Circumcision Information Brochure

What is a Circumcision?
There are various reasons for a circumcision. The most common reason is when the foreskin is narrowed (phimosis) and can no longer be pulled back over the glans. This can cause several problems, such as difficulty urinating, pain during an erection and sexual intercourse, or inflammation of the glans or foreskin.

In Brief
During a circumcision, the foreskin of the penis is fully or partially removed.

• The procedure is outpatient; you will not be admitted to our clinic.
• If you use blood thinners, please notify us.
• You will receive a local anesthetic.
• The surgery takes about 30 minutes. After the procedure, you will have some stitches.
• You are not allowed to drive yourself home after the procedure. Someone must pick you up.
• For residual pain, you may take paracetamol.
• Once you are back home, follow the advice in this brochure.
• If there are any problems after the surgery, please call Plastic Surgery at Haaglanden Clinics.

Preparation for Surgery
Before undergoing surgery, there are a few things you need to arrange:

• Arrange for someone to take you home. You can go home immediately after the procedure, but you are not allowed to participate in traffic yourself.
• Bring tight-fitting underwear or swimming trunks with you.
• Do not drink alcohol for 24 hours before the surgery. Alcohol acts as a blood thinner and can cause complications during the procedure.
• We advise you to stop smoking at least 2 weeks before the surgery and during the healing process. Smoking delays wound healing.

Medication
If you use blood-thinning medication (such as Marcoumar, Sinaspril, Sintrom, Ascal, or Apixaban), we request that you report this during your first intake consultation with the plastic surgeon. You will receive instructions from the plastic surgeon regarding the use of blood-thinning medication prior to the procedure.

On the day of surgery, you can start taking the painkiller paracetamol. You may take 1000 mg four times a day. Do not use Aspirin or Naprosyne, as these thin the blood.

Surgery
The procedure takes place in one of the treatment rooms. You can eat and drink normally beforehand. The circumcision is performed under local anesthesia, meaning you will be awake during the procedure.

The penis is disinfected, and the area is covered steriley. Next, you will receive the local anesthetic: a penile block at the base of the penis and, if necessary, additional circular anesthesia. This means you will receive an injection at the base of the penis, making it numb.

The plastic surgeon removes the foreskin, and the skin of the penis is reattached just below the edge of the glans using a number of dissolvable stitches. Afterward, the penis is dressed with gauze and ointment. You should wear the penis pointing upward after the surgery; therefore, tight underwear or boxer briefs are recommended. The stitches are dissolvable, meaning they disappear on their own and do not need to be removed later. The procedure takes about 30 minutes.

After Surgery
After the surgery, you will go home.

• You cannot drive yourself, so make sure someone picks you up.
• The anesthesia will wear off after about 2 hours, and sensation in the penis will return.
• You may experience some residual pain after the surgery. If necessary, you can take paracetamol, up to a maximum of 4 x 2 tablets of 500 mg per day.
• After the procedure, wear the penis pointing upward to reduce the chance of swelling.
• The glans will be uncovered after surgery, which may feel sensitive for the first few days.
• The glans may be red and swollen for a few days after the procedure.
• This sensitivity can last for several weeks and will decrease over time.
• You are allowed to shower normally. While showering, you should pull back any remaining foreskin (in case of a partial circumcision) and clean the wound thoroughly. Do not use soap.
• Keep the wound clean and dry.
• Apply Vaseline to the wound area twice a day.
• Sports or cycling are not recommended for the first week after the procedure. It is advised to wait 6 weeks before resuming sexual intercourse.
• Do not take a bath or go swimming for the first 2 weeks.
• You will receive an appointment for a check-up at Haaglanden Clinics. This will be approximately 2 weeks after the surgery.

Risks and Complications
Fortunately, complications with this surgery are very rare, but they cannot be ruled out.

• The surgery can cause post-operative bleeding at the wound site.
• The wound may also heal poorly, which can lead to a wound infection.
• If you develop a fever (above 38°C), please contact Haaglanden Clinics immediately.

Questions and Availability
For questions, all physical complaints, or if you feel something is not right, please contact Haaglanden Clinics at telephone number 070-221 21 21.

In case of an emergency or urgent complaints outside the opening hours of Haaglanden Clinics, please call the Emergency Department (Spoedeisende Hulp) of the Haaglanden Medisch Centrum at telephone number 088-979 23 80.

Please clearly state that you have been treated by a plastic surgeon from Haaglanden Clinics and that there are agreements in place for your aftercare to be handled by the HMC.