At birth the foreskin is adherent to the underlying penis but by the age of 3 years the foreskin can be pulled back in 90% of boys. Only 1% still have a non-retractile foreskin (phimosis) at the age of 17 years. From the purely medical viewpoint only the 1% of boys with congenital phimosis or a further 1% who develop inflammation and fibrosis of the foreskin (balanitis xerotica obliterans, BXO) have an absolute requirement for circumcision. It is not uncommon for boys to experience recurrent episodes of inflammation of the foreskin at the age of 3 or 4 years as the foreskin separates from the underlying penis. Although this will settle eventually some parents prefer to have their child circumcised if the episodes are particularly severe or frequent.
It is thought that circumcision reduces the risk of urinary tract infection however the reduction in risk is probably not sufficient to justify circumcision unless there is an underlying abnormality in the urinary system. Circumcision may also reduce the risk of sexually transmitted disease in later life but this is not yet proven. Circumcision does seem to protect against the development of penile cancer but this is an extremely rare tumour and again the benefit does not justify routine circumcision.
In hospital practice this is usually done under general anaesthetic.
The details of the technique vary from surgeon to surgeon. Essentially any adhesions between the foreskin and the underlying penis are separated. The outer layer of the foreskin is incised at the level where the shaft of the penis joins the end of the penis (glans). A further incision is made on the inner layer of the foreskin approximately 5mm below the glans. The foreskin is then excised and the 2 cut edges sutured together with an absorbable suture.
Length of operation
This usually takes about 20 minutes
Time in hospital
The vast majority of paediatric circumcisions are carried out as day case procedures.
Post op discomfort/limitations
The discomfort after a circumcision is not usually severe. Pain killers will usually be prescribed by the hospital.
Time off school
It is not usually necessary to have more than 1 or 2 weeks off school. Contact sports should be avoided until the wound has fully healed.
Risks & complications
Minor complications such as bleeding from the wound or a wound infection occur occasionally and may delay recovery but do not usually affect the final cosmetic appearance. Major complications such as partial amputation of the penis are extremely rare when circumcisions are carried out by experienced surgeons.
There is a vociferous group of individuals (see any of the many, mostly US based, web sites on circumcision) who feel that they have been abused by the process of routine paediatric circumcision. However this is not, in general, the practice of UK surgeons and as long as there is a clear medical indication for circumcision the outcome should be a great improvement on the preoperative condition.
Further reading: British Journal of Urology International 83 Suppl 1, 1999 Jan. A supplement devoted to the subject of circumcision.