Circumcision

Circumcision - characteristics

One of the procedures performed in the male genital organs is circumcision. Currently, the name of this procedure is rarely used for cruciality - the term derives from the Latin circumcisio, which means "cut around" in translation. Simply put, this procedure involves removing the penis foreskin (the foreskin is a skin fold that covers the penile acorn). Circumcision is a relatively frequent procedure - according to statistics, around 30% of all men are circumcised.

Circumcision is carried out in men from very distant times. There are even opinions according to which it belongs to those procedures that were first carried out in humans. For example, in ancient Egypt, the passage of the rite of circumcision was treated as a symbol of purity. This treatment is still carried out for religious reasons - this is the case, for example, in the case of followers of Judaism or Islam. The circumcision is currently performed not only for cultural reasons, but also for purely medical indications.
The circumcision procedure is carried out even in new-borns (in the case of this group of patients, the reason for its performance are usually religious aspects). In the case of adults, there is basically no age limit, which exceeding would make circumcision impossible - if the patient is in a good general health condition, then this procedure should not be contraindicated.
A variety of different tools can be used to remove the foreskin. Despite such diversity, two basic circumcision techniques are generally distinguished: partial circumcision and total circumcision. In the case of the first of these removal only the part of the foreskin is subjected. Circumcision is a procedure consisting in the resection of the entire foreskin.

Circumcision - benefits

As an advantage of circumcision one can treat first of all that after the procedure it is easier to keep a penis clean. Under physiological conditions, different kinds of impurities can accumulate under the foreskin - in a situation where the patient does not have this structure, the care of the hygiene of the intimate surroundings becomes simply simpler.
The aspects of circumcision and advantages of this procedure have already been dealt with by many scientists. Particularly high attention is paid to the impact of foreskin removal on the risk of sexually transmitted infections. There are indications that circumcised men have a lower risk of getting HIV from their partners (immediately should be noted here - traveling circumcision may reduce this risk, rather than completely eliminate it - therefore risky sexual contact and so recommended is the use of security). As other advantages of total circumcision one can consider a reduced risk of urinary tract infections, as well as a significant decrease in the risk of developing phimosis or inflammation of the glans. Nor can one forget that circumcision can lead to the disappearance of the patient's troubles. For example, a man with phimosis may experience difficulties with sexual activity - sexual contact with such a patient may simply cause pain. In this situation, resection of the foreskin can result in the elimination of such problems and make the level of daily functioning of such a patient significantly improved.
As general benefits of circumcision as a treatment one can treat such aspects as a short (because only a few dozen minutes) duration of the procedure, as well as the fact that after her travel there is no need to stay in the hospital. A favourable aspect is also the fact that after circumcision, the restrictions on everyday functioning do not last for a long time - convalescence actually takes several days.

Indications for the procedure

The medical indications for total circumcision include:
• phimosis (a condition in which the foreskin of the penis is impaired),
• Paraphimosis,
• inflammation of the glans penis or inflammation of the glans and foreskin (especially when they are recurrent),
• pre-cancerous changes that develop within the glans and / or foreskin of the penis.

Contraindications for the procedure

Circumcision is not a procedure that is part of life-saving procedures, and therefore it is performed only in people who are in a good general health condition. A contraindication to the procedure may be active infection, in children the procedure may not be possible, for example by prematurity.
The contraindications for total circumcision may be systemic diseases, such as, for example, blood coagulation disorders (performing a procedure in a patient with such problems could be associated with a significant risk of severe bleeding both during and after the procedure). The inability to perform foreskin resection can also result from problems affecting the penis itself. Circumcision may be contraindicated in the event of abnormal location of the urethra of the patient (resulting either from hypospadias or from superficial contact) or by the existence of acute inflammation of the glans penis.

Before the surgery

The preliminary stage before the removal of the whole foreskin is a consultation. Its purpose is, above all, to determine why circumcision would be carried out. If the pretext for resection of the foreskin are medical reasons, the physician must confirm the existence of the patient's condition (eg phimosis). Therefore, you should be prepared to consult your reproductive organs during the consultation. As already mentioned, circumcision is carried out in people who are in a good general state of health, therefore - if there is doubt as to whether the patient qualified for circumcision is completely healthy - various tests may be ordered. The basic ones include blood counts, coagulation parameters, and urinalysis.
If you qualify for circumcision, it becomes possible to set the date of the procedure. Patients do not have to make significant preparations in the period preceding the procedure. They may be asked to shave the pubic hair for a short time before circumcision (it is possible, however, that it will only be performed in the hospital, immediately before the procedure). People who smoke cigarettes may be given up to quit - the effect of nicotinic is, among others, poorer supply of oxygen to the body, and thus may lead to impaired healing of tissues and prolongation of convalescence after circumcision.

Type of anaesthesia

Circumcision is a procedure under anaesthesia. The choice of the technique of anaesthesia depends primarily on the age at which the patient is subjected to the procedure. For children, general anaesthesia is usually used. In adults, this technique of anaesthesia is also used, but much less frequently - in adult patients, circumcision is usually performed under local anaesthesia.

How does the procedure work?

