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Frequently asked questions about Circumcision

Read the answers given by Dr. Mihai Chertif to the most common questions of the patients of the Cosmedica clinic about the Circumcision procedure.

1. I read on your website and on other websites that this operation would be the oldest described in the world. If so, it should be a simple operation. What does circumcision involve?

– Yes indeed. Circumcision would be the oldest operation described. It is recognized especially by the peoples of the Mosaic or Islamic religion, who have been practicing this operation on newborns for several days. Some link it to faith, others to a custom that has been around for hundreds of thousands of years. Personally, I believe that this operation has been performed for thousands of years due to the infectious complications that appeared due to the lack of hygiene and access to water in certain regions. These occurred especially in patients who had a partial or complete phimosis and could not decal the glans and thus wash the area of ​​the glans, coronal groove and internal foreskin in which to collect secretions from the internal foreskin and coronal groove. These secretions became infected and produced balanitis and balanoitis. Since the skin of the foreskin is sometimes very long, the decision was to remove it and thus circumcision was born. Jews or Muslims have tried to enforce a law of religion to make sure that all men will be circumcised and that no one will have problems with the infection in that area. Throughout the generations, it has remained a tradition that is strictly respected even today.

Therefore, circumcision involves the complete or partial removal of the foreskin (the skin that covers the glans). The reasons may be related to the existence of a phimosis (the foreskin is completely narrowed), a paraphimosis (the foreskin is partially narrowed and sometimes recalibration is extremely difficult in erection – this condition in extreme situations can cause necrosis of the glans and requires emergency surgical decompression ), for religious purposes, for hygienic purposes (to prevent inflammation of the foreskin), to prevent penile cancer (if Quyerat’s erythroplasia occurs – premalignant condition, or any other fungal or premalignant pathology of the glans), to reduce the risk of transmitting diseases sexual.

Even though it is the oldest operation described in the world, sometimes it is not a simple operation, especially if it is not performed by someone with experience. The surgical specialties she practices are urology, plastic surgery or general surgery. We, as plastic surgeons, always try to offer the aesthetic facet of any operation, and circumcision is no better than that.


2. What preoperative preparation does circumcision require?

– Before surgery, we instruct patients to collect a set of blood and urine tests that are standard for any surgery in the intimate area. If the hair is excessive, we recommend that patients remove it or reduce it by epilation. It is very important that the urine and urine culture examination be taken seriously because a urinary tract infection can cause quite serious complications manifested by suture dehiscence and vicious scarring, which further leads to pain and abnormal positions of the erect penis.


3. When do you recommend circumcision surgery? Is it good for all men? I have seen some peoples do it a few days after birth. Why isn’t it done for everyone?

– As I mentioned above, in the Mosaic or Islamic peoples, circumcision is done a few days after birth. I think they do it now as a tradition or a habit already well rooted in their faith that is related to religion, but I am firmly convinced that it was linked to hygiene a few thousand years ago and the limited possibilities for proper hygiene. In Romania, there are many opinions and myths related to circumcision, but my opinion is that it is better without a foreskin than with. There are many more long-term benefits than disadvantages.


4. What anesthesia does circumcision require?

– We usually perform circumcision with local anesthesia combined with deep sedation to increase the comfort of our patients but it can be performed very well only with local anesthesia.


5. What complications can occur after circumcision surgery?

– The main complication to consider is hematoma . This means an accumulation of excess blood under the skin of the penis that occurs due to an aberrant blood vessel that has been sectioned and neglected, which during the operation did not bleed or raise suspicions. After surgery due to increased blood pressure that blood vessel may Excessive bleeding and this can cause an sometimes impressive amount of blood to build up under the skin of the penis, which requires surgery to loosen the suture, remove the blood clots and stop the bleeding. However, it happens very rarely, but most often in the case of adults because here the blood vessels are quite large. Another complication can be related to infection , which must be taken into account as in any operation, but which still happens very rarely.

