Circumcision styles

The high/low style is a way of stating how much inner skin is removed. The loose/tight style is a way of stating how much outer skin is removed. These styles are almost totally independent, hence there are four circumcision styles:

  • Low and Loose
  • Low and Tight
  • High and Loose
  • High and Tight

Dr Khan can discuss the characteristics of high and low cut, tight and loose cut types or styles of circumcision.

 1.     High and low “cut” circumcision

This concept is due to the scar line from the groove (sulcus) of the head of the penis (corona of the glans) and also depends upon how much inner skin called mucusa is removed. High “cut” means excess outer skin along with shaft of penile skin is cut, leaving long inner skin. Low “cut” means to cut more inner skin so that the scar line is very close to groove of the head of the penis. Some men think completely opposite to this concept. They may think “cut” or scar line is taken in relation to the base of the penis.  These high or low styles are not possible in all men. To put a scar line in the middle of the shaft or close to the base of the penis is not recommended as it leaves too long inner skin which can swell up due to lymphatic drainage (lymphoedema) and also over time, the inner skin stretches to become a loose fold of skin which gives unsatisfactory results in the long term. This also involves cutting too much shaft of penile skin.

2.     Tight versus loose circumcision

This might depend upon many factors such as how much total foreskin is removed, the mobility of penile shaft skin and attachment of the skin at the base of the penis at the abdomen (penoscrotal junction). Tightness of skin around the penis is sometimes not possible, no matter how much foreskin is removed during the circumcision. This is due to loose attachment of skin at the base of the penis to the body at penoscrotal junction. This might be caused by congenital reasons or the aging process. Tight circumcision should not be confused with quality of erection which depends upon many factors. Erection is not affected by circumcision. Loose circumcision may also be similar to partial circumcision. These concepts should be taken according the flaccid and erect state of the penis. Tight circumcision is not possible for those who have a considerable difference in size between fully flaccid and fully erect penis. They may  have a painful erection during sexual activity in first 3-6 months  if a tight circumcision is performed.

 

American Urologist Dr. Eid described on his website about “Cosmetic Circumcision” where he cut the sleeve of skin at base of penis leaving whole inner skin  

However, in Dr Eid experience , great care has been taken so that during an erection, the penis has an excellent cosmetic appearance. For that reason prior to the removal of skin, an artificial erection is induced in all patients so as to precisely determine the amount of skin to be excised. In addition of experiencing improved hygiene and self-esteem, after having a cosmetic circumcision patients are very pleased with the appearance of their penis.

In Dr Khan view, this can be done in very selective number of patients. There are following conditions required to achieve good outcome: 

1. Penoscrotal junctions has to be fixed  

2. There must be loose foreskin which can easily retract behind the head of penis  

3. There must not be in form of buried penis  

4. There is no pathological phimosis ( tight foreskin)  

5. There should not be BXO  

6. It needs to have general anesthedsia for get artificial erection to see for adequate removal of skin from base of the penis ( see photo)  

 

Ref:

1. http://www.circlist.com/styles/page1.html#terminology

2. https://www.urologicalcare.com/cosmetic-penile-surgery/cosmetic-circumcision/

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Cosmetic Circumcision from Dr. Eid website.  

Benefits Of Circumcision

Circumcision is a common procedure with minimum risks of complications by trained professional doctors. There are different opinions whether there is a need for a male to be circumcised.

Many medical studies and research showed that boy under 1 year is an optimal time for clinical circumcision. In our experience ideal age of circumcision is in babies under 4 weeks because a baby’s low movement facilitates the use of local anesthesia, usually sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal in this age group (ranges from £250) , and risks of complications are uncommon. Infant circumcision is safe, simple, convenient and cost-effective procedure.

The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis (tight foreskin) and paraphimosis ( foreskin stuck behind the head of penis)

When the men later becomes sexually active he has substantial protection by circumcision against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced.

Tight foreskin in adolescence or adulthood may evoke a fear of pain, sexual pain or reduced sexual pleasure. Tight foreskin may be due  Balanitis Xerotica Obliterans (BXO) which may required  circumcision. Balanitis Xerotica Obliterans (BXO) is a penile skin condition which affects the foreskin, It may also affect the rounded head of the penis (called the ‘glans penis’) and, less commonly, the urethra (the tube which carries the urine from the bladder out of the body).

