Circumcision is the surgical removal of the foreskin. It may be considered when a tight foreskin causes pain, makes hygiene difficult or leads to recurrent inflammation. Some men seek medical advice only when the discomfort begins to interfere with erections or sexual activity, or when the foreskin can no longer be pulled back over the head of the penis.
Not every foreskin problem requires surgery. A urologist should first identify the cause and determine whether medication or another conservative treatment may help, or whether circumcision is the more appropriate option.
Republikas laukuma klīnika provides urologist consultations and the necessary clinical assessment. If circumcision is recommended, the operation is performed at another medical facility.
What is circumcision?
Circumcision is an operation in which the foreskin covering the head of the penis is removed completely or partially. Following a full circumcision, the head of the penis remains exposed, including when the penis is not erect.
The procedure may be carried out for medical, personal, religious or cultural reasons. This article focuses primarily on circumcision in adult men for medical reasons.
When might circumcision be necessary?
The most common medical reason is phimosis — a tight foreskin that cannot be pulled back freely over the head of the penis. In adults, phimosis may result from scarring, recurrent inflammation, tissue injury or a skin condition such as lichen sclerosus.
A urologist may recommend circumcision when there is:
- a tight or scarred foreskin;
- pain during an erection or sexual intercourse;
- recurrent inflammation of the glans or foreskin;
- cracking, bleeding or scarring of the foreskin;
- difficulty maintaining intimate hygiene;
- difficulty urinating because of severe narrowing;
- recurrent paraphimosis;
- no adequate improvement with conservative treatment.
When inflammation recurs, the doctor may also need to assess the patient for infection, diabetes or a dermatological condition.
What is phimosis?
Phimosis means that the foreskin opening is too narrow for the foreskin to be fully retracted. It may cause tightness, pain, cracking, inflammation or discomfort during sexual activity.
In young children, the foreskin often cannot yet be fully retracted, and this does not necessarily indicate a medical problem. It should never be forced back, as this may cause tearing and scarring. A new or progressively tighter foreskin in an adult should be assessed by a doctor.
In milder cases, a urologist may recommend topical treatment, including a corticosteroid cream. Surgery may be needed when the foreskin is significantly scarred, symptoms recur or conservative treatment is unsuccessful.
Paraphimosis – when is urgent treatment needed?
Paraphimosis occurs when a tight foreskin has been pulled back, becomes trapped behind the head of the penis and cannot be returned to its normal position. The glans may become painful and swollen, and the constricting foreskin may impair blood flow.
This is not a condition that should wait for a routine appointment. Urgent medical care is required, particularly if swelling or pain increases or the colour of the tissue changes.
Is full circumcision always necessary?
Treatment depends on the cause and severity of the condition. Medication may be effective for some patients. In selected cases, foreskin-preserving surgery may be considered. A frenuloplasty may be suitable when a short frenulum is the main cause of the problem.
When the foreskin is severely scarred or lichen sclerosus is present, full circumcision is often a more appropriate and durable treatment. The urologist recommends an individual approach after examination and discussion with the patient.
How should I prepare for a urologist consultation?
The urologist will ask about the symptoms, how long they have been present, previous inflammation, pain during erections or intercourse and any treatments already tried. The foreskin and glans are examined for narrowing, scarring and signs of inflammation.
Before the consultation, it is helpful to consider:
- when the symptoms first appeared;
- whether they are getting worse;
- whether you have previously had inflammation or infections;
- which creams or medicines you have already used;
- whether you have diabetes, a bleeding disorder or another chronic condition;
- which medicines you take regularly, especially blood-thinning medication.
Dr. Kārlis Kaufmanis
Dr. Ērika Bitiņa-Barlote
If surgery is recommended, the patient is informed about the procedure, anaesthesia options, any necessary tests and the expected recovery period.
How is circumcision performed?
Circumcision is usually performed under local or general anaesthesia. The choice depends on the patient’s health, the extent of surgery, the medical facility’s clinical arrangements and the patient’s individual needs.
During the operation, the surgeon removes the required amount of foreskin, controls bleeding and closes the wound edges. Absorbable stitches are commonly used and do not usually need to be removed. Many patients can leave the medical facility on the same day, although the exact arrangements are determined by the operating team.
