Historically it has often been undertaken for entirely non-medical reasons.
Thus in some cultures it is routinely performed early in life as a religious requirement, or as a social custom on grounds of hygiene, or even deferred until adolescence as a ritual rite of passage into manhood.
It is a tribute to the healing ability of the penile tissues that the majority of circumcisions have a reasonable outcome, despite being undertaken by inexperienced surgeons or with crude operative technique and overly thick suture materials.
Nevertheless, complications do commonly occur, and we often see and treat patients who are unhappy with the results of both childhood and adult circumcisions.
Circumcision is typically regarded as an ‘all-or-nothing’ procedure, and commonly used techniques often lead to over-radical excision of skin and may risk damaging the glans.
Even when functionally satisfactory, skin may have been removed in an untidy and asymmetrical fashion leaving disfiguring irregularities and ugly stitch marks that may become a significant social embarrassment.
As a specialist GU reconstructive surgery centre, part of our repertoire is to revise and refine the unsatisfactory results of circumcisions performed elsewhere.
However we recognize the virtue of ‘getting it right’ in the first place, and so increasingly we are undertaking primary circumcisions whether for clinical or other reasons.
Circumcision does not necessarily have to be an ‘all or nothing’ choice, because in some situations a more conservative foreskin shortening procedure or maybe just release of a tight frenulum may be more appropriate.
We take the time to discuss these options so as to individualise the optimum solution for each patient.
Many young boys in the first few years of life have a tight or non-retractile foreskin that is a normal part of development, and this feature will often resolve with time.
When there is no obvious disease process present, we may therefore suggest in the first instance trying conservative management with a strong steroid cream for a couple of months, as quite a high proportion of foreskins will loosen and become normally retractable with such treatment.
However, in those cases where circumcision is indicated or desired, it is usually undertaken as a day-case procedure under a full general anaesthetic.
Whilst many surgeons also routinely use GA for adults, we find that a combination of a long acting local anaesthetic together with intravenous sedation usually provides a better patient experience, with a quick and uneventful recovery.
This option is more often preferred by our adult patients.