Circumcision (Trimming)

We have included this operation here among aesthetic surgery interventions, although it has religious as well as medical and aesthetic indications. Today, circumcision is performed not only for medical reasons (phimosis, frequent infections of glans and foreskin) but also for religious reasons, as well as in a larger sense, while preparing for penis dilatation, and for aesthetic reasons. Phimosis is a condition when the skin of a glans (praeputium) cannot be pulled over the glans of a penis, i.e. the head of a male sexual organ. It can be congenital (inborn), where it is a question about a long and narrow foreskin with a short frenulum (a part of the foreskin which connects it with the glans). When urinating, the foreskin ballooning can be frequently observed. In this way, urinating is being slowed down, and infections happen more frequent, as well as consequential inflammations, that lead to a stronger narrowing. Acquired phimosis appears usually well on in life, also because of scar tissue (fibrotic) changes of the foreskin as a consequence of frequent inflammations or a trauma. Each inflammation can be observed as a swelling, in the first phase, and after the defuse there appears a scar tissue (fibrotic) formation. In this way, the width of the foreskin becomes smaller, namely, the opening becomes narrower. The retention of urine in the area that makes foreskin narrower, along with smegma and peeled epithelial tissue, is a frequent cause of repeated inflammation processes of glans and foreskin (balanoposthitis). Chronic inflammatory development can be connected even with the appearance of penis cancer with grown-ups. Narrowings can be so strong that they can unable urination, and so to have sex is almost impossible.

It is important to mention the condition of paraphimosis, which derives from a violent attempt to pull over the inflamed or already fibrotically changed and narrowed foreskin over the glans, which leads to the state when foreskin cannot be any more put in a normal position. Something similar can happen even during a normal erection, or while trying to have sex. This condition causes strong obstruction of vein and lymphatic circulation, which leads to further swelling of glans and foreskin. If such a condition continues, a foreskin gangrene can develop, and if the obstruction is so strong that it makes unable the artery circulation, it can even lead to a gangrene of the head of a penis. Except visual medical finding the processes are accompanied by a strong pain, so that patients in such cases go to the physician who has to decide about an emergent surgical intervention, if a manual reposition is not possible.

Religious reasons are present with particular religious congregations, where ritual circumcisions are performed at a certain age.

Indications

Religious, aesthetic, medical – frequent inflammations of glans and foreskin, i.e. the condition of phimosis.

Pre-operational development

As with children, the treatment is performed under general anaesthesia, for which it is necessary to check laboratory blood and urine tests, as well as an examination of a pediatrician.

As with grown-ups, the treatment is usually performed under local anaesthesia or local intensified anaesthesia. In exceptional cases, regarding the wish of a patient, the operation can be performed under spinal or general anaesthesia.

The operation

As with the circular circumcision of the foreskin, it is a usual procedure to make a cut at the point where the body of a penis meets the glans, and to perform haemostasis, and the wound is then closed with stitches done with a resorptive material that will for about ten days be resorbed itself. The surgery takes about half an hour.

In the case of emergent surgery, when paraphimosis has developed, a dorsal incision should be performed under local anaesthesia, which enables reposition of the foreskin tissue over the glans in a normal position that will not any more disable the circulation. Afterwards, a complete circumcision can be performed.

Post-operational development

Placed vaseline gauze and dressing around the penis should be there for about a couple of days, and then everyday toilette using neutral soap and lukewarm water should be done, along with locally administered antibiotic oinment.

These operations are performed on an outpatient basis, which means that the patient, after recuperation period from anaesthesia, can leave the premises where he or she has been operated on, and to continue with medical attention at his or her home, under further control examinations on the part of the physician operator. Until the wound does not heal up, sex is not allowed.

Complications

Bleeding, heavy scar, but in principle, very rarely.

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