Difference between revisions of "Circumcision scar"

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[[File:Circumcised_flaccid.jpg|thumb|Penis with a visible circumcision scar]]
 
[[File:Circumcised_flaccid.jpg|thumb|Penis with a visible circumcision scar]]
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In males who have been circumcised, the '''circumcision scar''' refers to the [[scar]] after a [[circumcision]] has healed.  In some cases, the scar can be darker-colored, and, in all cases, it will encircle the shaft of the [[penis]].
+
In males who have been [[circumcised]], the '''circumcision scar''' refers to the scar remaining after a [[circumcision]] has healed.  In some cases, the scar can be darker-colored,<ref name="tirana2022">{{REFjournal
 +
|last=Tirana
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|first=
 +
|init=R
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|author-link=
 +
|last2=Othman
 +
|first2=
 +
|init2=D
 +
|author2-link=
 +
|last3=Gad
 +
|first3=
 +
|init3=D
 +
|author3-link=
 +
|last4=Eisadek
 +
|first4=
 +
|init4=M
 +
|author4-link=
 +
|last5=Fahmy
 +
|first5=
 +
|init5=MAB
 +
|author5-link=Mohamed A Baky Fahmy
 +
|etal=no
 +
|title=Pigmentary complications after non-medical male circumcision
 +
|trans-title=
 +
|language=
 +
|journal=BMC Urol
 +
|location=
 +
|date=2022-04-04
 +
|volume=22
 +
|issue=1
 +
|article=50
 +
|page=
 +
|pages=
 +
|url=https://bmcurol.biomedcentral.com/articles/10.1186/s12894-022-00999-5
 +
|archived=
 +
|quote=In a survey completed by the [[15 Square| National Organization of Restoring Men]] in the UK, 74% of the respondents were dissatisfied with the appearance of their circumcised penises, and 26% complained about the variation in skin color.
 +
|pubmedID=35379191
 +
|pubmedCID=8981744
 +
|DOI=10.1186/s12894-022-00999-5
 +
|accessdate=2023-11-07
 +
}}</ref> and, in all cases, it will encircle the shaft of the [[penis]].
  
 
==Appearance==
 
==Appearance==
−
The scar, which completely encircles the shaft of the penis, is located at the boundary of the shaft skin and the inner [[foreskin]] remnant, which is the portion of the foreskin that was not removed during circumcision. This foreskin remnant is mucosa that lies between the glans and the circumcision scar, which results in dissimilar tissue healing together. In adult circumcision part of the [[frenulum]] may remain intact. The foreskin remnant is dried mucosa and can often have a different color and texture than the rest of the penile skin. It can be pinkish or light-colored, and it typically becomes covered with keratin to protect it from a dry environment. Some circumcision scars result in a marked color difference on the shaft.
+
The scar, which completely encircles the shaft of the [[penis]], is located at the boundary of the [[shaft skin]] and the inner [[foreskin]] remnant, which is the portion of the [[foreskin]] that was not removed during [[circumcision]]. This foreskin remnant is [[preputial mucosa]] that lies between the [[glans]] and the circumcision scar, which results in dissimilar tissue healing together. In [[adolescent and adult circumcision]] part of the [[frenulum]] may remain [[intact]]. The foreskin remnant is dried [[mucosa]] and can often have a different color and texture than the rest of the [[penile skin]]. It can be pinkish or light-colored, and it typically becomes covered with [[keratin]] to protect it from a dry environment. Some circumcision scars result in a marked color difference on the shaft and a two-toned appearance.<ref name="tirana2022" />
  