The first stage of the total circumcision procedure is the patient's anaesthesia. Depending on the techniques chosen by the physicians, either the patient is under general anaesthesia or only local anaesthesia of penile tissues is used. After making sure that the patient will not feel any discomfort during the procedure, it is possible to initiate essential surgical interventions.
As you can guess, the tissues of the penis must be incised. Different types of discs, rings and other tools are used for this purpose - the choice of surgical instruments used during circumcision depends on from the age of the patient. There are also various circumcision techniques available, as an example one can specify the one in which the foreskin is first cut in the direction corresponding to the long axis of the penis, and then the tissues below the glans are cut off. After the foreskin resection, sutures are applied - usually self-absorbing forms are used.
The total duration of total circumcision varies, usually it reaches about 40-60 minutes (longer, for example, those procedures during which patients are put under general anaesthesia) may be longer. A dressing is put on the penis under the procedure. After a short time of circumcision, on the same day, the patient returns home - after the procedure there is no need to stay in the hospital.

Time and course of convalescence

Convalescence after total circumcision usually takes a few - because about 10 - days. At that time, it would be most beneficial (in the case of circumcision in adults) to take leave. It is best to talk to the treating physician about the time the patient should not go to work. He will be able to provide information on when the return to professional duties will be completely safe for the patient.
During the first few days after the procedure pain can be seen on the part of the penis, as well as its redness or swelling. Such problems are rather not complications of circumcision (they are usually treated as phenomena anticipated after surgery), and in addition to their spontaneous resolution occurs within 3-5 days. Patients may wonder if the procedure may lead to urinary problems. Generally speaking, there should not be such problems after circumcision - if the patient started to feel pain during the micturition or if there were any other problems with urination, you should consult a doctor. Such phenomena may suggest that there have been some complications of total circumcision.
As for the seams established during the procedure, if self-absorbing forms are used, then there is no need to go to the doctor to remove them.

Effects after surgery

The direct effect of total circumcision is that after the procedure the patient no longer has a foreskin within the penis. What will be the other results of the procedure depends on the reason for the procedure. If the foreskin resection was indicated due to the existence of a phimosis patient, circumcision may cause the patient to stop experiencing ailments that occurred due to the narrowing of the foreskin (such as e.g. penile irritation or pain during sexual contact). In the event that circumcision was performed in connection with recurrent glans, after surgery, such complaints may no longer be a problem for the patient.

Recommendations after the procedure

Among the recommendations after total circumcision are primarily those that concern penile hygiene. Patients are even sensitized to regularly change the dressings (wearing them may be recommended at different times, depending on the rate of tissue healing). If the patient is prescribed to use any medicines (eg antibiotics), then they should be used strictly according to medical recommendations.
After circumcision, patients may experience different degrees of pain. In case of their high intensity, you can take advantage of publicly available or with painkillers prescribed by a doctor. People who have undergone resection of the foreskin, for the first few days after the procedure to maintain personal hygiene should use the shower instead of bathing in the tub. In addition, when washing, be careful not to irritate the penile tissue.
It is also worth mentioning that patients subjected to circumcision during convalescence should carefully choose what they wear. It would be most beneficial to dress loose airy clothes during the healing of the penis - this reduces the risk of discomfort and irritation subjected to circumcision of the tissues.
In the case of various limitations experienced by patients after complete circumcision, sexual activity is the longest. For patients, it is recommended that they return to sexual contact at the earliest four weeks after the surgery. For some patients, maintaining such abstinence from sexual intercourse may seem far too long, but it is very important to follow this recommendation - too early a return to sexual activity could lead to complications of circumcision.

How long do the effects last after the treatment last?

Circumcision is the removal of the entire foreskin. Tissues that are subject to resection do not grow back - therefore the result of the surgery is simply permanent.

How to avoid complications after the procedure?

Complications after total circumcision are not frequent (for the most common of them, such as penile infection or bleeding after surgery, the estimated incidence is about 2%). Despite the low frequency of complications, patients may still be interested in whether they are able to somehow prevent the development of adverse events. To avoid complications after total circumcision, the patient should seek to be looked after by an experienced specialist. Just going to a surgeon who has extensive experience in performing a given procedure may allow a significant reduction in the risk of complications after total circumcision.
Analysing the possibilities of preventing complications after total circumcision one cannot fail to mention the role of the patients themselves. Patients should definitely follow the recommendations after the procedure. For example, caring for the hygiene of the penis can significantly reduce the risk of infection in the operated area. It is also important that patients - if they notice any disturbing ailments - do not wait to see a doctor
The occurrence of, for example, increased body temperature, severe pain or redness of the penis may suggest that the infection has developed. In the case of one or other complications of circumcision, it is important that his treatment be started as soon as possible - the sooner the problem will be provided, the lower the risk that complex complications will occur.

Possible complications after the procedure

Circumcision can be treated as a procedure of slight invasiveness. Despite this - as with any other surgery - the removal of the foreskin can lead to various complications. As examples of possible complications of total circumcision one can mention:
• sensory disturbances within the penis (consisting in both the reduction of the sensitivity of the glans and its hypersensitivity),
• infection of penile tissues,
• significant degree of penis pain,
• inflammation of the end part of the urethra,
• formation of a hematoma within a penis,
• removal of too much tissue during the procedure,
• the appearance of penile oedema,
• urination disorders,
• separation of the postoperative wound,
• the formation of a large scar,
• erectile dysfunction.

Complete removal of the foreskin is a procedure that allows you to get the desired result - there is no need to supplement the procedure with alternative treatments.

Author: Tomasz Nęcki, MD
Literature:
J. Fibak, "Surgery, Repetytorium", ed. PZWL, Warsaw 2010; W. Noszczyk (ed.), "Surgery", ed. PZWL, Warsaw 2005; Male circumcision: IWHO Library Cataloguing-in-Publication Data, ISBN 978 92 4 159616 9;
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