Circumcision methods: Difference between revisions

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[[Circumcision]] is performed in many ways which vary by culture, the person performing it, and the age of the subject. It may be performed by a specialized ritual circumciser in a non-medical setting, or a medical practitioner at a hospital or clinic. In some cultures, only the protruding end of the [[foreskin]] is cut off, and in others, the entire foreskin which covers the [[glans]] is removed. Some circumcisers take more [[skin]] than others, resulting in a "loose" or "tight" circumcision.

Generally, the foreskin is pulled forward and enough of it is removed to permanently expose the glans of the penis. Sometimes a protective device is used to avoid hurting the glans, and sometimes the circumciser simply performs the procedure freehand. In adults, stitches are used to stop the bleeding and help close the wound. In infants, circumcisers often use a clamp that crushes the foreskin and seals the wound, eliminating the need for stitches.

Generally, the [[foreskin]] is pulled forward and enough of it is removed to permanently expose the [[glans]] of the [[penis]]. Sometimes a protective device is used to avoid hurting the glans, and sometimes the circumciser simply performs the procedure freehand. In adults, stitches are used to stop the [[bleeding]] and help close the wound. In infants, circumcisers often use a clamp that crushes the foreskin and seals the wound, eliminating the need for stitches.

== Circumcision in detail: ~~Styles,~~ techniques and instruments ==

== Circumcision in detail: techniques and instruments ==

During circumcision, the [[foreskin]] of the [[penis]] is partly or completely removed. The exact amount and type of [[skin]] removed depends on the style and technique used, and therefore also on the tools being used.

~~=== Common styles ===~~

~~==== High & Tight ====~~

~~[[Image:Penis_unlabeled.jpg|200px|center]]~~

~~This style is the most common in the USA. In this style, the outer [[foreskin]], parts of the inner [[foreskin]] and parts of the [[shaft skin]] are removed.~~

~~The remaining part of the inner [[foreskin]] is folded back and sewed to the [[shaft skin]]. The scar is located closer to the body, hence the term "high".~~

The inner [[foreskin]], which originally faced inwards lying on the [[Glans penis|glans]], now faces outward; this causes the differently coloured section between [[Glans penis|glans]] and [[shaft skin]] which is characteristic for this style.

Of all styles, the tight ones remove the most [[skin]]. They already limit the mobility of the [[penile skin]] to a great extent when the [[penis]] is flaccid, and during an [[erection]] the [[skin]] is fully stretched and immobile. An insufficient amount of reserve [[skin]] can hamper a complete [[erection]] and lead to painful tension. Also, a skewed [[penis]] can occur due to an uneven distribution of the remaining [[skin]], often caused by an inaccurately placed cut or a uneven growth during wound healing. Due to the extensive shortening of the inner [[foreskin]], this style also means the loss of large amounts of sensitive tissue.

~~==== Low & Tight ====~~

~~[[Image:Low_and_tight.jpg|200px|center]]~~

In this style, both the inner and outer [[foreskin]] are completely removed. The [[shaft skin]] is sewed just below the rim of the [[Glans penis|glans]]. The scar is located close the [[Glans penis|glans]], hence the term "low".

This style is the most radical, as it removes the entire sensitive tissue of the [[foreskin]]. As in the high & tight style, large amounts of [[skin]] are removed. In a flaccid state, the [[skin]] is barely movable, and in an erect state it is totally immobile.

~~An insufficient amount of reserve [[skin]] can hamper an [[erection]] and lead to painful tension and a skewed [[penis]] in this style as well.~~

~~==== High & Loose ====~~

~~[[image:High_and_loose.jpg|200px|center]]~~

The outer foreskin is completely removed, as well as parts of the [[shaft skin]]. The inner foreskin is folded back and sewed to the [[shaft skin]]. The scar is located towards the body, hence the term "high". Unlike the high & tight style, the inner [[foreskin]] is less reduced, and lies in folds behind the [[Glans penis|glans]].

~~There is enough remaining reserve [[skin]] to ensure a complete and unhindered [[erection]]. Of all variants, this one removes the smallest amount of sensitive tissue.~~

~~==== Low & Loose ====~~

~~[[image:Low_and_loose.jpg|200px|center]]~~

The inner [[foreskin]] is removed, the outer [[foreskin]] is sewed on below the [[Glans penis|glans]]. The scar is therefore located close to the [[Glans penis|glans]], hence the term "low". The outer [[foreskin]] lies in folds behind the [[Glans penis|glans]]. Enough [[skin]] is left in place to ensure a complete and unhindered [[erection]].

