Men, Mind the Instructions for Adult Circumcision Aftercare
Male circumcision is among the first surgical procedures ever developed by humans, and it remains one of the most common. Estimates put the global rate of circumcision—the removal of the foreskin that covers the head, or glans, of the penis—at about 38 percent.
The prevalence of circumcision varies wildly by country and culture. An estimated 90 percent of males in Israel are circumcised. The tally is at least 86 percent in Muslim-majority countries. The current estimate for the United States shows about 71 percent of males are circumcised. So circumcision aftercare is an important topic.
By contrast, only about 20.7 percent of penises in the United Kingdom are without foreskin. And the rate is barely measurable at 0.1 percent in countries such as Belize and Armenia.
Culture and geography have always played a role in the circumcision decision, but today, people from all backgrounds decide to have their child or themselves circumcised—or not—even if it bucks their cultural traditions.
Plus, there is evidence that circumcision reduces the chances of men contracting HIV and other sexually transmitted infections (STIs), leading many people in higher-risk countries to opt for the procedure as adults.
Overall, there's a lot of people—adults and parents of infants—who need to know about circumcision aftercare.
What happens after the procedure?
Depending on your preferences and what you work out with your surgeon and anesthesiologist, you may be given a general anesthetic or put into a deep twilight state of sedation for the procedure. Either way, you'll likely be given a local anesthetic injection.
Circumcisions on infants usually take less than 30 minutes—more like 10 to 15 minutes for a skilled surgeon. For older teens and adults who require more stitches, it may take about 30 to 45 minutes.
Most medical professionals who offer circumcisions use sutures to close the incision, typically with a minimum of four stitches for infants and more for adults and teens.
"In kids, we use pretty rapidly absorbable sutures, and I just use surgical glue over that," said Amanda North, M.D., the director of urology at the Children's Hospital at Montefiore in the Bronx, New York. "I use the sutures to reapproximate the skin edges, then the glue to seal it. I find the sutures provide a little bit of hemostasis; they help prevent bleeding. Part of my criteria for how many stitches to put in is if the kid is bleeding at the end, I'll put a couple of extras in."
Adults and older children who get circumcisions can expect to have more sutures. They may wake up with their penis wrapped in a colorful tube of Coban bandage, which will hold everything in place for the first couple of days.
"In older patients where bleeding is more of a problem and they're going to get erections, you're probably going to put a lot more stitches in to make sure things don't fall apart afterward," North said. "And we usually use a compression bandage in the bigger kids because, with those erections, we don't want the stitches to come out. Coban looks a little like an Ace bandage but stretchy."
Circumcision aftercare for adults
North advises her patients to remove the bandages after about 48 hours. That's long enough for the incision to have closed, even if it isn't completely healed.
"I was trained that your skin is sealed—not healed, but sealed—within 48 hours," North said. "So I have people take their dressings off in 48 hours and take a shower. I even tell the patients if the dressing gets a little bit stuck to hop in the shower and let it get really wet to take it off after that 48 hours."
In North's practice, it's standard to slather a layer of bacitracin or other antibiotic gel on the affected area after the surgery, before applying the gauze wrapping. North counsels her patients to continue using antibiotic gel or petroleum jelly for several days after the gauze comes off to protect the healing area and keep the sensitive, newly exposed penis head from rubbing against anything.
"In the OR, we use bacitracin, but I tell parents it doesn't have to be an antibiotic ointment," North said. "It could just be Vaseline or something like that. The idea is to provide a barrier between the penis and the diaper or the underwear. A lot of teenage boys who have not been able to pull back their foreskin find that the head of the penis is very, very sensitive after the circumcision. That can be an even bigger complaint than the incisional pain."
Sexual health effects of circumcision
It's well-documented that circumcision reduces the risks of contracting HIV and other STIs. A 2006 study overseen by the National Institute of Allergy and Infectious Diseases found HIV rates among men in Uganda and Kenya who had undergone adult circumcision were reduced by 48 percent and 53 percent, respectively, compared with uncircumcised men.
A 2019 systematic review of 81 relevant papers found being circumcised helps men who have sex with women protect their female partners from getting STIs, including human papillomavirus (HPV), which is a primary cause of cervical cancer.
When considering how soon you can use your newly unsheathed penis for intercourse or other sexual activity following a circumcision, North advised caution for at least several weeks.
If there is an open wound on the penis, any intimate activity puts you at risk of infection.
"Some people say four weeks. I tell the teenagers six to eight weeks in the hopes that they'll wait four weeks," North said. "My rule of thumb is that if your sutures have dissolved, you're probably OK. You want the incision closed."
The need to wait is not only a matter of tearing open a not-quite-healed incision due to friction and overexuberance. If there is an open wound on the penis, any intimate activity—or contact with anything, really—puts you at risk of infection.
"We don't like to think about it, but any place you're going to be putting your penis in a sexual encounter is filled with bacteria," North said. "We had a teenager not too long ago who had a terrible infection from not heeding the surgeon's advice. He didn't end up needing skin grafts, but it was touch and go. And I am 100 percent certain he had sex within a week of his circumcision."
Listening to your surgeon is the lesson here. Circumcision aftercare for adults isn't that difficult, but it does include the extra precaution against having sex too soon.
Circumcisions are common and relatively low risk, and recovery is generally pretty easy. Whether a person decides to get their child circumcised or to get it done as an adult, there's little, apart from personal taste, to recommend against it.