−
The characteristics of the circumcision scar often depend on the technique that was used. Open surgical techniques using sutures may cause uneven scarring where the sutures were placed. Newborn circumcisions do not require sutures and therefore can result in a fine, even scar.<ref name="Infant">{{Cite conference| publisher = World Health Organization| title = Manual for early infant male circumcision under local anaesthesia|url=http://apps.who.int/iris/bitstream/10665/44478/1/9789241500753_eng.pdf| location = Geneva| date = 2010}}</ref> Circumcisions after the newborn period that are performed without sutures (techniques that use cyanoacrylate tissue adhesive instead of sutures and techniques like Plastibell that heal by secondary intention) often result in an even, circumferential scar.
+
The characteristics of the circumcision scar often depend on the technique that was used. Open surgical techniques using sutures may cause uneven scarring where the sutures were placed. Newborn circumcisions do not require sutures and therefore may result in a fine, even scar, but may also result in adhesions and [http://www.circumstitions.com/Restric/Botched1sb.html skin bridges].<ref name="gracely-kilgore1984">{{REFjournal
 +
|last=Gracely-Kilgore
 +
|first=Katherine A.
 +
|init=KA
 +
|author-link=
 +
|etal=no
 +
|title=Penile adhesion: the hidden complication of circumcision
 +
|trans-title=
 +
|language=
 +
|journal=Nurse Pract
 +
|date=1984
 +
|volume=9
 +
|issue=5
 +
|pages=22-4
 +
|url=http://www.cirp.org/library/complications/gracely1/
 +
|quote=
 +
|pubmedID=6728346
 +
|pubmedCID=
 +
|DOI=
 +
|accessdate=2019-10-19
 +
}}</ref> <ref>{{REFjournal
 +
|last=Ponsky
 +
|init=LE
 +
|author-link=
 +
|last2=Ross
 +
|init2=JH
 +
|author2-link=
 +
|last3=Knipper
 +
|init3=N
 +
|author3-link=
 +
|last4=Kay
 +
|init4=R
 +
|author4-link=
 +
|etal=no
 +
|title=Penile adhesions after neonatal circumcision
 +
|trans-title=
 +
|language=
 +
|journal=J Urol
 +
|date=2000
 +
|volume=
 +
|issue=
 +
|pages=
 +
|url=http://www.cirp.org/library/complications/ponsky2/
 +
|quote=
 +
|pubmedID=10893633
 +
|pubmedCID=
 +
|DOI=
 +
|accessdate=2019-10-19
 +
}}</ref> Circumcisions after the newborn period that are performed without sutures (techniques that use cyanoacrylate tissue adhesive instead of sutures and techniques like [[Plastibell]] that heal by secondary intention) often result in an even, circumferential scar.
 +
 
 +
Non-surgical [[foreskin restoration]] will eventually result in the scar being concealed within the new [[restored foreskin]].
  
 
==Problems with the scar==
 
==Problems with the scar==
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There is some controversy as to what happens to the severed nerves of the foreskin at the scar. Xin ''et al''. (1997) suggest that nerves regenerate, forming new receptors.<ref>{{vcite journal|author=Xin ZC, Choi YD, Rha KH, Choi HK|title=Somatosensory evoked potentials in patients with primary premature ejaculation |journal|journal=J Urol|date=1997|volume=158|issue=2|pages=451–7|url=|doi=10.1016/S0022-5347(01)64499-9|pmid=9224321|pmc=}}</ref> However, pathologists Cold & Taylor (1999) report: "Histology of the male circumcision scar shows amputation neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. Amputation neuromas do not mediate normal sensation and are notorious for generating pain."<ref name="cold-taylor1999">{{REFjournal
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<!--There is some controversy as to what happens to the severed nerves of the foreskin at the scar. Xin et al. (1997) suggest that nerves regenerate, forming new receptors.<ref name="Xin1997">{{REFjournal
 +
|last=Xin
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|init=ZC
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|author-link=
 +
|last2=Choi
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|init2=YD
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|author2-link=
 +
|last3=Rha
 +
|init3=KH
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|author3-link=
 +
|last4=Choi
 +
|init4=HK
 +
|author4-link=
 +
|etal=no
 +
|title=Somatosensory evoked potentials in patients with primary premature ejaculation
 +
|trans-title=
 +
|language=
 +
|journal=J Urol
 +
|date=1997
 +
|volume=158
 +
|issue=2
 +
|pages=451-7
 +
|url=
 +
|quote=
 +
|pubmedID=9224321
 +
|pubmedCID=
 +
|DOI=10.1016/S0022-5347(01)64499-9|
 +
|accessdate=2019-10-18
 +
}}</ref>-->Pathologists Cold & Taylor (1999) report: "Histology of the male circumcision scar shows [[amputation]] neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. Amputation neuromas do not mediate normal sensation and are notorious for generating pain."<ref name="cold-taylor1999">{{REFjournal
 