~~Since, in contrast to the high & loose style, the inner instead of the outer [[foreskin]] is removed, this style results in the loss of almost all of the sensitive tissue.~~

=== Techniques and instruments ===

Over time, a vast variety of methods has been developed to remove the [[foreskin]]. A multitude of clamps and tools is available to ease the work of the circumciser, to improve the chance for visually symmetrical results and to prevent injuries to the [[Glans penis|glans]] from inexpert cuts. I will introduce some of the most widely spread variants.

====Restraint====

When an infant boy is to be circumcised, it is the usual practice to immobilize the infant for the [[Pain| painful]] surgery by securely tying his limbs to a molded plastic board specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the trauma-producing situation of ''inescapable shock'', described as a "physical condition in which the organism cannot do anything to affect the inevitable."<ref name="vanderkolk2014">{{REFbook

When an infant boy is to be [[circumcised]], it is the usual practice to immobilize the infant for the [[Pain| painful]] surgery by securely tying his limbs to a molded plastic board, called a [[Circumstraint]], specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the [[trauma]]-producing situation of ''inescapable [[shock]]'', described as a "physical condition in which the organism cannot do anything to affect the inevitable."<ref name="vanderkolk2014">{{REFbook

|last=van der Kolk

|first=Bessel

|first=Bessel A.

|init=B

|init=BA

|author-link=Bessel van der Kolk

|year=2014

|title=The Body Keeps the Score

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[[File:Circumpendium-6-2-1-b.jpg||center|thumb]]

In modern operating theatres the [[foreskin]] is first grasped with forceps, pulled out and clamped above the [[Glans penis|glans]] for a while to reduce bleeding. Next, the [[skin]] is cut along the forceps with a scalpel. Following that, the remaining [[skin]] is manually trimmed according to the desired style and finally sutured.

In modern operating theatres the [[foreskin]] is first grasped with forceps, pulled out and clamped above the [[Glans penis|glans]] for a while to reduce [[bleeding]]. Next, the [[skin]] is cut along the forceps with a scalpel. Following that, the remaining [[skin]] is manually trimmed according to the desired style and finally sutured.

[[File:Circumpendium-6-2-1-c.jpg||center|thumb]]

Line 71:

Line 40:

[[File:Circumpendium-6-2-1-Mogen-clamp.jpg||center|thumb|Mogen-clamp]]

The Mogen-Clamp works in a similar way (middle), with the difference that it is locked shut after the [[foreskin]] is inserted, thus clamping it. After a few minutes the [[foreskin]] is cut in the same fashion as with the simple shield. The clamping is meant to reduce or prevent bleeding from the wound.

The [[Mogen]]-Clamp works in a similar way (middle), with the difference that it is locked shut after the [[foreskin]] is inserted, thus clamping it. After a few minutes the [[foreskin]] is cut in the same fashion as with the simple shield. The clamping is meant to reduce or prevent [[bleeding]] from the wound.

[[File:Circumpendium-6-2-1-Sheldon-clamp.jpg||center|thumb|Sheldon-Clamp]]

The Sheldon-Clamp (right) works in a similar way. The inner clamp grasps the tip of the [[foreskin]], pulling it into the outer clamp which is closed. The outer clamp then grips the [[skin]]. After a few minutes of pressure, the [[foreskin]] is cut between the two clamps.

The use of a shield, rather than forceps, is meant to provide a better protection of the [[Glans penis|glans]] from cutting injuries. However, if used improperly both the Mogen and the Sheldon clamp are subject to the risk of the tip of the [[Glans penis|glans]] being accidentally clamped and being cut into or severed.

The use of a shield, rather than forceps, is meant to provide a better protection of the [[Glans penis|glans]] from cutting injuries. However, if used improperly both the [[Mogen]] and the Sheldon clamp are subject to the risk of the tip of the [[Glans penis|glans]] being accidentally clamped and being cut into or severed.

==== Complex clamps ====

[[File:Circumpendium-6-2-2-Gomco-clamp.jpg|center|thumb|Gomco clamp]]

One of the most widely used clamps in the USA is the Gomco clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the [[skin]] is cut off with a scalpel along the upper side of the base plate and the clamp removed.

