What are the reasons to get a circumcision?
The most common reasons for circumcisions are:
- Phimosis – Tight foreskin with inability to pull back the foreskin over the glans penis
- Paraphimosis (inability to pull the retracted foreskin back over the glans)
- Balanitis and balanoposthitis (inflammation of glans and foreskin)
- Frenulum breve (short frenulum which tears with intercourse)
- Diseases of the foreskin, including cancer
- Genital warts, when large and non-responsive to medication
- Cosmetic appearance
What are the benefits of circumcision?
There is some evidence that circumcision has health benefits, including:
- A decreased risk of urinary tract infections.
- A reduced risk of some sexually transmitted diseases in men.
- Protection against penile cancer
- Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin).
Circumcision also makes it easier to keep the end of the penis clean.
Good hygiene can help prevent certain problems with the penis, including infections and swelling, even if the penis is not circumcised.
Circumcisions do not replace the need for condom use during sex to prevent STDs.
How is circumcision done?
During a circumcision, the foreskin is freed from the head of the penis, and the excess foreskin is clipped off. Adult circumcision takes about 30-40 minutes. The circumcision generally heals in seven to ten days.
My technique
I perform circumcisions under various anaesthetic methods including: local anaesthesia, local anaesthesia with sedation , or general anaesthesia.
For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a ring of tissue with a scalpel. In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the outcome to be customized to the patient's specifications if he has a particular cosmetic outcome he would like. This involves making an incision on the outer surface of the foreskin at the level where the edge of the glans (corona) is visible making an impression through the foreskin. I then retract the foreskin and make an incision in the inner (mucosal) surface of the foreskin following the contour of the glans. I mark the incision lines before making any incision and make measurements to be certain that the incisions will result in removing enough foreskin to meet the patient’s cosmetic preferences and allow for comfortable erections.
An adult circumcision should be crafted to accommodate the dimensions of the erect penis. I simulate erect length by stretching the penis. I mark incision lines with an ink marker and then stretch the penis and move the two incision lines into proximity. I want these two points to come together without excessive tension. This will avoid uncomfortable erections. Once I have determined the correct location of the incision lines, I make the outer incision, retract the foreskin and make the inner incision and remove the foreskin as one piece of tissue. Bleeding points are identified and cauterized with electrocautery. The frenulum is then removed if the patient desires this to be done. I then close the wound with fine sutures, placed in a very precise manner so that suture marks and tunnels will not occur, and finally apply a compression bandage to the surgical site.
The cosmetic outcome may be customized to patient preference. Since the incision on the outer surface of the foreskin is made separately from the incision on the inner, or mucosal, surface of the foreskin, these incisions can be made at different distances from the tip of the foreskin. The effect of this is that the incision line may be moved closer to the edge of the glans or further down the shaft. This is a separate issue from the overall tightness of the skin on the penis. The tightness has to do with the overall length of foreskin removed.