Adult circumcision: what the procedure involves and recovery day by day

Circumcision is a surgical procedure to remove the skin that covers the head of the penis, known as the prepuce or foreskin. In adult men, the procedure is performed by a urologist, usually under local anaesthetic. Recovery in adults usually takes longer than in children, so it is a good idea to plan your time off in advance.

The most common medical reasons for the procedure are:

• phimosis, that is, a tight foreskin that cannot be pulled back over the head of the penis
• recurrent paraphimosis, a condition in which the pulled-back foreskin cannot be returned to its normal position
• recurrent inflammation of the head of the penis and the foreskin
• scarring of the foreskin that makes hygiene or sex difficult

If the pulled-back foreskin cannot be returned and the head of the penis is swelling, you need to see a doctor urgently.

Some men choose the procedure for personal or religious reasons. Please check when booking whether Maja Hospital performs circumcision without a medical reason. In any case, the decision is made after a consultation with a urologist. Depending on the findings, the doctor may also suggest a different solution, for example topical treatment or a smaller procedure that widens the foreskin rather than removing it.

The first step is a consultation with a urologist. The doctor examines the foreskin and the head of the penis and asks about any previous inflammation, long-term conditions and the medicines you take regularly. It is important to tell the doctor about any blood thinners, diabetes and allergies, especially to local anaesthetics, and whether you have a pacemaker or another implanted device. Based on this, the urologist assesses whether circumcision is the right solution and when it can be done. If blood tests are needed, the doctor will tell you which ones.

Preparing for the day of the procedure itself is simple:

• have a shower at home and wear comfortable, loose clothing
• bring clean cotton underwear that holds the penis up against your abdomen, and the urologist will tell you what kind of underwear to wear for the first few days
• take your medicines as the urologist has told you, especially blood thinners, and do not stop any treatment on your own
• arrange for someone to drive you home, as driving yourself after the procedure is not recommended

The prices of circumcision and of a urologist consultation are listed in the Maja Hospital urology price list. Please check when booking exactly what the price of the procedure includes. If you have voluntary health insurance, check with your insurance company before the procedure whether, and under what conditions, it covers this procedure.

In adults, circumcision is usually done under local anaesthetic. In the Maja Hospital urology price list, it is listed specifically as a procedure under local anaesthetic, and the type of anaesthetic is ultimately decided by the doctor. The urologist injects the anaesthetic with a fine needle at the base of the penis. You will feel the needle prick and a brief stinging, and after a few minutes the area goes numb. You are awake during the procedure, but you usually feel no pain. You may feel touch or a slight pulling.

The doctor then removes the foreskin, stops the bleeding and joins the edges of the skin with fine stitches. Finally, a dressing is applied. The procedure itself usually takes about half an hour to an hour.

After a short rest and a check of the dressing, the urologist explains how to care for the wound, when the dressing comes off, which painkiller to take and when your follow-up appointment is. After a procedure under local anaesthetic, an overnight stay is usually not needed, and you go home accompanied by someone once the doctor judges that it is safe to do so. Follow the urologist's instructions even when you feel well.

Every body heals at its own pace, so this is an approximate guide. Your own timescales are set by the urologist who performed the procedure. In smokers and people with diabetes, healing may take somewhat longer.

• Day of the procedure: once the anaesthetic wears off, usually after a few hours, pain, stinging and tenderness set in, usually mild to moderate. Rest and the painkiller recommended by the doctor help.
• Days 1 to 3: swelling and bluish bruising are at their worst. This is an expected reaction of the tissue. The dressing is removed or changed as the urologist has instructed, usually after one to two days.
• Days 4 to 7: the swelling gradually goes down. The head of the penis is now constantly in contact with your underwear and may be oversensitive. This oversensitivity usually settles within two to three weeks, and afterwards most men find that the sensation in the head of the penis remains somewhat different from before the procedure.
• Week 2: most men return to work that is not physically demanding. Swelling and bruising usually settle by the end of the second week.
• Weeks 3 to 6: dissolvable stitches usually fall out within two to three weeks of the procedure, sometimes not until around the sixth week. Mild swelling below the head of the penis may persist for a while. Complete healing in adults usually takes four to six weeks, sometimes longer.

Swelling after circumcision is expected. It is at its worst in the first few days, and mild swelling below the head of the penis can persist for several weeks. For the first few days, many men find it more comfortable to rest and wear cotton underwear that holds the penis up against the abdomen.

Passing urine is usually possible without difficulty from the first day. The stream may spray because of the swelling and the dressing, so many men find it easier to sit down to pass urine. Mild stinging when passing urine in the first few days is not unusual. If the dressing gets wet with urine, do as the urologist has explained. If you notice blood in your urine or the stream is getting weaker and weaker, contact a doctor.

Night-time and morning erections are natural and cannot be prevented. In the first few days they may be uncomfortable because they pull on the stitches, and slight tightness around the scar during an erection can be felt for several months. Some men find it helps to empty their bladder before going to sleep. If the discomfort lasts longer, tell the urologist at your follow-up appointment.

Care at home is simple, but it is important to do it regularly:

• shower with lukewarm water when the urologist allows it, usually after 24 to 48 hours
• gently wash the area with a mild, unperfumed soap and pat it dry with a clean towel, without rubbing
• avoid baths, swimming pools, the sea and saunas until the skin has healed and the doctor allows it, usually two to four weeks
• use creams and dressings only if the urologist has recommended them
• do not pick off scabs or pull at the stitches

For circumcision, stitches that dissolve on their own (absorbable stitches) are most commonly used. They are not removed, but usually fall out on their own within two to three weeks, sometimes not until around the sixth week. If non-dissolvable stitches were used, the urologist removes them at a follow-up appointment. Ask the urologist which stitches were used and when your follow-up appointment is. If the stitches have not fallen out after six weeks, tell the doctor.

For office work, a few days to a week off is usually enough. Heavy physical work requires longer, usually two to four weeks. Walking is allowed and beneficial from the first few days. If your work involves long periods of sitting or travelling, choose loose clothing and take short breaks.

• driving: not on the same day, but once sitting and sudden braking do not cause pain
• running, cycling, the gym, heavy lifting and swimming: after two weeks at the earliest, and usually after two to four weeks
• sex and masturbation: usually after four to six weeks, once the wound has fully healed

Putting strain on the wound too early can reopen it or make the swelling worse. That is why it is best to get the final go-ahead for sport and sex at your follow-up appointment.

Circumcision is a common procedure, but like any operation it carries certain risks. Swelling and bruising occur in almost all patients. Less often, bleeding from the wound or infection occurs, and sometimes a further procedure is needed because of bleeding or excess skin. Rarely, the opening of the urethra becomes narrowed, which is noticed as a thinner or slower stream.

Once the initial oversensitivity settles, most men find that the sensation in the head of the penis is different from before the procedure, often somewhat reduced, and this change is usually permanent. The procedure does not affect fertility. The final appearance is usually visible after about six weeks. At the consultation, the urologist explains the risks in your case.

Mild swelling, bruising and stinging are part of normal recovery. Contact the urologist who performed the procedure as soon as possible if you notice any of the following:

• bleeding that does not stop after about ten minutes of gentle, steady pressure with clean gauze
• you cannot pass urine, the stream is very weak or there is blood in your urine
• a temperature above 38 °C or shivering
• spreading redness, warmth, pus or an unpleasant smell from the wound
• swelling that increases rapidly or pain that gets worse and does not ease after the recommended painkiller
• the wound has opened or the stitches have come loose too early

If you cannot pass urine at all or the bleeding does not stop, and the urologist is not available, contact the nearest emergency medical service or call 194.