When Paul* went for his circumcision during the Covid summer of 2020, his mum drove him to the hospital. “Imagine being 21 and your mum dropping you off to have an operation on your penis,” he recalls. “You feel like a kid. It’s not a stereotypically masculine thing to have done.”

Thousands of men get circumcised every year. Some do it because they’ve converted to a new religion. Others for aesthetic preference, though these are rare and are not covered on the NHS. Most adult circumcisions in Britain, however, are carried out for medical reasons, namely phimosis: a tight foreskin that cannot fully retract. This can lead to hygiene issues, but also pain during sex and, for a lot of men, anxiety around intimacy altogether. 

Craig*, a 23-year-old student who has a tight foreskin, is considering getting circumcised. “As a gay guy, I'm always worried men will think my penis is unhygienic and get grossed out by it,” he says. “Most are OK but a lot ask me really uncomfortable questions about my hygiene. I can pull it back to wash but it hurts.”

GP guidance in the UK states men must have tried an alternative treatment, for example steroid cream, before being referred to an NHS consultant urologist. Yet many men are frustrated when alternative treatments don’t provide long-term solutions, and are confronted with the question of whether or not to undergo surgery.

Mr Aditya Manjunath, Consultant Urological Surgeon, performs around 70 circumcisions a year, making it by far his most common procedure. For men under 40, the majority of cases are due to physiological phimosis. “Most younger men who see me are at the age where they're becoming sexually active and the foreskin is becoming a problem for them,” he says. “Before that, men often don't realise that there’s an issue at all. It only becomes an issue as they've become sexually active, and they are finding sex painful or their foreskin tears or bleeds during sex.”

Craig realised something wasn’t right when, at 14, he started being intimate with other guys and realised that their penises were different. “We tried pulling the foreskin back and I just winced in pain as it wouldn't move down.” Paul, now 27, likewise didn’t realise there was an issue until he was a teenager. “Before then, the only penis you know is your own. But then you're exposed to other penises, you're exposed to porn, and that’s when I realised ‘oh, mine doesn't look the same as theirs.’” 

For lots of men with phimosis, masturbation is fine. The problems start when they want to be intimate with another person. Sexual anxiety lives in the mind as much as the body, and for many men with tight foreskins, sex is very often entwined with fear. “I'm honestly terrified of any intimacy,” Craig admits. “The idea of topping during sex scares the shit out of me as I'm worried my foreskin’s going to rip. So I just don't have a sex life.”

When sex does happen, it can often lead to frustration, discomfort and embarrassment. Paul recalls one such incident from before his circumcision. “She couldn't understand why it wasn't working,” he remembers. “I was getting flustered. I thought, ‘oral sex shouldn't be painful.’”

Over time, these experiences can lead to deep-seated feelings of inadequacy. “There have been a few instances where I’ve felt quite a lot of shame because I wasn’t performing the way you're supposed to,” Paul says. “You do feel like there's something wrong with you. I guess there is something physically wrong. But it’s more than that. I think there's a lot of medicalised shame in general, but particularly with your genitals. It's not something you talk to your mates about.”

Circumcisions typically take 45 minutes to an hour to perform, and can be done with either local or general anaesthetic. Paul’s anaesthetic started to wear off as his mum was driving him home. That’s when the pain started. “During those initial days, it was some of the worst pain I've ever felt in my life,” Paul recalls. 

Those first few hours after the operation tend to be particularly unsettling. Stephen, 26, took the train home after his recent circumcision. “During the journey I had some significant bleeding which I didn't find out about until I got home,” he says. “Removing my underwear to a pool of blood was not fun.”

Pain and discomfort immediately following a circumcision are near universal. “I tell patients the first two weeks are challenging,” Mr Manjunath explains. “Your penis is going to be swollen, it may be bruised and it’s likely to be very sensitive, particularly the head (glans) of the penis. A lot of men think, you're in, you're out, you're back to normal the next day, which is not the case at all. You shouldn't really expect to be able to do very much at all for the first two weeks."

Erections are something to be feared during the recovery process. “As a young man, you often wake up with an erection and it's incredibly painful,” says Paul. Nighttime erections are “hell on earth,” echoes Stephen, who is in recovery. “It's agony. It’s also very emotionally draining as you don’t get much sleep and when you do there’s the fear you’re going to wake up in pain. But I have to keep reminding myself it’s for the greater good.”

Many men initially experience regret in the immediate aftermath of the operation. “I remember looking at my penis afterwards and it was all purple and bloody,” Paul says. “It looked horrible. And then you start thinking, ‘Oh my God, I've ruined my dick!’. But that only lasted a couple of weeks.”

Mr Manjunath emphasises that, once the stitches dissolve, the recovery process is usually pretty swift. “I try to see men six weeks after their operation if they need a follow-up and by then the vast majority are back to all the normal activities, including sexual activity.”

A huge fear among many men thinking about the procedure is that they will lose sensitivity in the penis, thereby losing sexual pleasure. The NHS page on circumcision states that the procedure “usually leads to loss of sensitivity of the head of your penis, which may be noticeable during sex” and adds that this may make sex and masturbation “different” but “should not have a major effect on your sex life in the long term.” 

However, Mr Manjunath is keen to dispel the common assumption that men will lose all sensitivity in the penis after a circumcision. “There isn't a lot of data out there, other than anecdotal, to say that it is a significant problem after circumcision, ” he says. “Yes, it can happen, [and] men should be counselled about that before they have surgery, but they should also be reassured that these side effects are rare." 

But while total loss of sensitivity - and the inverse problem, hypersensitivity - may be uncommon,  neither are mpossible outcomes. "Unfortunately there’s nothing that can really be done about it,” Mr Manjunath says. “I can't put your foreskin back again.”

Once the pain wears off, learning what sexual pleasure feels like can be fun, as Paul realised. “It was like rediscovering masturbation for the first time, which was actually quite exciting,” he says. “There were definitely new sensations. You have to learn a completely new way to pleasure yourself. You have to relearn your body.” 

For Paul, having sex for the first time was just as revalatory.  “I felt like I'd not really had a proper adolescence, that sense of discovery or having a ‘proper first time’ because it was never going right,” he says. “So being able to be with someone and actually enjoy it was really good.”

While it’s important that men feel comfortable talking about their bodies – to doctors, certainly, but also to family and friends – the decision whether to get circumcised can only be made individually. Lots of men sit on the fence for years, out of fear, but also from a reluctance to change something that, in many instances, is difficult but bearable. Circumcision is life-altering and the unknown is sometimes scarier than the imperfect familiar. 

“The idea of getting circumcised fills me with both dread and wonder,” Craig confesses. “I'm absolutely terrified of being laid out on a table with my dick out having it pulled, poked, prodded and cut like it's a slab of meat. It's the part of my body I care most about. The procedure feels oddly intimate and I’ll be leaving with my sex organ incomplete. On the other hand, I'm excited to no longer have to worry about it. I'll be glad when I can actually have a sex life free of worry.” 

* Names have been changed