A team of surgeons

Circumcision

    Do better, behave better, we are all looking for better living conditions, of which robust health is the precursor. To achieve this, the rules of hygiene must be observed. With this in mind, most people regularly shave their hair or body hair and cut their fingernails. To optimize their health and in certain circumstances, such as: phimosis, trauma to the penis, men often practice circumcision. What is circumcision? A brief presentation of this surgical procedure would help us to make a rational decision whether to perform it or not.

 

Well before getting to the heart of the matter, let's do a little anatomical reminder of the penis where circumcision takes place.

 

Anatomy of the penis

The penis is one of the male's external genitalia. It hangs between the legs, in front of the scrotum. Its average dimension is 7 to 10 cm, and, in erection, 10 to 18 cm. The penis is made up of a root located in the perineum and a body attached to it. The root consists of three erectile parts, the two pillars and the bulb. These parts are continued in the body of the penis by the two corpora cavernosa and the spongy body, respectively. The corpora cavernosa contain cavernous spaces, and the spongy body contains a portion of the urethra.

Le penis
Tree parts of the penis
Inside
Inside of the penis

The penis is made up of three distinct parts:

   The glans: this is the swollen end of the penis on which the urethral meatus is located, which corresponds to the opening of the urethra, the urinary tract. The skin that covers the glans forms a fold called the foreskin. It is possible to remove this small piece of skin by surgery, it is circumcision. On the underside of the glans is a fold of skin connecting the foreskin to the base of the glans, this is the frenulum of the foreskin (or thread of the penis). At the base of the glans, a circular relief emerges, it is the crown of the glans which delimits the balano-preputial groove below. The body: it is made up of erectile tissue which contains many blood vessels. There are three regions: the spongy body that surrounds the urethra, and the two cavernous bodies on the top of the penis. These cavernous bodies are surrounded by the albuginea, an elastic envelope that allows them to lengthen and increase in volume during erection. The penis contains neither muscle nor bones, contrary to an old popular belief.

 

The crown of the glans

This is the crown-shaped bulge, located at the base of the glans.

Glans
Foreskin
Crown

Circumcision, definition

   Circumcision is the partial or total removal of the foreskin, the mobile fold of skin that covers and protects the glans penis. Circumcision is practiced for three essential reasons: cultural (religious belief), medical (affections of the foreskin) and prophylactic (prevention).

 

Phimosis, an indication of circumcision.

  Phimosis is the narrowing of the opening of the foreskin that interferes with or prevents retraction of the foreskin behind the glans. The descaling then becomes difficult or even impossible. Phimosis is physiological in infants and children up to 4 years of age in, whom forced cracking should be avoided. If the phimosis persists beyond 5 years, circumcision may be offered. In infants, If circumcision is necessary, it is possible after the age of one year, except in the event of a complication. Thanks to the new advences in surgery, we see it more and more systematically practiced in newborns.

Circumcision op
Phimosis
Phimosis before and after surgery

Procedures for the intervention

   The surgical procedure is performed on an outpatient basis in children (general and local anesthesia) and adults (local anesthesia). As with any surgical intervention, a preoperative anesthesia consultation is necessary a few days before the operation. The intervention lasts between 15 and 30 minutes and consists of an ablation of the foreskin, which leaves the glans uncovered, more or less completely. Absorbable stitches are put in place. Most often the frenum of the foreskin is cut and sutured during the operation.

Technique circumcision
Circumcision

La circoncision

Postoperative folow-up

   The pain in the operated area is usually minimal and temporary and is relieved by analgesics in the days following the operation. This patient shown in the video was placed on antibiotic prophylaxis, he received the SAT and resumed the dressing every day, the evolution is favorable, we switch to neomycin, cream. Discomfort of the glans can persist for several days. The surgeon specifies how long to avoid baths and the date authorized for resumption of activities. Generally, it is necessary to wait 3 weeks to a month before resuming sexual activities.

 

Healing

   Complete healing requires 2-4 weeks with local care for a few days. The sutures fall spontaneously in principle within an average of 2 to 3 weeks.

 

Complications

  In the majority of cases, the operation takes place without complications. However, any surgical act may involve a certain number of risks and complications related to the general condition of the patient and the anesthesia. The most common complications are pain in the glans. More rarely, an hematoma and or an infection may appear on the scar, and in the longer term, a decrease in the sensitivity of the glans during sexual intercourse.

 

References:

  1.  Kim, Howard H; Li, Philip S; Goldstein, Marc (November 2010). "Male circumcision: Africa and beyond?". Current Opinion in Urology. 20 (6): 515–9. doi:10.1097/MOU.0b013e32833f1b21PMID 20844437S2CID 2158164.
  2. Jump up to:a b Sharma, SC; Raison, N; Khan, S; Shabbir, M; Dasgupta, P; Ahmed, K (12 December 2017). "Male Circumcision for the Prevention of HIV Acquisition: A Meta-Analysis". BJU International. 121 (4): 515–526. doi:10.1111/bju.14102PMID 29232046.
  3. Jump up to:a b c d Larke N, Thomas SL, Dos Santos Silva I, Weiss HA (November 2011). "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis". J. Infect. Dis. 204 (9): 1375–90. doi:10.1093/infdis/jir523PMID 21965090.
  4. Jump up to:a b c d e f Rehmeyer C, CJ (2011). "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type". J Am Osteopath Assoc. 111 (3 suppl 2): S11–S18. PMID 21415373.
  5. ^ Yuan, Tanwei; Fitzpatrick, Thomas; Ko, Nai-Ying; Cai, Yong; Chen, Yingqing; Zhao, Jin; Li, Linghua; Xu, Junjie; Gu, Jing (April 2019). "Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data". The Lancet Global Health. 7 (4): e436–e447. doi:10.1016/S2214-109X(18)30567-9ISSN 2214-109XPMC 7779827PMID 30879508.
  6. Jump up to:a b c d e Weiss, HA; Larke, N; Halperin, D; Schenker, I (2010). "Complications of circumcision in male neonates, infants and children: a systematic review". BMC Urol. 10: 2. doi:10.1186/1471-2490-10-2PMC 2835667PMID 20158883.
  7. Jump up to:a b c d Selekman, Rachel; Copp, Hillary (2020). "Urologic Evaluation of the Child". In Partin, Alan (ed.). Campbell Walsh Wein Urology (12th ed.). Elsevier. pp. 388–402. ISBN 9780323672276.
  8. Jump up to:a b The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad et al. "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle et al. "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera et al. "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.
  9. ^ Morris, BJ; Krieger, JN (November 2013). "Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review". The Journal of Sexual Medicine. 10 (11): 2644–57. CiteSeerX 10.1.1.693.6628doi:10.1111/jsm.12293PMID 23937309.
  10. ^ "Neonatal and child male circumcision: a global review" (PDF)World Health Organization. 2010. Archived (PDF) from the original on 2016-01-18. Retrieved 12 April2015.
  11. ^ Owings, Maria. "Products - Health E Stats - Trends in Circumcision Among Male Newborns Born in U.S. Hospitals: 1979–2010". www.cdc.gov. The Centers for Disease Control. Retrieved 1 May 2019.

 
 

Last edited: 11/07/2021