  |last=Cold
 
  |last=Cold
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  |first=C.J.
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  |init=CJ
−
  |author-link=
+
  |author-link=Christopher J. Cold
 
  |last2=Taylor
 
  |last2=Taylor
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  |first2=J.R.
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  |init2=JR
 
  |title=The prepuce
 
  |title=The prepuce
 
  |trans-title=
 
  |trans-title=
Line 30: Line 147:
 
  |DOI=10.1046/j.1464-410x.1999.0830s1034.x  
 
  |DOI=10.1046/j.1464-410x.1999.0830s1034.x  
 
  |accessdate=2019-10-10
 
  |accessdate=2019-10-10
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}}</ref> Three cases of penile cancer have occurred on the scar.<ref>{{cite journal |last1=Fetsch |first1=JF |last2=Davis CJ |first2=Jr |last3=Miettinen |first3=M |last4=Sesterhenn |first4=IA |title=Leiomyosarcoma of the penis: a clinicopathologic study of 14 cases with review of the literature and discussion of the differential diagnosis. |journal=The American Journal of Surgical Pathology |date=January 2004 |volume=28 |issue=1 |pages=115–25 |pmid=14707873|doi=10.1097/00000478-200401000-00014 |url=https://zenodo.org/record/1234754 }}</ref>
+
}}</ref> Several reports of cancer forming on the circumcision scar have been published.<ref>{{REFjournal
 +
|last=Bissada
 +
|init=NK
 +
|author-link=
 +
|last2=Morcos
 +
|init2=RR
 +
|author2-link=
 +
|last3=el-Senoussi
 +
|init3=M
 +
|author3-link=
 +
|etal=no
 +
|title=Post-circumcision carcinoma of the penis. I. Clinical aspects.
 +
|trans-title=
 +
|language=
 +
|journal=J Urol
 +
|date=1986-02
 +
|volume=35
 +
|issue=2
 +
|pages=282-5
 +
|url=http://www.cirp.org/library/disease/cancer/bissada1/
 +
|quote=
 +
|pubmedID=3944860
 +
|pubmedCID=
 +
|DOI=10.1016/s0022-5347(17)45614-x
 +
|accessdate=2019-10-18
 +
}}</ref> <ref>{{REFjournal
 +
|last=Fetsch
 +
|init=J
 +
|author-link=
 +
|last2=Davis
 +
|init2=CJ
 +
|author2-link=
 +
|last3=Miettinen
 +
|init3=M
 +
|author3-link=
 +
|last4=Sesterhenn
 +
|init4=IA
 +
|author4-link=
 +
|etal=no
 +
|title=Leiomyosarcoma of the penis: a clinicopathologic study of 14 cases with review of the literature and discussion of the differential diagnosis
 +
|trans-title=
 +
|language=
 +
|journal=
 +
|date=2004-01
 +
|volume=28
 +
|issue=1
 +
|pages=115-25
 +
|url=https://zenodo.org/record/1234754
 +
|quote=
 +
|pubmedID=14707873
 +
|pubmedCID=
 +
|DOI=10.1097/00000478-200401000-00014
 +
|accessdate=2019-10-19
 +
}}</ref>
  
