Manual for Male Circumcision under Local Anaesthesia

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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
Male circumcision under local anaesthesia Version 3.1 (Dec09) Most men get erections during the night while sleeping. If this occurs after the circumcision operation, you may experience some minor discomfort because of pulling on the stitches. This is nothing to worry about. Other complications Occasionally the head of the penis may remain very sensitive after the operation. This increased sensitivity will become less over the first few weeks, as the skin of the glans becomes slightly thicker. Instructions to follow before the operation Please bring a pair of well-fitting clean underpants to wear after the operation. They will hold the wound dressing in place for the first day or two. A day or two after the operation, once the dressing has been removed, it is better to wear loose underwear. On the morning of the operation, wash the genital area and the penis carefully with water and mild soap, giving special attention to the area under the foreskin. If you have long pubic hair, it is a good idea to clip this with scissors before the operation, so that it does not interfere with the dressing that will be put on after the circumcision. There is no need to shave your pubic hair in advance of the operation. You will be more comfortable if you empty your bladder before the operation. Instructions to follow after the operation In the first three days after the operation, it is helpful to avoid strenuous physical activity and rest at home. Lying on your back means that the penis is the highest point in your body and this takes the pressure off the area. However, you should also walk about regularly, for example to get meals or visit the toilet. You should not ride a bicycle for the first five days after the operation. Keep the area of the operation dry for 24 hours. Keep the area clean. Do not use any antiseptic cream, ointment or any other substance. If clean water is available, wash carefully twice a day in a shower or sitz bath (a warm-water bath taken in the sitting position, in which the hips and buttocks are in the water). Do not remove the bandage until told to do so by the clinic staff. The circumcision wound is closed with absorbable stitches. These dissolve by themselves and it is not necessary to return to the clinic to have them removed. You should return to the clinic if any of the following occurs: • Continued bleeding from the wound. • Formation of a large blood clot under the skin near the site of the operation. • Pain (you will feel some pain when the local anaesthetic wears off, but this should diminish after the first few hours. However, if the pain comes back, return to the clinic). • Swelling (after the procedure some swelling is normal and return to normal over the first few days. If the swelling gets worse, return to the clinic). • Discharge of fluid or pus; this may indicate infection. Avoid any sport or other strenuous activity for 4–6 weeks. The healing process will be well advanced after 7 days, but it takes 4–6 weeks for the wound to become strong. Full healing Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-21
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Manual for Male Circumcision under Local Anaesthesia

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