Circumcision using the ShangRing method has been gaining popularity lately. It is often marketed as a painless circumcision that takes only 15 minutes and can be done in the clinic rather than having to go to an operating theater. But does it live up to its reputation?
I have been conducting circumcisions using all sorts of techniques for years. Including using the ShangRing, Laser, Staplers etc etc. I would like to share my personal experience using the ShangRing and give you unbiased information on what my patients went through so that you can make an informed decision for yourself.
How is a ShangRing Circumcision done?
First of all, I will use a special tape to determine what size of ring you require.
A numbing cream is applied and left on for about 30 to 45 minutes to take effect.
The inner ring is then placed inside the foreskin. The outer ring is placed outside and locked into place.
The excess foreskin is then cut off. The whole process takes no longer than 15 minutes.
What happens after the ShangRing circumcision?
You will go home with the ring attached.
Wound care is actually very simple. You can shower and pass urine painlessly immediately after the procedure.
I usually will give patients an antibiotic to apply as well as oral antibiotics and painkillers. Of course different Doctors are going to have different practices.
As the skin heals, the ShangRing should fall off on its own. This takes about 3 weeks. It can take significantly longer in some patients.
What are the possible complications after a ShangRing circumcision?
Of course we all hope that you will heal nicely and quickly with no complications. However as with any surgery, complications can happen. The complications I have seen in my career include:
1. Bleeding. This usually happens as the skin starts to separate from the ShangRing. Remember that the skin will not separate all at once. Certain parts will start to pull away from the ShangRing faster than other parts. This will place tension on the skin and possible tear a blood vessel causing bleeding. Most bleeds can be stopped with just putting pressure on the bleeding area. However, because of the ShangRing still attached to the penis, this can be challenging. So rarely, we need to remove the ring to stop the bleeding. Then we may have to stitch the skin close again. Essentially converting the ShangRing procedure into a conventional circumcision procedure.
2. Pain. Again as parts of the skin separate before other parts, this places tension on the skin still attached to the ring. This can cause significant pain. Also, as the wound is healing there can be quite a bit of inflammation on the skin edge next to the wound. Inflammation will make the skin extremely sensitive and even painful. Most time, anti-inflammatory medicines and pain-killers are enough to control the pain. But in some cases the pain can be rather severe.
3. Wound dehiscence. This is a fancy way to say the wound opens up. The main function of the ring is to hold the skin together as it heals. As long as the ring is in place, there is no chance the wound will open up. However, often patients cannot tolerate the ring. It could be due to pain or inconvenience or other reasons. So Doctors have to remove the ring rather than waiting for it to fall. Ring removal can be quite a painful procedure in itself. After the ring is removed, if the wound is not yet healed enough, there is a risk the wound will separate (i.e the skin edges will pull away from each other) leaving a raw area in between. This is more likely during strong erections. Although the raw area will eventually heal, this will take some time and require careful wound care and dressing along the way.
4. Delayed healing. Many marketing materials claim that with the ShangRing method, healing can be achieved in 3 weeks. However, from my experience and from published study data, this is the exception rather than the norm. Most patients will take longer. Some even take as long as 2 months to fully heal.
5. Ring Slippage. I have been called to assist other Doctors on this more than once. Some Doctors use a technique that increases the chance of the ring coming off. This is not a problem and we can easily just convert the procedure into a conventional circumcision. However, please ensure that your Doctor is trained and familiar with how to do a conventional circumcision. Some Doctors are only familiar with using the ShangRIng and have to call for help when the ring slips.
What are the pros and cons of ShangRing Circumcision?
Pros:
1. Fast procedure. It takes only about 15 minutes vs a conventional circumcision that takes 35 to 45 minutes.
2. It can be done in the clinic potentially saving you operating theater fees. That said, conventional circumcisions can be done in the clinic also. So it depends on your medical facility.
3. The final look of the scar is nicer. It does not have the “rail road” appearance of conventional stitching. That said, not everyone heals nicely without scarring regardless of the method used. And also, with new stitching methods, we can achieve a similar final look.
4. It does not require any stitching. I know some patients are terrified of stitches. However with anesthesia in place, you will not feel the stitching anyway. And the stitches we use these days all dissolve on their own and do not need to be removed. Except in unique circumstances where the stitches are for some reason very stubborn.
Cons:
1. It is a “cookie cutter” circumcision. In other words, the amount of skin and the position of the scar is fixed by the ring. You cannot determine how “high” and how “tight” you want the circumcision to be. With conventional circumcisions, we can determine to the millimeter how much skin is to be removed and from where. For example some patients may want to keep more of the inner foreskin. This cannot be achieved with the ShangRing.
2. It takes longer to heal compared to other methods of circumcision.*
3. There is a higher risk of complications like bleeding and pain.*
4. More wound care is required.*
5. The ShangRing method cannot be used for complicated cases like when there are adhesions (i.e. the inner foreskin is stuck to the penis head) or when there is significant balanitits (infection of the foreskin). Also for cases where the foreskin is so tight that it has never been pulled back, the ShangRing method should not be used. This is because the foreskin should be released and pulled back to look for possible complications on the penis head before an actual circumcision is done.
* These statements are statistically true according to scientific studies. However, of course we do not know what is going to happen to individual patients.
My opinions on the ShangRing circumcision
It is a great tool for Doctors with more limited experience in circumcision surgeries. It is technically easier to perform compared to other methods of circumcision and consequently has a lower risk of complications during the surgery.
The first one to two weeks after ShangRing circumcision is also very stable. As long as the ring is on there is no risk of bleeding or the wound opening up.
As the skin starts to separate from the ring is when things may get a bit dicey. This is when complications like bleeding and pain can happen. At this point, many patients request for removal of the ring. The process of ring removal can be quite painful.
Wound healing usually take longer compared to other methods of circumcision like laser.
Personally, I always prefer to use the laser method then stitch the skin close. This requires more surgical experience. But it allows me to determine exactly how much skin is removed and how the final look will be like.
It costs the same as the ShangRing.
The surgery takes slightly longer time compared to the ShangRing but since the patient is either asleep or we use a long acting anesthetic, the patient is completely comfortable during the procedure anyway. So I do not think this makes a big difference.
It heals much faster than the ShangRing. I can confidently discharge the vast majority of patients between 2 to 3 weeks post surgery.
It has a lower risk of post surgical complications compared to the ShangRing.
What do I do if I am considering a ShangRing circumcision?
I would definitely tell you to speak to a Doctor who is familiar with multiple different methods of circumcision. He/She can best advise you on the method that will best suit your needs.
Should you wish to see me please do contact the clinic at:
WhatsApp: +65-97505037
Email: doc@drtanmedicalcenter.com.sg