Circumcision is a surgical procedure in which the foreskin of the penis is completely or partially removed. Circumcision may be performed for medical, religious, or cosmetic reasons. Circumcision is often recommended in cases of phimosis or severe narrowing of the foreskin. The foreskin normally protects the glans and allows the urethra to function properly.
A urologist determines whether circumcision is medically necessary or if alternative procedures are an option. The procedure is usually performed under local or general anesthesia. After circumcision, swelling and mild discomfort may occur, but these typically subside quickly as the wound heals. In urology, circumcision is one of the most commonly performed procedures on boys and men.
Reasons for Circumcision
In many cultures and religions, ritual circumcision of the penis is common among newborns and children. In Judaism, this takes place on the eighth day after a boy’s birth. In Islam, circumcision is performed on boys between the ages of 7 and 14. The most common medical reason for circumcision is a tight foreskin (phimosis). This can be congenital or result from recurrent infections or tears in the foreskin.
If the foreskin cannot be retracted completely over the glans, or can only be done so with pain, genital hygiene is compromised.
This increases the risk of:
- Inflammation
- Discomfort when urinating, as well as
- pain during erections and sexual intercourse
In recent years, adult men in particular have opted for circumcision for aesthetic reasons. Many men and women find a circumcised penis more aesthetically pleasing than an uncircumcised one.
Sketch of a circumcision @ Nena /AdobeStock
Circumcision Techniques
Various surgical techniques are used in circumcision.
These depend on:
- Reason for circumcision
- The patient’s age, as well as
- Desired outcome
In the classic open-hand technique, the doctor removes the foreskin along defined lines using a scalpel or surgical scissors. In the clamp and forceps techniques, the doctor carefully clamps off the foreskin. He then cuts it away along the forceps or clamp with a scalpel.
Other techniques for circumcising infants include the Plastibell bell and Circ-Ring. In these methods, the doctor ties off the foreskin using a thread or rubber band. The foreskin, which is no longer supplied with blood, detaches completely on its own after a few days and falls off. In modern laser circumcision, a medical laser is used instead of a scalpel.
Circumcision Styles
Depending on the type and style of circumcision, doctors remove the foreskin of the penis either completely or only partially. In a radical circumcision, they remove enough skin so that the glans is always completely exposed.
In a partial circumcision, on the other hand, they remove only part of the foreskin. The position of the scar on the shaft of the penis also depends on the style. We have adopted the English terms to describe the different styles.
If the scar is near the glans, the circumcision is called “low.” If the scar is on the shaft, doctors refer to it as “high.” Depending on how much skin the doctor removes, they describe it as a “loose” or “tight” circumcision.
Therefore, there are 4 different circumcision styles:
- high & tight
- high & loose
- low & tight, and
- low & loose
Aesthetic circumcision
A special procedure is aesthetic circumcision. Instead of removing the foreskin, the doctor removes a piece of penile shaft skin directly at the base of the penis.
The doctor then pulls the foreskin back to suture the shortened shaft skin directly at the base of the penis. This exposes the glans while completely preserving the sensitive areas of the foreskin.
The Procedure
Circumcision is usually performed on an outpatient basis under local anesthesia. It takes about half an hour. After the procedure, the patient must wear a bandage. Sexual intercourse is possible again after two to four weeks.
The body completely absorbs the suture material after about 4–8 weeks. The scar may still change in the first few months after the surgery. After half a year, it is barely noticeable.
If the circumcision is performed for medical reasons, health insurance covers the costs. Health insurance does not cover circumcision performed for aesthetic reasons.
Even though circumcision is a routine procedure, it requires the surgeon to have experience and expertise. This is the only way to ensure a cosmetically satisfactory result without complications.
FAQ
When is circumcision medically necessary?
Circumcision is often recommended in cases of phimosis (a tight foreskin) or paraphimosis. Recurrent inflammation of the foreskin and glans, discomfort during urination, or problems with the foreskin may also necessitate medical treatment. The urologist will determine the appropriate treatment after an examination.
How is a circumcision performed?
The circumcision procedure begins with an examination in the urology department. The procedure is performed under local anesthesia or general anesthesia. During the removal of the foreskin, the foreskin surrounding the glans is removed either completely or partially. The tissue is then sutured, allowing for either a complete or partial circumcision.
How long does it take to heal after a circumcision?
The healing process is usually uncomplicated. Swelling and mild discomfort are normal, especially the day after the procedure. Complete healing typically takes about two to three weeks. During this time, strenuous activity and sexual intercourse should be avoided.
What are the risks and complications associated with circumcision?
As with any surgical procedure, potential complications may arise. These include infection, scarring, post-operative bleeding, or sensory disturbances in the glans area. However, when performed properly in accordance with medical standards, serious complications are rare.
Does health insurance cover the cost of circumcision?
If the circumcision is performed for medical reasons, the costs are usually covered by health insurance. Cosmetic or religious circumcision is not a standard benefit covered by health insurance. Before the procedure, patients should inquire about the fee schedule for physicians and the individual costs involved.