Another complication, which is much more serious, is paraphimosis (the penis can be decaled but can not be recalibrated once the erection is installed) – if the skin and the narrow ring have not been removed enough which caused a narrowing of the foreskin circumference remained in place. It only happens if the surgeon has no experience.

Another complication that must always be prevented, we consider the most important, is if a large portion of the skin is removed, so that in case of erection the corpora cavernosa can not expand enough and there is pain and bending of the penis in the ventral portion. This condition is quite difficult to treat, through reconstructive operations that involve flaps in the tissues of the neighborhood and usually require multiple operating times.


6. I read in some publications that there are many types of circumcision. What do you think is the best experience?

– The question is not very concrete, but I will try to detail. As a classification, we can divide the circumcision operation from the technical point of view into: total circumcision (removing the foreskin completely, but not passing with the proximal excision of the coronal groove when the penis is relaxed) or partial (removing only the narrowed portion) and a functional circumcision (due to a complete or partial phimosis or due to the improvement of the quality of sexual contact) or aesthetic (due to aesthetic reasons due to a hypertrophy of the foreskin). As a type of technique, there is the option of using suture to stabilize the skin or by using the ring that will be removed once the distal portion of the foreskin self-necrosis.

Personally, I prefer the technique of total circumcision with the restoration of the balano-preputial groove with the stabilization of the skin by suture which will be absorbed in the first 2-3 weeks. In the end, any technique is good as long as some of the essentials and essential conditions listed above are followed. On the other hand, it also depends on the patient’s preference, especially if he can see several variants.


7. Is it true that there is a relationship between circumcision and the quality of intimate contact? Can circumcision help increase the length of the orgasm?

– Yes, it is true. There is a theory that involves desensitizing the glans due to the removal of the foreskin that previously covered it and thus its entry into permanent contact with the underwear, will partially amputate the sensitive nerve endings in the glans. Thus, the period of obtaining arousal and also of orgasm can be prolonged. I think this is just a theory, quite logical and very beneficial for many patients, but not for all. That is why it is good to know that, paradoxically, there are some patients who report an increase in sensitivity in the glans after circumcision, which is difficult to explain. In the vast majority of cases, circumcision can provide an intimate benefit.


8. If I have a partial or complete phimosis and I don’t want to go for circumcision, what can happen in the long run?

– If the phimosis is partial and there are no phenomena of paraphimosis in the erection, there is the option to delay the circumcision operation, especially depending on the patient’s preference. However, if there is a complete phimosis, we are talking about a medical indication for circumcision. It is not normal for the glans to be covered all the time, without the possibility of proper hygiene of the gland, the coronal groove and the foreskin, because the secretions that are normal to accumulate in the coronal groove can cause repeated inflammation that in the long run does not are beneficial. These inflammations can cause changes in the structure of the epithelium of the coronary duct mucosa and the glans, and Quyerat’s erythroplasia can occur, which is a precursor to penile cancer. Circumcision eliminates almost 100% of these inflammations and considerably reduces the risk of penile cancer and the risk of developing sexually transmitted diseases.


9. Can circumcision be combined with dorsal elongation, ventral circumcision, suprapubic liposuction, and fat thickening if I want to do them all in one operation?

– Circumcision can be combined with elongation procedures and suprapubic liposuction, but not with thickening with its own fat, due to the risk of infection. Even if a very tight suture is performed, the risk of an increase in subcutaneous pressure during an erection that will lead to a hint of fat through the suture trance is very high. Once the fat is discharged even in a small amount through the suture, it can cause an infection through contact with the outside, which can spread to the entire amount of subcutaneous fat.


10. What is the cost of circumcision?

– The standard cost of the circumcision operation is 1000 euros fully included with 1 day of accommodation and all controls until healing. Priv. Mihai Chertif

Cosmedica Clinic
Baia Mare
Plastic Surgery & Aesthetics

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