How painful is adult circumcision? A prospective, observational cohort study

Men are particularly concerned about pain after circumcision. Concerns about pain can be a reason to refuse surgery. We assessed the severity of postoperative pain and investigated factors that may influence postoperative pain.

We performed a prospective, observational cohort study in patients undergoing circumcision. Patients were asked to complete a questionnaire using a visual analog scale for pain (severity range 0 to 10) on days 1 to 3, 7 and 21, and record the analgesia used, complications and time off work. Other data recorded were patient age, clinical indication for surgery, foreskin retractility, presence of adhesions and histology.

Of 211 questionnaires 112 were returned (53.1%). Mean patient age was 46.4 years. The most common clinical indication for circumcision was phimosis (75% of patients). Postoperative pain was scored as mild to moderate, including a mean of 2.4 on days 1 to 3, 2.1 on day 7 and 0.5 on day 21. Patients younger than 35 years (p = 0.025) and patients with wound infection (p = 0.036) had higher pain scores. Only 11 patients (9.8%) had severe pain at any time during recovery, including 8 with wound problems. Average ± SD time off work in the employed population was 6.6 ± 6.5 days, including 5 days for light work and 11 days for heavy physical activity.

Pain is mild to moderate after circumcision in adults under general anesthesia with an intraoperative penile block. Severe pain is rare and mostly related to complications. Younger patients generally have more discomfort.