Problems affecting the foreskin, penis or scrotum can be uncomfortable, embarrassing or disruptive to everyday life.
Some conditions can be managed without surgery, while others may require a straightforward surgical procedure.
As a Consultant Urological Surgeon, I provide private assessment and treatment for a range of foreskin, penile and scrotal conditions in Wrexham, Chester and Shrewsbury.
Circumcision is a surgical procedure to remove the foreskin covering the head of the penis.
In adults, circumcision is most commonly performed for medical reasons when other treatments have not been successful or when circumcision provides the most appropriate treatment.
Common medical reasons include:
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Tight foreskin (phimosis)
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Recurrent balanitis or balanoposthitis
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Scarring of the foreskin
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Lichen sclerosus / balanitis xerotica obliterans (BXO)
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Difficulty retracting the foreskin
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Painful erections caused by foreskin tightness
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Recurrent problems associated with the foreskin
Circumcision can also form part of treatment for certain penile conditions, including some penile cancers.
Phimosis occurs when the foreskin is too tight to retract comfortably over the head of the penis.
In adults, this can cause:
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Pain during erections
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Difficulty cleaning beneath the foreskin
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Recurrent infections
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Difficulty passing urine
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Bleeding or cracking of the foreskin
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Discomfort during sexual activity
Treatment depends on the cause and severity.
In some cases, conservative treatment may be appropriate. If significant scarring or persistent tightness is present, circumcision may be recommended.
Balanitis is inflammation of the head of the penis.
When the foreskin is also affected, the condition may be described as balanoposthitis.
Symptoms can include:
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Redness
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Irritation
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Swelling
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Itching
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Pain
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Discharge
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Difficulty retracting the foreskin
Recurrent episodes may sometimes be associated with underlying conditions such as diabetes, skin disease or a tight foreskin.
Treatment depends on the underlying cause.
Lichen sclerosus is a chronic inflammatory skin condition that can affect the foreskin and penis.
It may cause:
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White or pale areas of skin
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Scarring
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Tightening of the foreskin
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Cracking or discomfort
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Difficulty retracting the foreskin
If scarring becomes significant, circumcision may be required.
Adult circumcision is usually performed as a day-case procedure.
The foreskin is removed and the remaining skin is carefully sutured beneath the head of the penis, usually using dissolvable stitches.
The procedure is generally performed under anaesthesia, with the most appropriate anaesthetic discussed before surgery.
Some swelling, bruising and sensitivity are expected following circumcision.
The penis generally takes several weeks to heal fully. NHS guidance advises that healing commonly takes around 4 to 6 weeks, although recovery varies between individuals.
You will receive specific advice about:
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Wound care
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Washing
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Pain relief
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Exercise
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Driving
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Returning to work
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Sexual activity
Sexual activity should be avoided until the wound has healed sufficiently, according to the post-operative advice provided.
As with any surgical procedure, circumcision carries potential risks.
These include:
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Bleeding
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Infection
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Swelling
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Wound problems
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Altered sensitivity
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Cosmetic dissatisfaction
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Persistent discomfort
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The need for further treatment
Rare complications can include narrowing or injury of the urethra.
These risks will be discussed with you before surgery.
The scrotum contains the testicles, epididymis and spermatic cord.
A lump or swelling in the scrotum can have many different causes. Most are benign, but a new testicular lump should always be assessed appropriately.
Scrotal surgery may be considered for a range of conditions including:
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Epididymal cysts
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Spermatocele
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Hydrocele
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Selected benign scrotal lumps
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Symptomatic scrotal conditions
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Other conditions requiring surgical assessment
An epididymal cyst is a fluid-filled cyst arising from the epididymis, the structure located behind the testicle.
A spermatocele is a cystic swelling that may contain sperm.
They are usually benign and may not require treatment.
Surgery may be considered if the swelling becomes:
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Large
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Uncomfortable
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Persistent
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Troublesome during exercise or daily activities
A hydrocele is a collection of fluid around the testicle that causes swelling of the scrotum.
Hydroceles can vary considerably in size.
They are usually benign but may become uncomfortable, heavy or cosmetically troublesome.
Where treatment is required, hydrocele surgery (hydrocelectomy) involves removing or modifying the sac containing the excess fluid to reduce the likelihood of recurrence.
During your consultation, I will establish:
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How long the lump or swelling has been present
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Whether it is increasing in size
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Whether it causes pain or discomfort
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Whether there has been previous surgery or trauma
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Whether you have any fertility concerns
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Whether the testicle itself feels normal
If appropriate, a scrotal ultrasound may be arranged before deciding whether surgery is required.
The aim is to establish the diagnosis before recommending an operation.
Recovery depends on the procedure performed.
You can expect some degree of:
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Swelling
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Bruising
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Tenderness
Supportive underwear and appropriate pain relief can help during the early recovery period.
You will receive individual advice about returning to work, exercise, driving and sexual activity.