Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Effects of circumcision
After the operation, the head of the penis is exposed all the time. The skin on the shaft of the
penis is left intact. In adults, it is left slightly loose to allow enough skin for erection. The
penis looks different and this may take some getting used to. It takes some months for the
stitch marks to fade completely.
Benefits of circumcision
There is more and more evidence that men who are circumcised have a lower risk of
catching HIV infection. In countries where most men are circumcised, the number of people
with HIV is much lower than in countries where most men are not circumcised. However,
male circumcision gives only partial protection against HIV infection; correct and consistent
use of condoms is the best form of protection. Other ways of reducing the risk of acquiring
HIV infection include not having sex and reducing the number of sexual partners. Sexual
behaviour remains the most important factor in HIV transmission. Avoiding multiple partners
and high-risk sexual behaviour, and always using condoms, reduce substantially the risk of
acquiring or transmitting HIV.
Circumcision also reduces the risk of some other sexually transmitted infections, such as
herpes and genital ulcers.
Sometimes circumcision is performed for medical reasons, such as when the foreskin is too
tight to be pulled back from the glans. After circumcision, it is much easier to wash the head
of the penis and keep it clean.
Problems and complications after the operation
Immediate problems
Some swelling and discomfort can be expected after the operation, but this normally gets
better after the first day or two. No special treatment is needed.
One of the possible complications of circumcision is bleeding or accumulation of blood under
the skin. This is because the skin of the penis is less tight than other parts of the body and
has a very good blood supply. If a large blood clot forms, it is sometimes necessary to
perform another small operation to remove it. If this happens, it may be necessary to stay in
hospital for a few days and rest for a week or two.
The wound can become infected, particularly in men with diabetes. The operation is
performed in sterile conditions, but the penis is in an area that is not as clean as other parts
of the body. The first signs of infection are increasing pain, redness and swelling at the site
of the operation. If this happens, you should return to the clinic for follow-up, as antibiotic
treatment may be needed. Antibiotics are not given routinely and antibiotic ointment should
not be used unless given to you by a nurse or doctor. The actual risk of having a
complication, such as bleeding or infection, is about one for every fifty men who have the
operation.
If you are unable to pass urine or have any difficulty in doing so, you should return to the
clinic for assessment.
Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-20