Male Circumcision: Medical Reasons, Choices and Aftercare

Male circumcision is an operation that removes the foreskin — the fold of skin covering the head of the penis.

• It may be recommended for particular medical problems affecting the foreskin.
• It may also be chosen for personal, cultural or religious reasons.
• On the NHS, circumcision is normally provided only when there is a medical reason.
• It is not automatically necessary for cleanliness. Most uncircumcised penises can be kept perfectly clean with ordinary, gentle washing.

Circumcision is a personal medical decision. It should be discussed with a qualified healthcare professional who can explain the reasons, the alternatives and what to expect.

A doctor may suggest circumcision when a foreskin problem is causing symptoms or is unlikely to settle with other treatment. Possible reasons include:

• Pathological phimosis — a tight or scarred foreskin that cannot be pulled back and is causing problems.
• Repeated balanitis — recurring inflammation or infection affecting the foreskin and the head of the penis.
• Balanitis xerotica obliterans, also known as lichen sclerosus— a skin condition that can cause scarring and tightening.
• Paraphimosis, or repeated difficulty returning a pulled-back foreskin to its normal position.
• Pain, splitting or bleeding caused by scarring of the foreskin.
• Rarely, treatment connected with abnormal or cancerous tissue.

Important: a foreskin that does not pull back in babies and young boys is usually a normal part of development. On its own, it does not automatically require treatment.

• It is normal for boys under five not to be able to pull back their foreskin.
• In some boys, the foreskin does not separate fully until later childhood or puberty.
• A child’s foreskin must never be forcibly pulled back. Doing so can cause pain, injury and scarring — and scarring can create the very problem people are trying to avoid.
• Only wash the outside gently until the foreskin retracts naturally on its own, which happens at different ages for different boys.

Speak to a GP if a child has pain, repeated infections, difficulty passing urine, ballooning that troubles him, or persistent swelling. You can find a GP through the NHS.

Where circumcision is being considered for a child on medical grounds, it should involve proper assessment, safeguarding, suitable pain relief and valid consent. Where the child is old enough to understand what is proposed, his own wishes should be heard and taken seriously.

Circumcision is not always the first treatment. Depending on the cause, a clinician may recommend:

• Observation, where the tightness is normal for the person’s age and is causing no problems.
• A prescribed steroid cream, sometimes used alongside gentle stretching advised by a clinician.
• Treatment for infection or inflammation, such as an antifungal or antibiotic treatment.
• Improved gentle washing, avoiding perfumed products that irritate the skin.
• Other foreskin-preserving procedures where these are clinically appropriate.

Nobody should try to cut, forcibly stretch or treat the foreskin themselves. This risks pain, bleeding, infection and permanent scarring.

If circumcision is being considered for an adult or older child, this is what usually happens:

• A GP assesses the problem and may refer the patient to a urology service.
• The specialist discusses the alternatives, the risks and the reasons, and takes consent.
• The operation is carried out under local or general anaesthetic, depending on the patient and the procedure.
• Most people return home the same day.
• Dissolvable stitches may be used, so they do not usually need removing.
• The penis commonly takes around four to six weeks to heal, although recovery varies from person to person.

Follow the hospital’s own instructions about washing, returning to work, exercise, masturbation and sexual activity. If anything is unclear, ring the ward or clinic number given on the discharge information.

• Wash gently with warm water.
• Do not force the foreskin backwards.
• Once the foreskin retracts comfortably, gently pull it back, rinse underneath, and return it to its normal position afterwards.
• Avoid strong or heavily perfumed soaps if they cause irritation.

A small amount of natural white material (smegma) under the foreskin is normal and simply rinses away with warm water. It is not dirt, and an uncircumcised penis is not unhygienic.

Seek medical advice for persistent soreness, discharge, an unpleasant smell, bleeding, swelling or difficulty passing urine. Our GP Services page explains how to arrange an appointment.

Some families and individuals choose circumcision for personal, cultural or religious reasons rather than to treat a medical condition. Sixpence Support UK does not advise for or against these beliefs. Anyone considering the procedure should use a properly trained practitioner, ask about pain relief, hygiene, complications, safeguarding and aftercare, and make sure valid consent has been obtained.

• NHS — Circumcision in men
• NHS — Tight foreskin (phimosis)
• British Association of Urological Surgeons — Circumcision
• BAUS — Tight foreskin (phimosis)
• NHS — Find a GP
• NHS 111 online

Important notice: Sixpence Support UK provides general information only. This page is not a diagnosis, individual medical advice, or a substitute for assessment and treatment by a qualified healthcare professional. Always speak to a GP, pharmacist or another qualified health provider about your own symptoms, medicines and circumstances. In an emergency, call 999.