In patients with tight foreskin (medically called phimosis), it is sometimes required that the foreskin be removed surgically. This procedure is called circumcision, also known as Sunna/Khatna/ Usually the need of surgery arises in two circumstances:
- Severe Phimosis where it is not possible retract the prepuce at all to maintain reasonable penile hygiene
- Recurrent Balanoposthitis
In most other cases with mild degree of phimosis a short course of steroids to loosen the skin is often recommended to my patients. Before this conservative form of management is initiated, a physical examination is mandatory so that only the right patients receive this course.
What are the benefits of Circumcision ?
- Circumcision is a procedure to remove excess foreskin. Circumcision not only relieves the problems arising due to tight foreskin but also provides these additional benefits:
- Reduction and protection from STDs and HIV
- Improved penile hygiene and penile appearance
- Decreased glans sensations leading to longer sex
What are the other options if one does not want circumcision ?
If you want a less extensive procedure or have religious concerns then you can also opt for dorsal slitting of the prepuce which is a less invasive and quicker way to get rid of problems arising out of phimosis. However its cosmetic outcomes are inferior to circumcision and many other benefits of circumcision are not available or inferior with dorsal slit of the prepuce. Preputioplasty can also be offered in some patients where the phimosis and mild and a localized area of narrowing is present. If the frenular band is the problem for which you are choosing circumcision we can excise this band alone or perform a frenuloplasty. You may not get the other benefits of circumcision in case you opt for frenuloplasty.
What are the steps to be taken prior to Circumcision ?
In patients who are advised circumcision we follow this strict protocol:
- Assessment of the preputial skin for presence of acute or chronic balanoposthitis
- Biochemical evaluation in the form of Hemoglobin, Bleeding time and clotting time
- Initiation of Estrogen to suppress erections at least 3 to 4 days prior to surgery
- Regular bathing and shaving of pubic hair 2 to 3 day prior to the surgery
- Application of Prilocaine eutectic mixture to minimize needle pain 30 minutes prior to the procedure
- Informed consent along with signature of an accompanying person.
- Changing into a patient gown and shifting to the Operating Room
- Assessment of vital parameters in the preoperative room and administration of analgesics
- Shifting into the main operating room and initial assessment
- Completion of procedure in 20-30 minutes
- Shifting of patient to the recovery room once stable
- Assessment of vitals for 30-60 minutes
- Change back to regular clothes and briefing of post operative instructions in consultation room
- Dispensing of medication by pharmacy and discharge*
- Return to hospital after one or two days for removal of dressing
- Follow up visit at 7 days to ensure adequate healing and the absence of any infection
*Please remember that the patient has to be accompanied by a relative/guardian and is not allowed to drive back home after the procedure as certain medication may make the patient drowsy and unfit to drive.
Dressing appearence after circumcision.
The front portion which contains the urinary opening is kept free so that patient can pass urine normally
When can you resume work after circumcision ?
It is possible to resume office work after 24-48 hours. Many of our patients come directly from the office and report back the next day. Still if you are not sure you can take a day off after the procedure.
When can I resume normal life after circumcision ?
Normal life is not disturbed by this procedure. Just after the procedure you can eat, drink walk and talk. It is however recommended to take rest to allow faster healing. Bathing is recommended prior to coming for review and removal of the dressing on the next or second day.
What are the common problems that come after circumcision and how is it possible to deal with them ?
Here are some common problems that you can encounter after the procedure:
- Bleeding: Minor bleeding is uncommon but possible after circumcision. Sometimes there may even be a major bleeding in which you are strongly advice to visit the emergency department of the hospital. Minor bleeding leads to just some staining of the bandages while major bleeding with result in staining of underclothes and pants/pyjamas. Minor bleeding does not require any special treatment however it may be required to compress the penile region in event of a major bleeding.
- Glans Discomfort: Since the glans is a hypersensitive area, there may be initial irritation or discomfort in the glans due to exposure to the external environment. Even the touching of underclothes may lead to discomfort and we often advise that you apply a wet cotton over the glans for sometime. You can also apply a local anesthetic ointment (Lignocaine Jelly) over the exposed glans to reduce its sensitivity.
- Pain: Undue touching or injury may lead to pain in the suture line. Sometimes morning stiffness can also lead to stretching of the suture line and early morning pain. You can take an SOS dose of prescribed painkiller and the pain should settle down in half an hour.
- Swelling: It is natural to have some swelling of the preputial region after the surgery. The swelling subsides on its own after 24-48 hours. Sometimes there may be pain due to this swelling in which case the bandages can be loosened to give more space for the tissues to expand.
Why choose Dr. Raman Tanwar for Circumcision ?
Circumcision is a minor and relatively complication free procedure. Indeed it is so common that every doctor (and even quack) can perform this procedure. Dr. Raman Tanwar is an acclaimed urologist performing cosmetic circumcision which is different from conventional circumcision in many ways:
- Gives a natural look of a short prepuce. We preserve a small fold of skin so that the penis looks uncircumcised yet easy to maintain
- Performed under magnification. This ensures that the results are absolutely cosmetic and the best in the world. This also means that complications like bleeding are minimised.
- Expert precision that bypasses problems like shortening of the penis, glandular injury and meatal stenosis. No excess skin is removed and our team understands that we need to cut only as much as is necessary Performed with same sterility standards as a cardiac surgery. All our circumcisions are performed in controlled environment in the comfort of a modular operating room with laminar air flow which ensures minimal infection after the procedure. Dr. Tanwar takes circumcisions very seriously. After all it’s a once in a lifetime opportunity.
- Acclaimed Support and protocols: We perform circumcision using a strict protocol which ensures superior outcomes and provide good postoperative support through various patient information resources like this.
Hope this article solves many doubts that you have had regarding circumcision. This page is a guide for our patients who have undergone or are about to undergo the procedure by Dr. Raman Tanwar. If you have any suggestions as to how we can improve the information on this page please do let us know by filling the feedback form.