Plastic surgery abroad - Estonia

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Penis circumcision surgery

Why should you have a circumcision?

Men want to have circumcision for several different reasons:

• medical (e.g. phimosis, paraphimosis, the foreskin is too long etc.),
• religious,
• social,
• personal,
• hygiene reasons.

Phimosis means that the foreskin is unusually tight and cannot be drawn back from the head of the penis. The too tight foreskin can cause painful erections and intercourse. Inflammations are also more likely to occur with foreskin.

The second most common condition is called paraphimosis. Paraphimosis is a medical condition in which case the foreskin becomes trapped behind the glans, and cannot be pulled back to its normal flaccid position covering the glans. Paraphimosis should be treated as a medical emergency, as it can result in gangrene or other serious complications, most commonly just in inflamed, sore and red penis head. Repeated inflammations of the penis and foreskin or tears in the skin are less common reasons for seeing a surgeon.

Other reasons can be religious, social or personal. For example, an excess, too long foreskin that may cause discomfort during sexual intercourse (difficulties in using a condom) or just does not look attractive, can be a reason for circumcision.

Also, it can be performed for hygiene reasons, especially for men working in warm airless conditions, where the risk of getting infections under the foreskin caused by bacteria called smegma is bigger. Smegma is a white cream-like substance that has an unpleasant odour and is formed between the foreskin and the glans.

Before you decide to undergo the surgery, you should make sure you are aware of all the risks and positive outcomes, also possible alternatives, because the foreskin is a part of the body which has been given its own functions by nature and whenever possible, should be left the way it is.

Penis circumcision procedure

The circumcision surgery is rather simple and does not take much time. Genitals are first cleaned with an antiseptic. Complete shaving is not recommended as it increases the risk of infection, but the need may arise to trim the pubic area slightly. Generally the circumcision is performed under local anesthesia with an analgesic injection that is made into the nerves on the back of the penis. Then the patient lies on his back.

When the penis has become numb, the foreskin is gently separated from the penis stem. Thereafter, the foreskin is pulled over the glans, fastened with special forceps and the redundant foreskin is partly or wholly cut off with a scalpel. The wound is sewn up after the removal of the foreskin.

There are many different ways to do circumcision:

• it may be minimal (the foreskin is shortened slightly to enable its movement over the glans; the penis remains functionally and cosmetically uncircumcised),
• partial (the glans is partly uncovered by the foreskin when the penis is slack),
• extensive (the glans is mostly uncovered, but sometimes partly covered with the foreskin; the skin is not too tight and enables some moving in the erectile state),
• medium (most prevalent style, in which case the glans is never covered with the foreskin),
• narrow (the penis stem has little or no free skin, so the glans is protrusive and easily traceable).

Complications due to circumcision are rare and could include hematoma or hemorrhage, bleeding and inflammation, but these complications are avoidable or minimal. Some men have experienced a change in the sensitiveness of their penis, it may have gained or lost sensitivity. The result is that achieving ejaculation might take longer. But it is good news to those men who were suffering from premature ejaculation.

Pre-surgery and post-surgery advice

As with every surgery, you need to consult a surgeon before having circumcision and give him or her the necessary information. You need to provide the surgeon with your medical history, tell him what kind of allergies you have, about whether you have diabetes and the medications you are taking.

During the consultation with a surgeon you should explain in detail the kind of a result you are expecting: complete or partial removal of the foreskin, narrow or wide cut, higher or lower positioning of the scar etc.

It is not necessary to shave completely, but it is recommended to trim the pubic area so that the hair wouldn't cause any problems with the bandage after the surgery. You should pay more attention to hygiene on the day of the surgery. Drinking alcohol is prohibited before the surgery.

The area that was operated on will be inflamed and bruised after the surgery, but this should disappear within a week or two. It may be necessary to take painkillers during the first few days after the surgery. In case of bleeding (can happen within 24 hours after the surgery) a sterile bandage should be applied to the scar for about 10 minutes. You should wear comfortable and loose (not too tight) underwear and clothes after the surgery, so that you wouldn't cause any traumas to the area that was operated on.

During the recovery period (in average 3 weeks) you should avoid strenuous activities such as sports and the like. Sexual intercourse should be abstained from until the wound has completely healed. Erection can be painful and cause the sutures to break unless absorbable sutures are used. The stitches will be removed usually after 2 weeks time.

Taking care of your penis

Whether you have had circumcision or not, you should always take care of this part of your body. You should pay extra attention to everyday hygiene. In case the foreskin is too tight (phimosis), it hinders the washing and that can lead to inflamed foreskin due to bacteria that might grow there if you don't wash it often enough.

Circumcision can, therefore, be a solution for maintaining perfect hygiene. However, until the boy is 3-years-old it is impossible to clean the under-foreskin area due to the condition called physical phimosis, which will withdraw usually when the child has reached school age. The foreskin should never be pulled back forcibly. If it is still hard or impossible to draw the foreskin back from the head of the penis, it is definitely necessary to visit a doctor.

One can have phimosis from birth, or it can develop later in life as a result of recurrent foreskin inflammation. It is often helpful to try to stretch the foreskin carefully to make its entrance wider. The other option is to see a professional to discuss surgery.

Circumcision has many advantages:

• it makes it simpler to keep good hygiene,
• it can save from painful erection,
• can help avoid diseases, such as infections in urinary tract, penis cancer and risk of sexually transmitted diseases,
• helps to avoid the warmer and moist environment, which creates a perfect environment for the infection and its incubation under the foreskin.

The head of the penis can be more sensitive after removing the foreskin, but this will decrease in time, since the glans will become thicker to protect it from rubbing and irritations. Therefore it might take longer to ejaculate than before. In any case you should consider both the advantages and disadvantages before having circumcision.