Before surgery, the expected benefits, alternatives and possible risks are explained. If general anaesthesia is planned, the patient must follow the facility’s instructions regarding fasting, drinking and regular medication.
Recovery after circumcision
Swelling, bruising, tenderness and a small amount of blood or wound discharge may occur during the first few days. The glans may initially be particularly sensitive to touch and clothing. These sensations usually settle gradually.
Initial wound healing often takes at least 10 days, although swelling and sensitivity may remain for several weeks. Some patients return to work after approximately one week, depending on the physical demands of their job and their doctor’s advice.
Patients are generally advised to:
- follow the operating team’s wound-care and washing instructions;
- wear comfortable underwear that limits unnecessary friction;
- use only the recommended pain relief;
- temporarily avoid sport, cycling and strenuous physical activity;
- avoid sexual intercourse and masturbation for at least four weeks, or for as long as instructed;
- attend a follow-up appointment if one has been arranged.
Night-time erections may cause pulling or discomfort. Severe pain or bleeding should be reported to the medical facility where the operation was performed.
Possible risks of circumcision
Circumcision is a surgical procedure and, like any operation, has potential complications. These may include:
- bleeding;
- wound infection;
- marked or prolonged swelling;
- pain;
- delayed or impaired wound healing;
- scar changes or an unsatisfactory cosmetic result;
- changes in sensitivity of the glans;
- rarely, the need for further surgical correction.
Individual risk depends on general health, medication, the presence of inflammation and the type of surgery. These factors are discussed before the procedure.
When should I seek help after the operation?
Contact the treating medical facility if:
- bleeding does not stop or becomes heavier;
- pain is getting worse and is not controlled by the recommended medication;
- you develop a fever;
- the wound becomes increasingly red or hot, or produces pus;
- swelling increases rapidly;
- urination becomes difficult or impossible;
- the colour of the glans changes.
Heavy bleeding, inability to urinate or signs of impaired blood flow require urgent medical attention.
Does circumcision affect sexual function?
Sexual activity can usually be resumed after complete healing. Sensations may initially feel different because the glans is no longer covered by the foreskin and must adapt to regular contact with clothing.
When intercourse was painful before surgery because of phimosis, cracking or recurrent inflammation, treating the underlying problem may improve comfort. Individual experiences vary, however, so the expected result should be discussed with the urologist before surgery.
Urologist consultation before circumcision in central Riga
If you cannot fully retract the foreskin, experience pain during erections, have recurrent inflammation or suspect phimosis, book an appointment with a urologist in Riga.
At Republikas laukuma klīnika, the urologist will assess your symptoms, perform an examination and explain the appropriate treatment options. If circumcision is required, the operation is performed at another medical facility. The location, preparation, type of anaesthesia and postoperative care are confirmed individually.
To book a consultation, call 28002363. The clinic is located at Republikas laukums 3-18, Riga, on the first floor of Centra nams; the entrance is on the side facing the Ministry of Agriculture.
Frequently asked questions
Is circumcision painful?
The operation is performed under anaesthesia, so pain should not be felt during the procedure. Pain and tenderness may occur after the anaesthetic wears off and can usually be controlled with the recommended pain medication.
Can phimosis be treated without surgery?
In some cases, a prescribed topical corticosteroid cream or other treatment directed at the underlying cause may help. Surgery may be required if the foreskin is significantly scarred or symptoms persist.
What type of anaesthesia is used?
Circumcision may be performed under local or general anaesthesia. The doctor and anaesthetist select the appropriate option according to the patient’s health and the circumstances of surgery.
How long should I avoid sexual activity?
Patients are generally advised to avoid intercourse and masturbation for at least four weeks. Sexual activity should resume only after the wound has healed and in accordance with the operating doctor’s advice.
Do the stitches need to be removed?
Absorbable stitches are commonly used and gradually dissolve. The operating doctor will confirm this because the type of suture material can vary.
Where is the circumcision operation performed?
The urologist consultation and assessment of medical indications take place at Republikas laukuma klīnika. If surgery is recommended, circumcision is performed at another medical facility.
