Circumcision: When It Is Indicated And What Should Patients Expect Today
Pain during sexual intercourse, difficulty retracting the foreskin to expose the glans, recurrent infections, and small fissures in the foreskin. Many men live with these symptoms for years without consulting a specialist.
It is estimated that phimosis and other foreskin-related disorders affect approximately 7% of the male population. In Italy, circumcision in adults is less common than in many other countries. However, when these symptoms begin to affect the quality of life and sexual wellbeing, the issue becomes clinically significant.
We interviewed Dr. Giuseppe La Pera, urologist at UPMC Salvator Mundi International Hospital, to better understand when circumcision may be indicated and how, thanks to advanced surgical technologies and a personalized approach, even complex cases can be treated with less invasive procedures and faster recovery times.
In Italy, circumcision is not as common as it is in other countries. Why is it important to talk about circumcision?
In Italy, this is still a clinically relevant issue for some patients. These mainly consists of men with a genuine medical indication, including phimosis, recurrent infections, chronic inflammatory conditions, lichen sclerosus of the foreskin (a condition that causes loss of elasticity, small fissures, itching, and progressive narrowing of the foreskin), or pain during sexual intercourse.
In these situations, the condition can have a tangible impact on a person’s quality of life. A specialist consult is essential to determine whether circumcision is truly indicated, and identify the most appropriate approach.
At UPMC Salvator Mundi International Hospital, the assessment is tailored to each single patient, including the most complex cases. The surgical technique is selected according to the individual’s anatomy, the presence of scarring, and any associated medical conditions.
What’s the extent of the recovery in terms of time? What can a patient expect in terms of postoperative pain?
These are understandably the most common and important questions patients ask.
With conventional techniques, surgery can cause swelling, tenderness, and variable recovery times. In recent years, for selected patients the circular stapling device has reduced surgical trauma compared with traditional manual techniques, with effective outcomes:
- Reduced intra-operative bleeding
- Less postoperative swelling
- Generally lower levels of postoperative discomfort
- Faster return to normal daily activities
Many patients are able to resume their everyday tasks within a few days. Sexual activity, however, should not be resumed until complete healing, which generally takes around four to five weeks. The surgical wound must be fully healed before the tissues are subjected to the stresses of sexual intercourse. Returning to sexual activity too early may increase the risk of the wound reopening.
So the main advantage is the faster recovery, rather than the duration of the procedure?
Exactly. From the patient’s perspective, the most important aspects are his postoperative comfort, his functional recovery, and the final outcome.
Modern technologies can make the procedure less traumatic in selected cases, but every operation requires an individualized assessment. There is no one-size-fits-all solution.
Is the cosmetic outcome an important issue?
Yes, although this is often discussed discreetly. Circumcision alters the anatomical appearance of the penis, and for many patients cosmetic outcome is an important consideration alongside the clinical benefits.
Modern mechanical techniques generally allow for a more uniform and consistent closure than traditional hand-sewn sutures, resulting in more standardized outcomes. The final result, however, depends on several factors, including individual anatomy, the underlying clinical indication, the healing process, and the used technique.
How do you determine whether a patient is an appropriate candidate or not?
The assessment always begins with a specialist consult. During the assessment, the patient’s clinical condition, his anatomy, associated disorders, personal goals, and the most suitable surgical approach are carefully examined.
In specific cases, such as a severe phimosis, advanced lichen sclerosus, or a significant scarring, an alternative approach may be preferred to the circular stapling device, sometimes involving reconstructive surgery. In more complex cases, a multidisciplinary approach may also be required.
Every recommendation must be tailored to the individual patient: there is no universally appropriate solution.
When is circumcision not recommended?
Over more than forty years of clinical practice, I have occasionally seen patients with a completely normal anatomy requesting circumcision solely because their partner preferred a circumcised penis.
Personally, I do not believe that this alone constitutes a sufficient medical indication. Circumcision should be performed if there is a genuine health-related need or a desire to solve a condition affecting a man’s personal well-being and sexual confidence.
Among younger individuals, phimosis and disorders affecting foreskin retraction can lead to insecurity and difficulties in their relationships. One of my research studies, published on PubMed and conducted on a group of students in Ostia and Ladispoli (near Rome), found that boys with phimosis tended to begin their sexual activity later than their peers without these conditions.
This is why specialist evaluation is essential to determine if there is a real clinical indication and which treatment pathway is most appropriate for each individual case.
Why do so many men delay the procedure, and how can they overcome their fears?
This happens very frequently. Many patients live with the problem for a long time for a variety of reasons: embarrassment about discussing intimate symptoms, fear of pain, concerns about the impact on their sex life, or simply a gradual adjustment to the discomfort. Circumcision involves a part of the body that is highly sensitive, both physically and emotionally, which naturally leads to hesitation.
The first step to overcome fear is to talk with an experienced specialist. Often, fear is driven by uncertainty and by the mixed or incomplete information available online. A specialist consult will help clarify the nature of your problem, whether there is a genuine indication for treatment, which technique is most appropriate, and what can realistically be expected in terms of recovery and healing times.
Many men still associate circumcision with older surgical methods and assume that the procedure is highly traumatic. Understanding that modern surgical approaches are less invasive and better standardized can significantly reduce anxiety.
Most importantly, the aim is not to persuade people to undergo a procedure, but to help them understand which choice is most appropriate for their individual situation.