One of the most widely used clamps in the USA is the [[Gomco]] clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the [[skin]] is cut off with a scalpel along the upper side of the base plate and the clamp removed.

[[File:Circumpendium-6-2-2-plastibell.jpg|center|thumb|Plastibell method]]

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[[File:Circumpendium-6-2-2-Smartclamp.jpg|center|thumb|Smartclamp]]

The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the [[Gomco]] and [[Plastibell]] methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it - like the [[Plastibell]] - falls off by itself after the clamped [[skin]] dies off in the following days.

The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the [[Gomco]] and [[Plastibell]] methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it — like the [[Plastibell]] — falls off by itself after the clamped [[skin]] dies off in the following days.

All of these methods have in common that the [[foreskin]] has to be separated from the [[Glans penis|glans]] first. In case of the circumcision of a child, it is in most cases (see chart above) necessary to forcibly tear apart the [[synechia| balanopreputial membrane]], which fuses the [[foreskin]] to the [[Glans penis|glans]], either by violently retracting the [[foreskin]] or separating it by pushing a blunt instrument underneath the [[foreskin]], both of which can result in injuries and inflammations of the [[Glans penis|glans]].

* [[Circumcision instruments]]

* [[Pain]]

* [[Trauma]]

~~{{REF}}~~

[[Category:Body modification]]

[[Category:Circumcision]]

[[Category:Education]]

[[Category:Genital cutting]]

[[Category:Genital surgery]]

[[Category:Male genital mutilation]]

[[Category:Penis]]

[[Category:Trauma]]

[[de:Beschneidungsmethoden]]

