foreskin to fall off naturally within 7 to 10 days.

Indications

In some areas of the world, Circumcision is performed as a religious ritual. It is also performed for the following medical reasons are:

• To reduce the risk of sexually transmitted diseases
• For hygiene
• To reduce urinary tract infections
• To reduce the risk of penile cancer
• To reduce the risk of HIV infection
• In the treatment of phimosis and balanoposthitis
• In the treatment of swelling of the foreskin

Contraindications and risk factors

Circumcision is not performed if the individual has:

• Blood clotting disorders
• Premature birth
• Genital structural abnormalities
• Presence of any penile warts on the foreskin
• Presence of any acute illness or infection
• Uncontrolled diabetes or hypertension
• Poor general health

Investigations before the procedure

Investigations that are done for newborns before Circumcision include coagulation tests to check bleeding time and clotting time. For adults, the following tests are considered:

• Detailed physical examination of the penis
• Coagulation tests
• Random blood sugar
• Urinalysis
• HIV test

Preoperative advice

Preoperatively before Circumcision, the risks and benefits of the procedure are discussed.

Intraoperative details

Anaesthesia: Circumcision is done under local anaesthesia.

Duration: The procedure takes 10 to 15 minutes.

Description of the procedure

The patient is positioned on his back on the operating room table. Penis and the surrounding area is cleaned with an antiseptic solution. Anaesthesia is injected at the base of the penis. Topical anaesthesia can also be applied. A special clamp is used to separate the foreskin from the head of the penis and a scalpel is used to remove the excess foreskin. In other methods, the foreskin is separated and a plastic ring is placed on the penis that allows the foreskin to fall off naturally after 7 to 10 days. This is mostly performed in newborns. Antibiotic cream or petroleum jelly is applied around the penis and it is packed with gauze.

Postoperative details

Postoperatively after the Circumcision:

• It takes 10 days for the penis to heal
• Avoid putting pressure on the penis
• Follow effective pain management measures
• Avoid wetting the penis until it heals

Specific instructions are to be followed in newborns after Circumcision are:

• The bandage should be changed with each diaper change
• Apply petroleum jelly to the tip of the penis so that it does not stick to the diaper
• Wrap the diaper loosely without putting much pressure on the penis
• Wash the penis gently after bowel movements
• Seek medical consultation if the plastic ring does not fall off within 2 weeks
• Observe for signs of infection including bleeding, discharge from the penis, or inability to urinate within 12 hours after the procedure

Role of diet/ Exercise/ Lifestyle changes

Specific diet and exercise restrictions after a Circumcision procedure in adults include the following:

• Avoid heavy lifting for a few weeks
• Avoid strenuous exercises and activities like jogging or cycling for a few weeks
• Perform gentle exercises and walking
• Avoid sexual intercourse for six weeks after the procedure
• Diet as directed by the physician
• Observe the site for any signs of infection such as increased pain, difficulty urinating, discharge from the penis, fever, swelling, or redness

Complications

Circumcision is done in infants with very minimal complications. Circumcision done in adults can rarely lead to complications. Some of the complications of Circumcision include:

• Bleeding
• Infection
• Removing too much or too little foreskin
• Improper healing of the foreskin after the surgery
• Injury to the penis
• Adverse reaction to anaesthesia
• Excessive swelling of penis or scrotum
• Problem during urination
• The remaining foreskin can reattach to the penis, requiring a correction surgery

Prognosis

The overall prognosis of Circumcision is excellent.

Indications for hospitalization if required

Circumcision is performed in a hospital setting and the duration of the stay depends upon the medical condition of the individual.

Suggested clinical specialist/ Departments to consult for the procedure

• General surgery
• Urology

Additional information

Circumcision is performed in children for religious or cultural reasons. It is most common in Muslims and jews. It is performed as a religious ceremony at home by a person who is surgically trained to do ritual Circumcision.