Usually, circumcision is a day-care procedure and is carried out as an outpatient procedure. The surgery usually takes around five to ten minutes. Circumcision can be carried out by one of the following methods, depending on your case:

Conventional techniques:

• Dorsal slit technique: This technique prevents both phimosis and paraphimosis. In this procedure, the foreskin is separated from the head of the penis. With the help of forceps (a surgical instrument for holding something in place), both layers of the foreskin are cut off a few mm from the head of the penis.
• Sleeve technique: In this procedure, the foreskin is retracted over the head of the penis, and a circumferential incision is made, usually distal to the corona (the proximal portion of the glans of the penis).
• Forceps-guided method: In this method, the foreskin is separated and pulled out in front of the glans.

Modern techniques:

• Stapler circumcision: In this process, circumcision is performed using a circular stapling device. It is bloodless and the most efficient technique.
• Laser circumcision: In this procedure, a laser is used to conduct the circumcision, as the laser has many advantages with regard to precision and sealing of cut surfaces.

What to Plan Before Surgery? 

A few days before surgery, your surgeon will schedule an appointment with you for the following:

• A complete physical check-up that also includes details about your medical history.
• The surgeon will explain the circumcision procedure and the benefits and risks of performing the surgery.
• If you use blood-thinning medications (e.g., aspirin), you will need to stop taking those a few days before surgery.
• The patient or his/her relative will be asked to sign a consent form
• They will also discuss the medications you currently use. Do not forget to carry your routine medications during the pre-operative appointment.
• Diet Before Surgery:

• Avoid eating food or drinking fluids after midnight or six hours before surgery. This also applies to children undergoing the surgery.
• If your newborn is scheduled for circumcision, you should feed them formula six hours or breast milk four hours before surgery.
• If a child older than one year is scheduled for circumcision, do not feed them solid foods (including chewing gum and candy) or liquids (e.g., milk, fruit juice, and formula) after midnight.
• Children (including infants) should have only clear liquids (water, apple juice, grape juice) up to two hours before surgery.

On the Day of Surgery?

Once you or your child arrive at the hospital on the day of surgery, the healthcare staff will direct the next procedures:

• The patient will be requested to remove any jewellery, contact lenses, or objects on your body.
• They will ask you to remove your clothes and change them into a hospital gown.
• The healthcare staff will provide you with an identification bracelet.
• They will record your blood pressure, pulse rate, and blood pressure & move you to the operating room.

What to Expect During Surgery?

You can expect the following:

• The anaesthesiologist will either administer general anaesthesia, which will ensure that you are asleep throughout the procedure, or local anaesthesia, which will numb your penis and the area surrounding it without making you unconscious.
• Alternatively, you could be injected with a spinal anaesthetic that ensures you do not feel anything below your waistline.
• After the surgery, your surgeon may use vaseline (petroleum jelly) along with an uncontaminated piece of gauze to cover your surgical site.

What to Expect After Surgery?

At the Hospital:

• After the successful completion of the circumcision, you will be transferred to a recovery room for observation.
• Vital signs will be monitored (breathing, blood pressure, and pulse rate) and check your wound dressing. 
• The penis will look sore and swollen, but this will resolve within seven days post-surgery.
• You will need to ask your friend or family member to drive you home after discharge.

At Home:

• You can have a bath 24 hours after the circumcision procedure. You should avoid using a hot tub or swimming pool for 14 days post-surgery.
• In case you have a dressing, you should keep the dressing for two to three days post-surgery or as recommended by your surgeon.
• Keep yourself well hydrated in the first 24 hours after surgery.
• Apply an ice pack intermittently to the surgical site, for about 20 minutes at a time, on the first day after surgery.
• It may take around seven to ten days for your penis to recover. So, you will need to take bed rest for that period.
• Avoid activities that can damage your wound, e.g., cycling, swimming, weight lifting, or other sports.
• Avoid sexual activity for at least a month after your surgery.
• Wear loose-fitting and comfortable clothes for two to three days after surgery to prevent irritation of the penis.
• Clean the tip of your penis at least once daily using water.
• Apply vaseline to the tip of your penis. This will prevent your penis from sticking to your underwear.

Medications: 

• For three or four days after circumcision, you are likely to experience discomfort and swelling near the head of your penis. For this, your surgeon will recommend painkillers.

Myths & Facts

Myth: This surgery will cause sexual dysfunction in men.

Fact: This is not true. Circumcision does not cause sexual dysfunction.

Why Is Circumcision Done?

Circumcision is generally carried out for either medical or non-medical reasons. 

Medical indications:

• A tight foreskin that cannot be pulled back/retracted (phimosis). It is usually caused by a bacterial/fungal infection or high blood sugar levels due to diabetes.
• Recurrent balanitis (a condition where the glans of the penis is red, sore, and swollen). A condition called balanitis xerotica obliterans further leads to phimosis. In a few scenarios, balanitis xerotica obliterans can also cause the head of the penis to become inflamed and scarred.
• Inflammation of the prepuce causes pain and swelling of the foreskin of the penis (balanoposthitis).
• A condition in which the prepuce of your penis can be retracted (pulled back) but cannot be moved back to its original position (paraphimosis). This condition causes the head of the penis to become tender and swollen.
• A reddish patch, ulcer, or growth is seen on the tip of the penis or below the prepuce (cancer of the penis).

In such medical conditions, your surgeon will only recommend circumcision if other treatments do not work.

Non-medical indications:

Circumcision is done in newborn or older children as a part of religious practices in the Jewish, African, and Islamic communities. In such a case, your surgeon makes sure that you know the risks and complications associated with circumcision.

Circumcision is not recommended in a newborn in the following circumstances:

• The age of the newborn is less than 12-24 hours
• Presence of an illness that requires monitoring by the healthcare staff
• Bleeding disorder (haemophilia and thrombocytopenia) or skin disorders that can affect normal healing
• Hypospadias (urethral opening is on the underside of the penis)
• When the penis is twisted (chordee)
• Abnormal development of the penis (penile torsion)
• Webbed penis
• When the penis is of normal size but is hidden under the skin of the abdomen, scrotum (a sac behind the penis that holds the male reproductive organs), or thigh (buried penis)
• When the passage through which urine passes through the body is underdeveloped (urethral hypoplasia)
• A rare birth defect called epispadias is located at the opening of the urethra (a passage through which urine is passed to the exterior of our body), in which urine is removed by the body not from the urethra but from an abnormal location.

When to See a Doctor?

Cultural practices:

• Some cultures practise circumcision as a tradition, although it is not required.
• If you are pregnant and wish to get your baby circumcised, you can visit your urologist before your baby is born.
• You should discuss with your urologist in advance as circumcision is carried out within 24-48 hours after birth.

Medical conditions: You should visit your doctor if you or your child have any of the following problems:

• A tight foreskin, which is difficult to pull back from the head of your penis
• Swollen penis
• Unable to return the foreskin to its original place after pulling back
• A red patch or ulcer on the foreskin

Your doctor will examine your penis and check if you need circumcision. 

What to Expect If You Delay Surgery?

For non-medical reasons, delayed circumcision does not have any negative consequences. However, in case of medical reasons, delayed circumcision can lead to progression of the underlying conditions, like:

• Untreated balanitis can lead to chronic (extended) inflammation (redness, soreness, and pain).
• Similarly, long-standing phimosis can lead to permanent scarring, causing the constriction of your foreskin. It may also lead to dyspareunia (painful intercourse) in patients with diabetes.