Circumcision is a surgical procedure that involves the removal of the foreskin, the retractable fold of skin covering the head of the penis. This procedure is performed for various reasons, including medical, religious, and cultural considerations. While the general concept remains consistent, the specific techniques and approaches can vary depending on factors such as the patient’s age and the instruments used.
Common Circumcision Techniques
The Gomco clamp is widely used for newborn circumcisions. Preparation involves cleaning and often a dorsal penile nerve block for anesthesia. The foreskin is separated from the glans, and a bell-shaped component of the clamp is placed over the glans, beneath the foreskin. The foreskin is pulled over the bell, and a base plate secures it between the bell and the plate.
The clamp is then tightened, crushing the foreskin to create a bloodless line of excision. After about five minutes, the excess foreskin is removed with a scalpel. The clamp is disassembled, and the glans is gently freed from the bell.
The Mogen clamp offers a quicker surgical alternative, used in newborns. Unlike the Gomco, it often does not require an initial cut in the foreskin. After preparing the area and separating the foreskin from the glans, the foreskin is pulled forward through the hinge of the Mogen clamp. Care is taken to ensure the glans is not caught within the clamp’s blades.
The clamp is then closed and locked for about 60 to 90 seconds, crushing the foreskin to reduce bleeding. A scalpel is used to excise the foreskin from the flat side of the clamp, and the clamp is then removed. Sutures are generally not required with this method for newborns.
The Plastibell device provides another common technique for infants and young boys. Preparation involves numbing the area and separating the foreskin from the glans. An appropriately sized plastic ring is inserted underneath the foreskin, over the glans. The foreskin is then stretched over the ring and secured tightly with a sterile suture thread, cutting off the blood supply.
The handle of the Plastibell is then broken off, and any excess skin protruding beyond the ring is trimmed. The plastic ring remains on the penis, and the foreskin tissue gradually dies and falls off, typically within 7 to 10 days.
Circumcision for Different Age Groups
The approach to circumcision varies significantly with the patient’s age. For newborns, within the first few weeks of life, the procedure is simpler and faster, often completed in 10 to 30 minutes. Local anesthesia, such as a dorsal penile nerve block or topical cream, is used to manage discomfort. Pliable infant tissue allows for a straightforward procedure, often performed in an office setting. Healing is also quicker in infants, usually taking about a week.
In contrast, adult circumcision is a more involved procedure due to thicker, developed foreskin and anatomical differences. The surgery can take longer, ranging from 30 minutes to over an hour. Anesthesia options for adults are broader, including local, regional, or general anesthesia, depending on complexity and patient preference. Adult procedures may involve techniques like dorsal slit or sleeve resection, and stitches are generally required to close the incision, dissolving within about 10 days. The recovery period for adults is also longer, often extending up to three weeks.
Considerations Before and After
Before undergoing a circumcision, preparations are recommended. Patients should clean the genital area thoroughly, and hospitals may provide antiseptic soaps. It is advisable to wear loose-fitting underwear or clothing after the procedure. If general anesthesia is to be administered, patients are instructed to stop eating and drinking for a specified period before surgery, often from midnight. Patients should also inform their doctor about all medications and natural health products, as some, like blood thinners, may need to be stopped.
Following the procedure, managing pain and proper wound care are important. Pain medication, such as acetaminophen or prescribed pain relievers, can be used to alleviate discomfort. Swelling and bruising are common and typically subside within one to two weeks. Instructions will be provided for wound care, which may include applying petroleum jelly or antibiotic ointment to the incision site to prevent sticking. Depending on the technique, dressings may need to remain in place for around 24 to 72 hours.
Hygiene is also important for aftercare. Patients may be advised to avoid submerging the penis in water for a few days, opting for sponge baths or gentle showers. For infants, frequent diaper changes are recommended. The area should be rinsed with water, avoiding commercial wipes that might cause stinging. Strenuous activities, including heavy lifting and sexual activity, should be avoided for several weeks, generally four to six weeks, to promote healing and prevent complications like bleeding or stitch disruption.