@@ Line 2: / Line 2: @@
 [[Circumcision]] is performed in many ways which vary by culture, the person performing it, and the age of the subject. It may be performed by a specialized ritual circumciser in a non-medical setting, or a medical practitioner at a hospital or clinic. In some cultures, only the protruding end of the [[foreskin]] is cut off, and in others, the entire foreskin which covers the [[glans]] is removed. Some circumcisers take more [[skin]] than others, resulting in a "loose" or "tight" circumcision.
-Generally, the foreskin is pulled forward and enough of it is removed to permanently expose the glans of the penis. Sometimes a protective device is used to avoid hurting the glans, and sometimes the circumciser simply performs the procedure freehand. In adults, stitches are used to stop the bleeding and help close the wound. In infants, circumcisers often use a clamp that crushes the foreskin and seals the wound, eliminating the need for stitches.
+Generally, the [[foreskin]] is pulled forward and enough of it is removed to permanently expose the [[glans]] of the [[penis]]. Sometimes a protective device is used to avoid hurting the glans, and sometimes the circumciser simply performs the procedure freehand. In adults, stitches are used to stop the [[bleeding]] and help close the wound. In infants, circumcisers often use a clamp that crushes the foreskin and seals the wound, eliminating the need for stitches.
-== Circumcision in detail: Styles, techniques and instruments ==
+== Circumcision in detail: techniques and instruments ==
 During circumcision, the [[foreskin]] of the [[penis]] is partly or completely removed. The exact amount and type of [[skin]] removed depends on the style and technique used, and therefore also on the tools being used.
-=== Common styles ===
-==== High & Tight ====
-[[Image:Penis_unlabeled.jpg|200px|center]]
-This style is the most common in the USA. In this style, the outer [[foreskin]], parts of the inner [[foreskin]] and parts of the [[shaft skin]] are removed.
-The remaining part of the inner [[foreskin]] is folded back and sewed to the [[shaft skin]]. The scar is located closer to the body, hence the term "high".
-The inner [[foreskin]], which originally faced inwards lying on the [[Glans penis|glans]], now faces outward; this causes the differently coloured section between [[Glans penis|glans]] and [[shaft skin]] which is characteristic for this style.
-Of all styles, the tight ones remove the most [[skin]]. They already limit the mobility of the [[penile skin]] to a great extent when the [[penis]] is flaccid, and during an [[erection]] the [[skin]] is fully stretched and immobile. An insufficient amount of reserve [[skin]] can hamper a complete [[erection]] and lead to painful tension. Also, a skewed [[penis]] can occur due to an uneven distribution of the remaining [[skin]], often caused by an inaccurately placed cut or a uneven growth during wound healing. Due to the extensive shortening of the inner [[foreskin]], this style also means the loss of large amounts of sensitive tissue.
-==== Low & Tight ====
-[[Image:Low_and_tight.jpg|200px|center]]
-In this style, both the inner and outer [[foreskin]] are completely removed. The [[shaft skin]] is sewed just below the rim of the [[Glans penis|glans]]. The scar is located close the [[Glans penis|glans]], hence the term "low".
-This style is the most radical, as it removes the entire sensitive tissue of the [[foreskin]]. As in the high & tight style, large amounts of [[skin]] are removed. In a flaccid state, the [[skin]] is barely movable, and in an erect state it is totally immobile.
-An insufficient amount of reserve [[skin]] can hamper an [[erection]] and lead to painful tension and a skewed [[penis]] in this style as well.
-==== High & Loose ====
-[[image:High_and_loose.jpg|200px|center]]
-The outer foreskin is completely removed, as well as parts of the [[shaft skin]]. The inner foreskin is folded back and sewed to the [[shaft skin]]. The scar is located towards the body, hence the term "high". Unlike the high & tight style, the inner [[foreskin]] is less reduced, and lies in folds behind the [[Glans penis|glans]].
-There is enough remaining reserve [[skin]] to ensure a complete and unhindered [[erection]]. Of all variants, this one removes the smallest amount of sensitive tissue.
-==== Low & Loose ====
-[[image:Low_and_loose.jpg|200px|center]]
-The inner [[foreskin]] is removed, the outer [[foreskin]] is sewed on below the [[Glans penis|glans]]. The scar is therefore located close to the [[Glans penis|glans]], hence the term "low". The outer [[foreskin]] lies in folds behind the [[Glans penis|glans]]. Enough [[skin]] is left in place to ensure a complete and unhindered [[erection]].
-Since, in contrast to the high & loose style, the inner instead of the outer [[foreskin]] is removed, this style results in the loss of almost all of the sensitive tissue.
 === Techniques and instruments ===
 Over time, a vast variety of methods has been developed to remove the [[foreskin]]. A multitude of clamps and tools is available to ease the work of the circumciser, to improve the chance for visually symmetrical results and to prevent injuries to the [[Glans penis|glans]] from inexpert cuts. I will introduce some of the most widely spread variants.
 ====Restraint====
-When an infant boy is to be circumcised, it is the usual practice to immobilize the infant for the [[Pain| painful]] surgery by securely tying his limbs to a molded plastic board specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the trauma-producing situation of ''inescapable shock'', described as a "physical condition in which the organism cannot do anything to affect the inevitable."<ref name="vanderkolk2014">{{REFbook
