What is a circumcision?

A circumcision is a surgical procedure in which the foreskin covering the tip of the penis is removed. The procedure is performed in the newborn as a religious aspect as well as in certain medical conditions like phimosis, Balanopthisis which does not resolve, and in certain cases of chronic urinary tract infection. While in the adults and young boys, the procedure is performed to lower the risk of cancer of the cervix, HIV, and other sexually transmitted diseases.

Circumcision is a personal decision which many men make later in life for various reasons. Some men find that a tight foreskin (phimosis) can be uncomfortable or even painful. Some feel that they have too much foreskin. For others, they simply prefer the appearance of a circumcised penis.

It is important to understand that the sensation of the glans (head) of the penis may be irreversibly altered (reduced) and therefore one should be certain that circumcision is right for them before proceeding.

What are the types of the surgeries?

Circumcision is a simple procedure performed by surgical scissors. Plastibell circumcision is a procedure in which a plastibell device is used to circumcise in the newborn. A plastibell is a plastic ring with a deep groove. It is placed on the head of the penis in the infants to remove the foreskin.

Alternate treatments

The rigid foreskin can be treated with steroidal creams to make it loose so that it can be retreat behind the penis head. Sometimes, preputioplasty can also be performed, which involves the cutting and enlarging the foreskin rather than removing it surgically.

Which individuals are suitable for the surgery?

The circumcision is performed in the individuals who have concerns about certain conditions like:

• A tight foreskin
• A trapped foreskin
• Infection between the head of the penis and the foreskin

Which individuals are not suitable for the surgery?

The surgery is not performed in the following individuals:

• Premature infants
• Infants who have abnormalities in genital structure such as hypospadias
• Individuals with a family history of bleeding disorders
• Adults who have any underlying medical condition or infection at the surgical site

How to prepare for the surgery?

Circumcision is usually performed as a day care procedure. The surgeon checks your medical condition before the surgery. If you are planning to prepare yourself or your son for the surgery, you might need provide an informed consent before the procedure. You will be advised not to eat or drink for at least 6 hours before the surgery. If you have any doubts regarding the procedure, you can communicate with the surgeon and clarify your fears regarding the surgery.

What will happen during the surgery?

Circumcision in adults:

You will be given a general or local anesthesia causing your penis to become numb along with the surrounding area. In some cases, your surgeon may give you a spinal anesthesia. Later, the surgeon uses scalpels or surgical scissors to uplift the foreskin and remove it. The remaining skin around the penis is stitched with dissolvable sutures. The surgeon stops the bleeding by using heat. Later, you would be sent home after covering the surgical site with a petroleum jelly applied gauze.

Circumcision in the newborn:

Anesthesia is not given to the newborn as it may pose risks of breathing and other side-effects. The baby is laid on the bed, and the foreskin is separated from the head of the penis. The procedure usually takes 10 min. Later, the plastibell is placed over the penis, which falls off after 3-5 days of the surgery along with the foreskin.

What is the aftercare of the surgery?

You would be discharged home on the same day after the surgery. The surgeon may prescribe some medications to reduce the pain and swelling. Complete recovery takes about 10 days. Certain measures to be taken after the surgery include:

• Cleaning the surgical area with warm water for several times a day
• Wearing loose pants and undergarments to avoid discomfort
• Applying petroleum jelly in the area if you have any pain and discomfort
• Keeping off from the work for a week time
• Avoiding sexual intercourse for 4-6 weeks

For newborns, change the bandage each time while changing the diaper. Apply petroleum jelly to the penis and make sure that it doesn’t stick to diaper.

What are the postsurgical considerations?

There are not many risks associated with the circumcision surgery. Swelling, pain and discomfort up to 3-4 days after the surgery are common. There may be a risk of infection, chance of removing too much or too little of foreskin, and difficulty in urination. In rare cases, the nerve damage can occur leading to complete loss of sensation of the penis.

In most cases, the procedure may be performed using local anesthetic and it will take under an hour to complete. You will be asked to keep the area dry for 3 days. The sutures will dissolve on their own within about 3 weeks. You will need to refrain from sexual intercourse for 4 to 6 weeks following your procedure.

You need to contact your surgeon if you have a fever or the skin around the surgical site is infected, or if you have difficulty urinating. You may report the problems of dark and bad smelling urine.

Circumcision repair

Many men are bothered by a poorly performed circumcision. Common problems include uneven or wide scars, suture “track marks,” and uneven, excessive or tethered skin. In some cases, usually following a circumcision performed as an adult, too much skin has been removed leading to uncomfortable or painful erections and intercourse. Many men have lived with these issues all of their lives but have been uncomfortable discussing them.

Fortunately, there are solutions to repair circumcisions and many of our patients express satisfaction and great relief after finally having had these issues dealt with.

Scrotal Reduction

“Peno-scrotal webbing” refers to excessive skin that spans between the under surface of the penis and the scrotum. Some men find this unsightly and want the web removed. For others, the skin can be so excessive it can interfere with intercourse or even the ability to roll a condom onto the penis. A peno-scrotal web can be improved by a procedure that actually lengthens the midline of the web, allowing it to settle back towards the scrotum. In some cases excess skin will be removed.

This procedure can be performed under local anesthetic if it is a small web, but larger webs requiring skin removal are best dealt with under a general anesthetic (with you asleep). You will be asked to keep the area dry for 5 days following surgery and the sutures will dissolve on their own within 3 weeks. You will need to avoid strenuous activity such as sports or vigorous exercise for 4 to 6 weeks following surgery.