FREQUENTLY ASKED QUESTIONS ABOUT CIRCUMCISION
What are the reasons for performing circumcision ?
The most common reasons for performing circumcision are:
- Cosmetic appearance
- Phimosis (tight foreskin)
- Paraphimosis (inability to pull the retracted foreskin back over the glans)
- Balanitis and balanoposthitis (inflammation of glans and foreskin)
- Recurrent Urinary Tract Infections caused by Balanitis or Balanopostitis.
- Frenulum breve (short frenulum which tears with intercourse)
- Diseases of the foreskin, including a growth which may be a cancer
Do you use skin glue (Dermabond) to close circumcision wounds?
Use of glue to close the skin is a useful tool, but it may be a poor choice for certain circumcisions and will be advised at consultation.
One problem with using glue for circumcision wounds is that it does not bring the skin edges as close together as sutures do. This means the scar will be wider and more visible, with the use of glue. The key for an ideal circumcision wound is to carefully place sutures close to the skin edges, the use of very fine suture material, and careful tying of the sutures to approximate the skin edges in a neat looking way. This promotes least time to optimum wound healing and best scar cosmetically.
Do you use lasers in performing circumcision?
Lasers are great for use in some types of surgical procedures. For circumcision, a laser offers no benefit and invites potential problems as it has the potential to damage the tissue adjacent and deep to the incision. A laser cuts, and does nothing else. The surgeon cannot control the depth of the cut with a laser. For circumcision, it is important that the surgeon is able to control the depth of an incision cut to a very fine degree. Too much depth of cut, as with a laser, can lead to injury to the urethra or erectile bodies (Corpora Cavernosa).
How does adult circumcision differ technically from neonatal circumcision?
Neonatal circumcision is often performed utilizing a clamp device which remove the redundant foreskin, stop bleeding arteries and veins by crushing them, and bond the skin edges without the need for sutures. The most common devices used are the Mogen clamp. This clamp creates a pressure bond to hold together the skin edges so that there is no need for sutures. This device provide an adequate wound closure for infants because they do not have powerful enough erections to pull apart the skin edges. Moreover, the scar is minimal even without suture wound closure. The bond created by these clamps at the skin edges consists of the clamp crushing the two opposing skin edges together.
In an older child or adult, the force of a powerful erection can potentially pull apart the wound edges resulting in wound ‘dehiscence’ or opening up of the wound thus making it important to perform adequate wound closure during a circumcision. Adults aften require a suture closure (stitches) to provide a secure enough wound closure to allow the wound to remain intact despite the force of erections, but surgical methods other then sutures can be used. In adults careful suture closure leads to a much finer scar once the healing is complete. Sutures approximate the healing wound edges of close together so that the end result is a fine line.
Neonatal circumcisions are done with minimal local anaesthesia according to their body weight. Using a clamp device, a neonatal circumcision is a relatively quick procedure. An adult circumcision is a more lengthy procedure and requires a more elaborate local anaesthesia.
Many surgeons perform circumcisions under general anaesthesia. This is a more complicated and expensive procedure than local anaesthesia. We perform all of the procedures for our patients utilising local anaesthesia. This involves injections around the base of the penis with the anesthetic agent. The injections are not particularly painful since the injections are just beneath the skin surface and are mostly described by patient’s as being a ‘discomfort’. After the local aesthetic is injected, a few minute’s time is allowed for the effect to occur and then we check the patient’s sensation to ascertain that he is not able to feel pain. Mr.Roy marks 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. Rarely, the erections can still be uncomfortable or painful initially but this settles down in the next few weeks.An adult circumcision should be crafted to accommodate the dimensions of the erect penis, which is simulated as erect length by stretching the penis. The foreskin is removed with meticulous attention to detail. Any bleeding points are identified and skillfully dealt with, often with careful superfical and targeted electrocautery. The wound is then closed and finally a light compression dressing to the surgical site is applied.
Is a consultation visit necessary prior to deciding on circumcision?
Yes, it is important to have a consultation visit. The consultation time required is approximately 30 minutes.
What is the recovery time for adults after circumcision?
A week of moderate activity is suggested following circumcision. Sedentary activity and travel is possible the same day.
Are there differences in circumcision procedure and outcome based on patient ethnic background?
We perform circumcision procedures with an equal concern for the attention to detail with surgical technique. The principal features of technique that impact the quality of cosmetic and otherwise outcome are :
- Length of foreskin removed.
- Symmetry of the incision lines.
- Gentleness of handling of the skin and the Dartos fascia layer which lies beneath the skin.
- Careful attention to control of bleeding arteries and veins.
- Careful attention to aligning the skin edges for wound closure.
- If suturing, delicate handling of the suturing (stitching) process so that suture scarring (“railroad track” scarring) does not result or is minimal.
- Proper postoperative dressing (bandage) application to minimize swelling and stretching of the healing tissues.
For adult circumcision, Mr.Roy usually likes performing the sleeve resection technique in which the foreskin is removed utilising a scalpel. This gives a symmetrical, fine incision line with razor sharp precision that a scalpel has in a skilled hand.
Will having a circumcision change the size of my penis?
Absolutely not. The structures of the penis that give it length and girth are deeper in the anatomy than the skin. The skin is the only component that is altered with a circumcision, therefore there is no alteration of penile size with a circumcision.
Where will I be given the local anesthesia for this procedure?
The injection is done at the base of the penis utilising a local anesthesia called Lidocaine. The patient usually only feels several needle sticks and after that, no pain or discomfort.
Do you perform circumcision for cosmetic reasons?
Mr.Roy respects the aesthetic wishes of his patients and will gladly perform circumcisions for purely cosmetic reasons as indicated.