In our previous article, we discussed the technical aspects of circumcisions. Here, we highlight some essential points to guide your decision on whether to do a circumcision.
To simplify things, this article will run through;
3 Reasons to get a circumcision
2 Considerations when doing the procedure
1 Patient’s Procedure and Recovery Journey
3 Reasons to get a circumcision
There are many reasons to undergo a circumcision. Setting aside religious reasons, there are also many medical reasons for a circumcision such as phimosis (tight foreskin), recurrent infections and Diabetes. Circumcision also improves hygiene, sexual performance and reduces the risks of contracting infectious diseases such as HIV and other STIs. We covered these in detail in our previous article on circumcision. However, many patients also undergo a circumcision for more personal or social reasons. These include:
1. Personal satisfaction
Sex should not be painful, however having a foreskin that is not loose enough can make for an unpleasant sexual experience. Although you may be able to retract your foreskin in a non-erect state, you may experience pain and discomfort when retracting the foreskin during an erection. This results in pain during sex and even premature ejaculation or erectile dysfunction.
2. Partner preferences
Understanding your partners’ preferences is the foundation to good sexual health. Some partners prefer a circumcision for a range of reasons including hygiene, smell and sensation during sex.
3. Looks
Form is a function.
Having to “get things in place” and retract the foreskin before sex can be a real buzzkill. That is why there are patients who find that having a circumcision gives a “cleaner” look that is “ready to go”!
2 Considerations before doing the procedure
Once you have arranged for a date to do the circumcision, you should start thinking about the next 2 points:
1. Local or General Anesthesia
Local Anesthesia
Anesthesia is the form of medication that keeps you from feeling pain. Local anesthesia means that only the penis is “numbed” for the procedure. This is the standard for routine adult circumcisions. You will feel pulling, movement and temperature of the area as the doctor is removing the skin but there will be no pain. A drape can be placed to block your view of the procedure being done in most cases.
In our practice we use a combination of cream and injection anesthesia to achieve maximum comfort during the procedure. Because we use the numbing cream first, the injection is barely or not even felt.
General Anesthesia
If you do want to be completely asleep during the procedure, General anesthesia is used. A medicine is used to put you to sleep. When you awaken, the procedure will be over. While you are asleep, we will also apply local anesthesia so that when you wake up, you will not be in pain and in fact feel completely comfortable.
2. Downtime
There will be a wound after removing the foreskin. In general the wound is pretty shallow and should take between 3 – 4 weeks to heal completely in most patients (some patients take up to 6 weeks). This does not mean you are bed bound for that period of time. It just means that you cannot undertake strenuous activity – gym, swimming, running and sexual intercourse. Moving around and going to an office based job is very do-able.
Pain control medication is also given to help take the edge off the pain as the wound heals.
Pro-Tip: Do NOT wait till you feel the pain to start taking the medication, take it even when there is no pain!
1 Patient’s Procedure and Recovery Journey
You are now ready for your circumcision!
Here’s 1 example of a routine patient journey for circumcision.
We will be using a patient undergoing a Shang Ring Circumcision. For more details about the technical details of Circumcision refer to our previous blog post.
Patient name: Mr Tan
Procedure: Shang Ring Circumcision
Anesthesia: Local
Procedure time: 10am
930am Mr Tan arrives at the clinic 30 minutes before start time.
A numbing cream is applied to the area and left on for 30 minutes.
945am Mr Tan goes downstairs to get a coffee while he waits for the cream to take
effect. (There is no need for fasting before a procedure done under Local
Anesthesia).
10am Mr Tan arrives back at the clinic
Procedure is done with Mr Tan lying flat on a bed.
Area is cleaned and drapes are placed to obscure Mr Tan’s view
Doctor tests if the numbing cream has worked by pinching the area and asking if he feels any pain
If he can feel some pain, a small injection is administered to the area – this should not hurt as the area is already partially numb from the cream.
Once numb, the doctor inserts the inner Shang Ring and clamps it with the outer ring.
Foreskin is removed with a diathermy.
1030am Procedure complete.
No dressing required.
The area remains numb for 1 – 2 hours.
Recovery
Recovering from a circumcision depends on how fast your wound healing is. Factors that slow wound healing include diabetes, smoking and infection of the wound. Therefore you will be given a course of antibiotics to reduce the chances of an infection.
The circumcision wound can be thought of as a concave bed, new cells need to grow out of this bed to bring the edges of the wound together and eventually form new overlying skin. Keeping the wound clean enables these cells to grow well and for the wound to heal faster.
For the Shang Ring method, there is minimal need to care for the wound while the ring is on as the wound is held together by the ring. When the ring comes off after 2 weeks, there will be some remaining areas of the wound bed that have not completely healed. It can take a further 2 – 3 weeks for the wound to completely seal up and for the overlying skin to return to its original state. Cleansing with the water and appropriate wound dressing can help speed up this process.
In summary
Circumcision is a very straight-forward procedure that can have several benefits. This guide gives you a few essential points to consider before you make your decision but is not exhaustive, do speak to your doctor about all of your concerns before deciding if a circumcision is for you!
Click here to read out previous article: Circumcision and Frenulectomy – What to Expec
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