Changes

[[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.

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.

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.

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.

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.

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.

The oldest method of removing the [[foreskin]] uses just a few instruments. In the simplest case, the [[foreskin]] is pulled out with a cord, a knife is placed directly above the [[Glans penis|glans]], and the [[skin ]] finally cut with a hit on the blunt edge of the knife. No stitches are placed and the [[skin ]] is left to grow together naturally.

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.

Completely freehand techniques are also common. The penile [[skin ]] is first cut in two places along the circumference, in the area of the shaft [[skin ]] and [[foreskin]]. After that the [[skin ]] area between the cuts is removed and the remaining [[skin ]] sutured.

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.

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.

In the [[Plastibell]] method, the [[skin ]] is first cut lengthwise, then a plastic ring is placed over the [[Glans penis|glans]] and the [[foreskin]] pulled over it. A tightly tied string is used to fix the [[foreskin]] to a rim in the ring, thereby strangulating it.

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.