Men's surgical procedures explained: circumcision, vasectomy, hydrocele, varicocele and hernia

Most men's day-surgery operations treat a structural problem: a foreskin that is too tight, a band under the glans that is too short, fluid around a testicle, enlarged veins above a testicle, a testicle that has not descended, or a weakness in the groin wall. Vasectomy is the exception, since it is an elective choice for permanent contraception rather than the treatment of a fault. The table summarises each procedure using the NHS and BAUS leaflets; follow the links on this page for detail.

Circumcision removes the foreskin. The NHS says it is only available on the NHS for medical reasons, usually when other treatments have not worked, and BAUS lists the foreskin-preserving alternatives of steroid cream, dorsal slit, frenuloplasty and preputioplasty. Frenuloplasty lengthens a tight frenulum. Both operations use dissolvable stitches and both carry a risk of altered sensation in the head of the penis, according to BAUS. For adults the detailed guide covers criteria, recovery and risks; separate guides cover infants and children, where the legal and ethical position differs.

Conditions behind these operations include balanitis, phimosis and lichen sclerosus. Skin disease is usually treated medically first, and the British Association of Dermatologists notes that strong steroid ointment reduces the need for surgery in lichen sclerosus.

A hydrocele is a collection of fluid around the testicle. BAUS says it does not need treatment if small or not bothersome, that draining with a needle brings the fluid back quickly and is not recommended, and that surgery involves an incision into the scrotum, draining the fluid and bunching or removing the sac so it does not re-form. The testicle will always feel bulkier afterwards. BAUS gives risks such as haematoma and infection (each between 1 in 10 and 1 in 50) and recurrence (between 1 in 50 and 1 in 250).

A varicocele is a group of enlarged veins above the testicle. BAUS says observation is reasonable if it causes no pain and does not affect fertility, testosterone levels or testicular size, and describes tying the veins through a groin incision, often with an operating microscope, as a day-case operation, with radiological embolisation as a non-surgical alternative. For an undescended testicle, the NHS says surgery (orchidopexy) is usually done at around one year in children, while BAUS says an undescended testicle carries a higher risk of cancer and that an adult with a lifelong undescended testicle may be offered removal.

Vasectomy is covered in detail in its own guide. In summary the NHS describes it as a permanent method of contraception, usually done under local anaesthetic, with a success rate of over 99% and semen tests to confirm it around 12 weeks later. The Birmingham and Solihull ICB policy page describes minimally invasive vasectomy in a community clinic as the first choice for NHS funding.

A hernia is where part of an internal organ pushes through a weak area of muscle. The NHS says most develop in the tummy or groin, some cause a lump, some improve alone and others need surgery, and that the treatment depends on the type, the cause and whether it is new or has come back. It advises seeing a GP if you think you have a hernia, and NHS 111 if you have a hernia with pain, a bloated tummy, nausea or vomiting, constipation, fever or sudden confusion.

On the NHS the usual first step is a GP, who may examine you, arrange tests such as a scan, and refer to urology or general surgery. Local commissioners decide which procedures they fund and on what criteria, which is why access differs between areas. The Birmingham and Solihull ICB publishes its policies online: it lists criteria for medical circumcision and for vasectomy, and says reversal of male sterilisation is not routinely commissioned. Waiting times were not found in any published source read for this guide and none are stated.

If you choose a private provider, the same checks apply for every procedure here: the surgeon is a GMC-registered doctor, the provider is registered with the Care Quality Commission, the quote is in writing and lists what it covers, the anaesthetic is explained, and there is a named route for out-of-hours problems. No prices are given because none were found in the sources read.

The NHS says to go to A&E immediately or call 999 for sudden, severe testicle pain, testicle pain with nausea, vomiting or tummy pain, or pain lasting more than an hour or continuing at rest, because twisting of the testicle (torsion) can lead to loss of the testicle if not treated quickly. It advises an urgent GP appointment or NHS 111 for a testicular lump, swelling or change in shape. For a hernia, the NHS says to get help from NHS 111 if it is painful and comes with a bloated tummy, vomiting, constipation, fever or sudden confusion. A foreskin that cannot be returned over the glans, or being unable to pass urine after circumcision, needs 999 or A&E. Routine concerns go to a GP.

• What is the diagnosis, and has observation or a non-surgical option been considered?

• Which operation is proposed, what is the usual anaesthetic, and what are the risks that apply to me?

• How long until I can drive, return to work, exercise and have sex?

• Who do I speak to if there is bleeding, swelling or fever after I go home?

• Will a follow-up appointment or test (for example a semen test) be needed, and who arranges it?