−
==Additional images==
+
The circumcision scar may tighten up in front of the [[glans penis]], trapping it, and cause iatrogenic secondary [[phimosis]].<ref>{{REFjournal
 +
|last=Redman
 +
|first=
 +
|init=JF
 +
|author-link=
 +
|last2=Scriber
 +
|first2=
 +
|init2=LJ
 +
|author2-link=
 +
|last3=Bissada
 +
|first3=
 +
|init3=NK
 +
|author3-link=
 +
|etal=no
 +
|title=Postcircumcision phimosis and its management
 +
|trans-title=
 +
|language=
 +
|journal=Clin Pediatr (Phila).
 +
|location=
 +
|date=1975-04
 +
|season=
 +
|volume=14
 +
|issue=4
 +
|article=
 +
|page=
 +
|pages=407-9
 +
|url=
 +
|archived=
 +
|quote=
 +
|pubmedID=1120386
 +
|pubmedCID=
 +
|DOI=10.1177/000992287501400415
 +
|accessdate=2022-05-26
 +
}}</ref><ref>{{REFjournal
 +
|last=Blaylock
 +
|first=
 +
|init=HJ
 +
|author-link=
 +
|last2=Vemulakonda
 +
|first2=
 +
|init2=V
 +
|author2-link=
 +
|last3=Ritchey
 +
|first3=
 +
|init3=ML
 +
|author3-link=
 +
|last4=Ribbeck
 +
|first4=M
 +
|init4=
 +
|author4-link=
 +
|etal=no
 +
|title=Outpatient Management of Phimosis Following Newborn Circumcision
 +
|trans-title=
 +
|language=
 +
|journal=J Urol
 +
|location=
 +
|date=2003-06
 +
|season=
 +
|volume=159
 +
|issue=5
 +
|article=
 +
|page=
 +
|pages=2332-4
 +
|url=http://www.cirp.org/library/complications/blalock1/
 +
|archived=
 +
|quote=
 +
|pubmedID=12771793
 +
|pubmedCID=
 +
|DOI=10.1097/01.ju.0000067602.42875.d8
 +
|accessdate=2022-05-26
 +
}}</ref>
 +
 
 +
== Additional images ==
 
<gallery>
 
<gallery>
 
File:Circumcisedtwice.jpg|Two toned circumcision scar on an erect penis
 
File:Circumcisedtwice.jpg|Two toned circumcision scar on an erect penis
−
File:Justin Roger Hayes - Gomco clamp scar.jpg|Distinctive brown ring scar resulting from neonatal circumcision using the [[Gomco clamp]] method
+
File:Justin Roger Hayes - Gomco clamp scar.jpg|Distinctive brown ring scar resulting from neonatal circumcision using the [[Gomco|Gomco clamp]] method
 
File:Circumcision Scar.jpg|Errors in circumcision may cause uneven scarring
 
File:Circumcision Scar.jpg|Errors in circumcision may cause uneven scarring
 
File:Adult circumcision before and after (2).jpg|Before and after
 
File:Adult circumcision before and after (2).jpg|Before and after
Line 42: Line 284:
 
</gallery>
 
</gallery>
  
−
==References==
+
{{SEEALSO}}
−
{{reflist}}
+
* [[Adult circumcision]]
 +
* [[Cicatrix]]
 +
* [[Circumcision scar removal]]
 +
* [[Keratinization]]
 +
* [[Traumatic neuroma]]
 +
 
 +
{{LINKS}}
 +
* {{REFweb
 +
|url=http://covenantcircumcision.info/pages/scarring.html
 +
|title=Some photos enlarged to show detail
 +
|last=
 +
|first=
 +
|init=
 +
|publisher=Covenant circumcision
 +
|date=
 +
|accessdate=2023-08-22
 +
}}
 +
See page 100 ''et seq''.:
 +
* {{REFbook
 +
|last=Fahmy
 +
|first=Mohamed
 +
|init=M
 +
|author5-link=Mohamed A Baky Fahmy
 +
|year=2009
 +
|title=Complications in Male Circumcision
 +
|url=http://circumcisionharm.org/images-circharm.org/Fahmy%20Ch%2010,%2011,%20title,%20TofC.pdf
 +
|page=193
 +
|isbn=978-0-323-68127-8
 +
|accessdate=2020-06-23
 +
}}
 +
 
 +
{{REF}}
  
−
[[Category:Cosmetic surgery]]
 
 
[[Category:Circumcision]]
 
[[Category:Circumcision]]
−
[[Category:Penis]]
+
[[Category:Genital cutting]]
−
[[Category:Human male reproductive system]]
+
[[Category:Genital surgery]]
 +
[[Category:Male circumcision]]
 +
 
 +
[[de:Beschneidungsnarbe]]

Latest revision as of 00:14, 23 December 2023

IntactiWikiGraphicWarning.png

Penis with a visible circumcision scar

In males who have been circumcised, the circumcision scar refers to the scar remaining after a circumcision has healed. In some cases, the scar can be darker-colored,[1] and, in all cases, it will encircle the shaft of the penis.