In BXO there is long term (chronic) inflammation of the glans penis; referred to as ‘balanitis’.  Patches (called lesions) appear on the affected skin which have an abnormally dry appearance (referred to as ‘xerotica’) and are seen as white, thickened plaques.  Lesions start in the foreskin but then can extend to the surface of the skin on the glans penis causing the involved areas of skin to fuse together.  As a result, the foreskin can become firmly adhered to the glans so retracting the foreskin (pulling it back) becomes difficult or impossible. This is called phimosis. Issues or concerns passing urine, painful erection and tight foreskin.

In summary, circumcision is the procedure which can be done under anesthesia with minimum risks of complications by professional trained doctors.

Ref:  surgical guide for circumcision 2012 DOI 10.1007/978-1-4471-2858-82

 

Circumcision In Islam

Circumcision in Muslium community

1. Introduction:

Circumcision is a universal practice that is greatly influenced by cultural and religious traditions. It is the most frequent operation on males.

Prophet Sunnah:

This practice is attributed to the Prophet Muhammad (pbuh).

Therefore, circumcision acquired the status of Sunnah (Prophet’s tradition), although the tradition is attributed to the Prophet Abraham. Allah ordered Prophet Muhammad (pbuh) to follow the religion of Abraham (pbuh). When Allah says “Then we inspired you: ‘Follow the religion of your father Abraham, the upright in Faith.’ (Qur’an 16:123)”; and, thus, part of the religion of Abraham is circumcision.

The Prophet Muhammad (pbuh) narrated  in authenticated books - Bukhari and Muslim: “The Prophet Abraham circumcised himself when he was eighty years old”.

2. Male circumcision is part of the fitrah (in Arabic).

Prophet Muhammad (pbuh) said: “Five are the acts to fulfil to fitrah: Circumcision, clip ping or shaving the pubes, clipping of the nails, plucking or shaving the hair under the armpits, and clipping (or shaving) the moustache.” mentioned in books of Bukhari and Muslim.

The act of circumcision is referred to in Arabic as Taharah which translates to cleanliness, virtue, or purity.

Furthermore, the performance of circumcision as recommended in Islam is medically beneficial and reflects the wisdom of the Islamic statements.

3. Age of circumcision:

The Prophet Muhammad recommended performing circumcision at an early age. During the time of the Prophet Muhammad (pbuh) circumcision was done for boys at the time of their Aqiqah (traditional celebration for the birth of a child which involves the sacrifice of an animal in thanks to Allah). The Prophet (pbuh) performed the Aqiqah of al-Hasan and al-Hussein (the prophet’s grand- sons) and circumcised them on the seventh day as related in al-Bayhaqi and Tabarani. If it is essential, circumcision can be delayed for medical reasons. Our audits showed that ideal age of baby circumcision is under 4 weeks old  newborn.

The prevalent practice in modern-day Egypt as well as the majority of the Muslim world is that children born in hospitals are circumcised before discharge. In Saudi Arabia, male well babies are circumcised on day 3  

4. Male Circumcision in Islamic community in UK

Sunnah represents an accepted basis for the derivation of religious law.

I recommend we should circumcise all male well newborn within 4 weeks of life to get best results and minimum complication unless there is medical reasons not to have circumcision

5. Medical benefits about circumcision

The higher prevalence of Urinary tract infections in uncircumcised boys under 1 year old boys has been well documented in many studies.

Research  in sexual transmitted diseases including HIV that examined 26 research articles (from the USA, UK, Australia, Africa, India, and Peru) found circumcision protected against these diseases and  lower in circumcised men. Medical studies has proven that lack of circumcision increases the risk of inflammation of the glans (balanitis) and foreskin (posthitis) die to tight foreskin (phimosis ) In boys the incidence in the uncircumcised is twice as high as in those who are circumcised.

In summary , circumcision has recommended by Prophet and also has a medical advantages.

Dr. A R Khan

Modified Dates 6/4/19

Ref:  surgical guide for circumcision2012 DOI 10.1007/978-1-4471-2858-8

Doctor talking with young mother in the clinic