+When an infant boy is to be [[circumcised]], it is the usual practice to immobilize the infant for the [[Pain| painful]] surgery by securely tying his limbs to a molded plastic board, called a [[Circumstraint]], specially made for that purpose. The infant thus is preventing from fighting or fleeing, which is the [[trauma]]-producing situation of ''inescapable [[shock]]'', described as a "physical condition in which the organism cannot do anything to affect the inevitable."<ref name="vanderkolk2014">{{REFbook
   |last=van der Kolk
-  |first=Bessel
+  |first=Bessel A.
-  |init=B
+  |init=BA
+ |author-link=Bessel van der Kolk
   |year=2014
   |title=The Body Keeps the Score
@@ Line 60: / Line 29: @@
 [[File:Circumpendium-6-2-1-b.jpg||center|thumb]]
-In modern operating theatres the [[foreskin]] is first grasped with forceps, pulled out and clamped above the [[Glans penis|glans]] for a while to reduce bleeding. Next, the [[skin]] is cut along the forceps with a scalpel. Following that, the remaining [[skin]] is manually trimmed according to the desired style and finally sutured.
+In modern operating theatres the [[foreskin]] is first grasped with forceps, pulled out and clamped above the [[Glans penis|glans]] for a while to reduce [[bleeding]]. Next, the [[skin]] is cut along the forceps with a scalpel. Following that, the remaining [[skin]] is manually trimmed according to the desired style and finally sutured.
 [[File:Circumpendium-6-2-1-c.jpg||center|thumb]]
@@ Line 71: / Line 40: @@
 [[File:Circumpendium-6-2-1-Mogen-clamp.jpg||center|thumb|Mogen-clamp]]
-The Mogen-Clamp works in a similar way (middle), with the difference that it is locked shut after the [[foreskin]] is inserted, thus clamping it. After a few minutes the [[foreskin]] is cut in the same fashion as with the simple shield. The clamping is meant to reduce or prevent bleeding from the wound.
+The [[Mogen]]-Clamp works in a similar way (middle), with the difference that it is locked shut after the [[foreskin]] is inserted, thus clamping it. After a few minutes the [[foreskin]] is cut in the same fashion as with the simple shield. The clamping is meant to reduce or prevent [[bleeding]] from the wound.
 [[File:Circumpendium-6-2-1-Sheldon-clamp.jpg||center|thumb|Sheldon-Clamp]]
 The Sheldon-Clamp (right) works in a similar way. The inner clamp grasps the tip of the [[foreskin]], pulling it into the outer clamp which is closed. The outer clamp then grips the [[skin]]. After a few minutes of pressure, the [[foreskin]] is cut between the two clamps.
-The use of a shield, rather than forceps, is meant to provide a better protection of the [[Glans penis|glans]] from cutting injuries. However, if used improperly both the Mogen and the Sheldon clamp are subject to the risk of the tip of the [[Glans penis|glans]] being accidentally clamped and being cut into or severed.
+The use of a shield, rather than forceps, is meant to provide a better protection of the [[Glans penis|glans]] from cutting injuries. However, if used improperly both the [[Mogen]] and the Sheldon clamp are subject to the risk of the tip of the [[Glans penis|glans]] being accidentally clamped and being cut into or severed.
 ==== Complex clamps ====
 [[File:Circumpendium-6-2-2-Gomco-clamp.jpg|center|thumb|Gomco clamp]]
-One of the most widely used clamps in the USA is the Gomco clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the [[skin]] is cut off with a scalpel along the upper side of the base plate and the clamp removed.
+One of the most widely used clamps in the USA is the [[Gomco]] clamp. First, a cut is placed into the [[foreskin]], then the metal bell is placed over the [[Glans penis|glans]]. After that, the bell, together with the [[foreskin]], is pulled through the opening in the base plate and hung into the lever. By fastening the screw the lever pulls the bell upwards, jamming the [[foreskin]] between bell and base plate. After several minutes of clamping, the [[skin]] is cut off with a scalpel along the upper side of the base plate and the clamp removed.
 [[File:Circumpendium-6-2-2-plastibell.jpg|center|thumb|Plastibell method]]
@@ Line 88: / Line 57: @@
 [[File:Circumpendium-6-2-2-Smartclamp.jpg|center|thumb|Smartclamp]]
-The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the [[Gomco]] and [[Plastibell]] methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it - like the [[Plastibell]] - falls off by itself after the clamped [[skin]] dies off in the following days.
+The Smartclamp and a couple of similar designs are one way clamps, representing a mixture of the [[Gomco]] and [[Plastibell]] methods. The [[Glans penis|glans]] is inserted into the plastic tube, the [[foreskin]] pulled over it. The base plate of the outer clamping mechanism is pushed over the [[foreskin]] and cocked shut, jamming the [[foreskin]] between the bulging lower rim of the tube and the lower base plate. The [[foreskin]] is now cut off along the upper side of the base plate. The entire clamping mechanism remains on the [[penis]], until it — like the [[Plastibell]] — falls off by itself after the clamped [[skin]] dies off in the following days.
 All of these methods have in common that the [[foreskin]] has to be separated from the [[Glans penis|glans]] first. In case of the circumcision of a child, it is in most cases (see chart above) necessary to forcibly tear apart the [[synechia| balanopreputial membrane]], which fuses the [[foreskin]] to the [[Glans penis|glans]], either by violently retracting the [[foreskin]] or separating it by pushing a blunt instrument underneath the [[foreskin]], both of which can result in injuries and inflammations of the [[Glans penis|glans]].
+{{SEEALSO}}
+* [[Circumcision instruments]]
+* [[Pain]]
+* [[Trauma]]
+{{REF}}
-{{REF}}
+[[Category:Body modification]]
+[[Category:Circumcision]]
+[[Category:Education]]
+[[Category:Genital cutting]]
 [[Category:Genital surgery]]
+[[Category:Male genital mutilation]]
+[[Category:Penis]]
+[[Category:Trauma]]
 [[de:Beschneidungsmethoden]]