Appearance

The scar, which completely encircles the shaft of the penis, is located at the boundary of the shaft skin and the inner foreskin remnant, which is the portion of the foreskin that was not removed during circumcision. This foreskin remnant is preputial mucosa that lies between the glans and the circumcision scar, which results in dissimilar tissue healing together. In adolescent and adult circumcision part of the frenulum may remain intact. The foreskin remnant is dried mucosa and can often have a different color and texture than the rest of the penile skin. It can be pinkish or light-colored, and it typically becomes covered with keratin to protect it from a dry environment. Some circumcision scars result in a marked color difference on the shaft and a two-toned appearance.[1]

The characteristics of the circumcision scar often depend on the technique that was used. Open surgical techniques using sutures may cause uneven scarring where the sutures were placed. Newborn circumcisions do not require sutures and therefore may result in a fine, even scar, but may also result in adhesions and skin bridges.[2] [3] Circumcisions after the newborn period that are performed without sutures (techniques that use cyanoacrylate tissue adhesive instead of sutures and techniques like Plastibell that heal by secondary intention) often result in an even, circumferential scar.

Non-surgical foreskin restoration will eventually result in the scar being concealed within the new restored foreskin.

Problems with the scar

Pathologists Cold & Taylor (1999) report: "Histology of the male circumcision scar shows amputation neuromas, Schwann cell proliferation and the bulbous collection of variably sized neurites. Amputation neuromas do not mediate normal sensation and are notorious for generating pain."[4] Several reports of cancer forming on the circumcision scar have been published.[5] [6]

The circumcision scar may tighten up in front of the glans penis, trapping it, and cause iatrogenic secondary phimosis.[7][8]

Additional images

  • Two toned circumcision scar on an erect penis

  • Distinctive brown ring scar resulting from neonatal circumcision using the Gomco clamp method

  • Errors in circumcision may cause uneven scarring

  • Before and after

  • Excised frenulum on a circumcised penis

  • Frenulum remnant and scar from a Gomco clamp circumcision of a 34 year old male

    Frenulum remnant and scar from a Gomco clamp circumcision of a 34 year old male

See also

External links

See page 100 et seq.:

References

  1. ↑ a b REFjournal Tirana R, Othman D, Gad D, Eisadek M, Fahmy MAB. Pigmentary complications after non-medical male circumcision. BMC Urol. 4 April 2022; 22(1): [50]. PMID. PMC. DOI. Retrieved 7 November 2023.
    Quote: In a survey completed by the National Organization of Restoring Men in the UK, 74% of the respondents were dissatisfied with the appearance of their circumcised penises, and 26% complained about the variation in skin color.
  2. ↑ REFjournal Gracely-Kilgore KA. Penile adhesion: the hidden complication of circumcision. Nurse Pract. 1984; 9(5): 22-4. PMID. Retrieved 19 October 2019.
  3. ↑ REFjournal Ponsky LE, Ross JH, Knipper N, Kay R. Penile adhesions after neonatal circumcision. J Urol. 2000; PMID. Retrieved 19 October 2019.
  4. ↑ REFjournal Cold CJ, Taylor JR. The prepuce. BJU Int. 1 January 1999; 83 Suppl 1: 34-44. PMID. DOI. Retrieved 10 October 2019.
  5. ↑ REFjournal Bissada NK, Morcos RR, el-Senoussi M. Post-circumcision carcinoma of the penis. I. Clinical aspects.. J Urol. February 1986; 35(2): 282-5. PMID. DOI. Retrieved 18 October 2019.
  6. ↑ REFjournal Fetsch J, Davis CJ, Miettinen M, Sesterhenn IA. Leiomyosarcoma of the penis: a clinicopathologic study of 14 cases with review of the literature and discussion of the differential diagnosis January 2004; 28(1): 115-25. PMID. DOI. Retrieved 19 October 2019.
  7. ↑ REFjournal Redman JF, Scriber LJ, Bissada NK. Postcircumcision phimosis and its management. Clin Pediatr (Phila).. April 1975; 14(4): 407-9. PMID. DOI. Retrieved 26 May 2022.
  8. ↑ REFjournal Blaylock HJ, Vemulakonda V, Ritchey ML, Ribbeck, M. Outpatient Management of Phimosis Following Newborn Circumcision. J Urol. June 2003; 159(5): 2332-4. PMID. DOI. Retrieved 26 May 2022.
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