title: How painful is adult circumcision? A prospective, observational cohort study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Western General Hospital, Edinburgh, Scotland, United Kingdom. bhavan@doctors.org.uk
authors.forename: Bhavan Prasad
authors.initials: BP
authors.lastname: Rai
authors.forename: Asim
authors.initials: A
authors.lastname: Qureshi
authors.forename: Nourdin
authors.initials: N
authors.lastname: Kadi
authors.forename: Roland
authors.initials: R
authors.lastname: Donat
mesh_terms: D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D000768:Anesthesia, General / Q000379:methods*; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics