General knowledge and basic functions of the foreskin
Moderator: Is the foreskin long? Does it need to be operated? These questions have always troubled many male friends, first of all, please give you literacy, introduce the common knowledge of foreskin and some of its basic functions.
Song Weidong: Circumcision is very common in men. The foreskin, as a component of the male external genitalia, has an important physiological function. The medical community has been conducting research on the function of the foreskin, and as the research progresses, there is a newer understanding and appreciation of the function of the foreskin. At present, the functions of the foreskin that are more recognized in the medical community are as follows: First, the foreskin covers the head of the penis and plays a protective role for the head of the penis. In primitive humans, this function appears more prominent, primitive humans due to hunting and other activities, in the deep forest often have a variety of mosquito bites, because the penis head is more sensitive, easily stimulated parts, so because the foreskin cover, can make the crowd more convenient to complete a variety of activities. Modern humans, already not in the original activities of hunting, and are well dressed, especially cotton well-made underwear, increasing the protection of the genitals. However, the foreskin as a result of thousands of years of human evolution, its protective role should not be ignored. In addition, it is believed that because the foreskin covers the glans of the penis, during sex, it can slow down and share the stimulation of the glans, thus making delayed ejaculation to prevent premature ejaculation. Furthermore, the foreskin plays a lubricating role in sexual life. The structure of the foreskin is delicate and can slide freely, which is incomparable to any other organ. The inner plate of the foreskin has a secretory role, and the secretion is like a lubricant, which can increase the tenderness and pleasure during sex. As you can imagine, without this lubrication function of the foreskin, the friction of the penis during sex is too great, which will make both couples feel uncomfortable and affect the quality of sex life.
There is one more point to make clear to everyone: the idea that circumcision can cause inflammation is not very comprehensive. This is a very good way to get the most out of your life. So, when you are concerned about the foreskin, you must not ignore the normal physiological function of the foreskin.
The host: the foreskin also has some autoimmune function, has the function of sterilization?
Song Weidong: Yes, the foreskin itself secretion has a bactericidal component in it, but, because of the moist and warm environment of the foreskin cavity, bacteria can be more likely to breed here. This is a matter of balance, if the growth of bacteria exceeds the self-cleaning function of the foreskin, then inflammation of the foreskin may occur. In addition, as mentioned above, the inner plate of the foreskin has many secretory glands, secretions can play a lubricating role, the accumulation of secretions, can not be properly cleansed and removed, will also be conducive to the reproduction of bacteria, resulting in foreskin inflammation.
Moderator: Many male friends may think that the existence of the foreskin leads to more and more dirty things or bacteria in the foreskin cavity, through your explanation, we have a more comprehensive understanding of the foreskin.
What is circumcision and prepuce all about?
Song Weidong: The so-called prepuce means that the foreskin of the penis can still wrap around the head of the penis when it is fully erect, but the foreskin of a patient with prepuce may easily flip up. The foreskin is not only long, but the ring in front of the foreskin is narrow, so the foreskin cannot be turned up, which is called prepuce.
The host: is it physiological or acquired causes?
Song Weidong: generally more congenital, but of course there are also some acquired factors, for example, this patient is first of all, the foreskin is too long, if the foreskin is too long repeatedly infected, has not been very good treatment, such repeated infection, resulting in adhesion of the foreskin and glans, the foreskin can not be turned up, this is a class of acquired factors caused by the prepuce.
Moderator: Is this surgery the same as circumcision?
Song Weidong: Circumcision of this kind of adherent prepuce is more difficult, because the process of doing so is to free the inner plate of the foreskin from the skin on the surface of the penis and glans, but if the adhesion is longer and the adhesion is more practical, it is easy to damage the foreskin or glans when separating. If there is damage to the surface of the foreskin after stripping, local fine stitching must be done.
Moderator: What determines whether the foreskin is long or not? How to determine the long or not long?
Song Weidong: We just talked about the definition of prepuce, that is, the foreskin is wrapped around the head of the penis when erect; in fact, when many of our patients come to see the doctor or go to the hospital for consultation, the penis is in a weak state, so the judgment based solely on the weak state is not too scientific.
The main reason for this is that it is not necessary to do surgery if the foreskin is too long?
Song Weidong: Not necessarily, it depends on the situation and decide. The common view of doctors over the years is that it is better to deal with the circumcision. Of course, this view is that long foreskin is the direct cause of penile cancer and can also lead to repeated infections. With the advancement of clinical research, it is now believed that if simple circumcision is not repeatedly infected, the chance of causing penile cancer is not particularly high. Therefore, it is not bad to pay attention to cleanliness and hygiene by oneself and wash the secretion of penile foreskin cavity frequently for simple circumcision without recurrent inflammation. If the patient has circumcision and recurring glansitis, circumcision is also an effective treatment after controlling the acute inflammation. However, circumcision must be done, and the narrow ring of the foreskin should be removed as soon as possible, and if there are adhesions, the foreskin and glans should be separated so that the head of the penis is naturally revealed. Here, we would like to introduce you to the knowledge of penile cancer and circumcision. It is believed that the repeated stimulation of circumcision is one of the causes of penile cancer. The most common type of penile cancer is squamous epithelial carcinoma, which is a medical term that means the nature of cancer that occurs. How does this squamous carcinoma of the penis form? In general, there is a connection with repeated inflammation and irritation of the penile foreskin. This is one of the reasons why circumcision is recommended for patients who are circumcised and have recurrent glans penis inflammation.
Sometimes circumcision is accompanied by other diseases
Moderator: Is it best to go to the hospital for a checkup for this surgery? Or do you think you should do it?
Song Weidong: Yes, you should go to the hospital for a checkup. And we recommend trying to go to some regular large hospitals to avoid misdiagnosis. This is because some patients who seem to be circumcised are not really circumcised, but have other diseases. To give a simple example, some patients from the appearance of the penis is particularly small, and the foreskin is particularly long, these patients are mostly obese patients, children can develop, some adults will also have, such patients are not simply long foreskin, and even some patients do not have a long foreskin, but from the appearance of the foreskin is long, this is the medical term hidden penis, the treatment and simple circumcision is different.
Moderator: Is it a combination of factors?
Song Weidong: It is because the spongy body of the penis is “hidden”. Many of these patients have normal penile corpus cavernosum development, but why does the penis look so small? If such patients are circumcised, the foreskin will be short in the future and will need to be repaired surgically, so simple circumcision is contraindicated in patients with occult penis.
Moderator: That’s a kind of cosmetic surgery, right?
Song Weidong: You can also say so. We found in the clinic that many patients came to us after circumcision in outside hospitals and “felt something was wrong”, but we found out that they had an invisible penis and were not suitable for circumcision.
Moderator: That is not diagnosed properly?
Song Weidong: So don’t look at circumcision as a very simple disease, and don’t think of circumcision as a minor surgery that doesn’t matter, but it’s actually quite harmful if it’s not done properly.
Circumcision related issues
The host: just Dr. Song talked about circumcision, please give a specific and comprehensive introduction to this surgery?
Song Weidong: The so-called circumcision is the removal of the overgrown penile foreskin, including the outer and inner plates of the foreskin, and then the circular incision is closed with sutures. It is an open surgery. The operation allows the head of the penis to be completely exposed, so as not to leave a “sanitary corner”, it is also less likely to cause local infection of the foreskin.
The host: what is the general way this surgery is used?
Song Weidong: Now there are many methods of circumcision, one is the open surgery just mentioned; there is also a ring ligation, more is the Han’s ring ligation method, now there are companies in China also launched a similar ring ligation device. There is also a laser excision of the foreskin, now the large hospitals to carry out laser circumcision or less, because the laser method does not show too many advantages compared to open surgery.
Moderator: Will circumcision with a laser be a smaller wound? Or is there no pain?
Song Weidong: If the anesthesia is not good, it is still painful.
Moderator: So there is not much difference between surgery and laser?
Song Weidong: Yes. The laser method is to use the laser as a knife to cut the foreskin, in fact, it is the same as replacing the scalpel with a laser. We all know that the laser method is a thermal cutting, after cutting a circle, still have to deal with the circumcision wound, and the scalpel method is not much difference in substance.
Song Weidong: This question is a bit more complicated. Why is it more complicated? The reason is that there are two views abroad on circumcision: one view is that it should be cut, and one view is firmly against circumcision. Of course, their views have their own origins. Objectively speaking, we have to consider both the function of the foreskin itself and the possible hazards of overcircumcision. So when it comes to circumcision, there is a principle requirement to cut short or cut long. The principle of the operation is that the foreskin is straightened in the weak state of the penis, the outer plate of the foreskin is circumcised at the level of the coronary sulcus, the inner plate should be kept 0.5 to 1.0 cm, and more can be kept at the ventral tether. In general, this is also related to the experience of the surgeon. However, abroad, it is now advocated to keep the circumcision as long as possible.
Moderator: It’s better than short.
Song Weidong: Haha, it’s better than short. There are also some cases, for example, according to our understanding, circumcision is done quite well: the entire glans is exposed in a weak state; but in foreign countries, many people do this effect after the foreskin reset, that is, with some special equipment and facilities, the foreskin pulled downward, so that it is extended some more, so that the free sliding function of the foreskin is restored again.
Moderator: It’s short when you cut.
Song Weidong: Yes, at least the patients who did the reset think so. After the cut is short, the pulling action of the external equipment to reset.
Moderator: Does this have anything to do with less cutting?
Song Weidong: If this patient is recurrent inflammation, it is recommended not to leave too much foreskin. Of course, some patients come to the hospital after the procedure and say, “Doctor, you left too much for me. The key is to see what criteria you use to define how much or how little foreskin is left. Just now we talked about the diagnostic criteria of circumcision, after circumcision, the foreskin left behind is still up to the standard of circumcision? If it does not reach the standard of circumcision, it is not called circumcision.
Moderator: So this surgery can be done repeatedly? If he feels that the foreskin is too long.
Song Weidong: This is to be considered from the point of view of beauty, someone is to do surgery for cosmetic reasons, the doctor left long, he felt that did not achieve the desired cosmetic effect, he will ask to do again. But I hope that patients should communicate well with their own doctors before the surgery, and be sure to tell your doctor your subjective desire, the desired effect.
Moderator: It is better not to do it twice?
Song Weidong: Yes, tell your ideas and expectations to the doctor, who will try to meet your expectations according to your actual situation.
Moderator: If you cut it short, it is like the cosmetic surgery you just mentioned?
Song Weidong: If the cut is short, you can do some very simple skin release to promote recovery, in addition, the foreskin has a strong compensatory mechanism, after surgery with the erection of the pull, the foreskin can compensate to stretch freely. However, if the defect is too much, it is necessary to do flap transfer for surgical correction.
Moderator: This is more complicated, right?
Song Weidong: This is a plastic surgery.
Moderator: The cost is also quite high?
Song Weidong: Yes.
Moderator: Now I would like you to explain how the preventive circumcision is?
Song Weidong: At the beginning we talked about the function of the foreskin, the so-called prophylactic circumcision, that is, the circumcision of patients with long foreskin, in order to prevent penile cancer or foreskin glansitis, or to facilitate the development of the penis, and perform circumcision. However, simple circumcision is not always necessary. In contrast, circumcision is an absolute indication for surgery.
Moderator: Some patients are still to be observed?
Song Weidong: Now our view is that prophylactic surgery is not needed, why? One, because the foreskin itself has its own function; second, circumcision, although a minor operation, can occasionally have complications, and the risk of surgery still exists. The first is that the circumcision of the foreskin can be done without surgery. Of course, if the patient is circumcised or has recurrent infections secondary to the circumcision, it is best to perform circumcision to eliminate future problems.
There is another indication for the surgery is often referred to as “circumcision”. It is a religious practice. For example, if the patient is a Muslim, the foreskin is removed when the boy reaches the age of five or seven (usually done at an odd number of years). Circumcision means that the boy has truly become a Muslim. If you come to our hospital for the purpose of religious circumcision, we do perform the procedure. After all, the hospital has much better sanitary conditions.
As I said earlier, some patients are circumcised for cosmetic purposes. The hospital will also do it, but in general, for this part of the patient, we have to tell him the corresponding medical knowledge, so that he understands the relevant medical knowledge, and then leave the choice to do or not to do to himself.
Moderator: This is appropriate for each individual, ha, we have also read many reports, about the Western countries have the habit of circumcision of children at birth, that in China seems to have very few such cases, why do you think the Western countries will have this habit?
Song Weidong: Religious factors. In foreign countries, such as Israel and other countries, they are mostly Jewish, male babies are circumcised immediately after birth. This is not quite the same as the Muslims, who do it when they reach the age of five or seven.
Moderator: So this is done before development, will it have a great impact on the future?
Song Weidong: I also checked the relevant information, most of them do circumcision, similar to the Korean circumcision just mentioned, with a special collar, the foreskin over the top, and then compression. The extra foreskin that is crimped is ischemic and eventually necrotic and crusted over. No negative effects of this circumcision of infants seem to have been found so far. On the contrary, because of the early circumcision of these Jewish and Islamic male infants, the occurrence of penile cancer is rare among them.
Moderator: So is this circumcision surgery a general anesthetic or a local anesthetic?
Song Weidong: For adults, local anesthesia is enough. For children, it is important to consider whether they can cooperate well with the doctor during the surgery. If the child is too small, general anesthesia can be used, or basic anesthesia can be added to facilitate the operation.
Moderator: Do you think that this kind of surgery for children will have some effects on their physiology and heart?
Song Weidong: Any surgery may have a certain psychological impact on the recipient, but this impact can be large or small, and children are no exception. But in general, the surgery is relatively short, not particularly traumatic, and the recovery is relatively quick, so it will not have a serious negative psychological impact on people.
Precautions after circumcision surgery
Moderator: Will there be any side effects after this surgery?
Song Weidong: There are more or less side effects, although circumcision is small, there are complications. For example, if the bleeding is not completely stopped during the operation, a large hematoma may occur after the operation. We have seen such patients in our hospital. They came to us in the evening for an emergency visit after having surgery in another hospital. When the dressing was opened, the penis was very swollen and a large hematoma was formed under the foreskin. There was nothing else to do but to remove it and re-stop the bleeding, apply pressure and bandage it. Hematomas are more frequent within 24 hours after surgery.
There are also complications related to the application of electrocoagulation during the surgery to stop the bleeding. The need for electrocoagulation to stop bleeding in circumcised patients is debatable. Some doctors feel that there are many small bleeding spots that need to be treated during circumcision. The ligature is more troublesome, so electrocoagulation is used to stop the bleeding. For this electrocoagulation to stop bleeding, I hope you doctors should be careful because electrocoagulation to stop bleeding may lead to some complications, such as nerve damage due to too much voltage during electrocoagulation, which can lead to postoperative erectile dysfunction. There are even reports of necrosis of the penile corpus cavernosum due to electrocoagulation. Therefore, when using it, try to use with double-strike electrocoagulation and click electrocoagulation as little as possible.
Infection is also a common complication, which is better understood as any surgical incision can be infected. This part of the foreskin determines a greater chance of infection. One is that urination soaks the dressing and the wound, which can easily cause infection; furthermore, this area is more moist and hidden, which can easily cause bacteria to multiply. Therefore, it is necessary to apply effective antibiotics for a period of time after surgery. Of course, the drip seems to be a bit “trivial”, oral antibiotics are completely sufficient and effective.
Moderator: Will there be scars after the surgery?
Song Weidong: If the incision is infected, there will be scars. Generally speaking, if the wound recovers well and there is no obvious infection, the post-operative scars are not too obvious. However, if the patient has a scarring body, the post-operative scars may be obvious. When most patients come for a review one month, two months or three months after circumcision, only a white line remains at the surgical incision and the scar is very small.
The host: How long is the recovery period after this surgery?
Song Weidong: Generally speaking, there is no infection, no other bleeding and other abnormalities, the third day after surgery to come to the hospital for a change of medicine, the purpose of the change of medicine, one is to replace the auxiliary materials, and another is to check the wound situation. If the incision is fine, the patient should not come to the hospital, because most of us use absorbable sutures and do not need to remove the sutures.
Moderator: Should the patient have some care during these days? Or what should we pay attention to on a daily basis?
Song Weidong: We usually prescribe some erythromycin ointment to the patient, together with the application of effective oral antibiotics and so on. If necessary, add some estrogenic drugs to suppress erections and facilitate recovery.
The host: the operation is done after the hospitalization?
Song Weidong: generally not hospitalized, now in domestic hospitals, circumcision are carried out in the outpatient clinic.
Moderator: What kind of preparation does the patient need to do before the surgery?
Song Weidong: There is no special preparation. If the circumcision is combined with inflammation, the inflammation should be well controlled and there should be no more glans penis at the time of the surgery. If there is inflammation, it is very unfavorable to do surgery. One reason is that it can lead to infection of the incision after surgery. The other is that it can lead to local adhesions, and if the inner plate of the foreskin and the glans are adhered, it is quite troublesome, and the results of another operation may not be ideal. Two patients in our ward were like this, and they were circumcised in a foreign hospital when the glans was infected. So before you do the surgery you must cure the foreskin glansitis and not rush the surgery to prevent adverse consequences.
Moderator: That is in a healthy state before doing it?
Song Weidong: Yes.
The host: after the surgery will there be restrictions on medication or diet in the next few days?
Song Weidong: just said, the postoperative fear of bleeding, and mainly within 24 hours, although individual patients within 48 hours will also have re-bleeding. The penis is an erectile organ, normal men have 4 to 6 physiological erections at night, but he does not know it, he can remember is to wake up in the morning, which is what we call the morning erection, erection may induce bleeding, therefore, effective hemostasis during surgery and postoperative sedation, application of estrogen to suppress erection is still necessary.
Moderator: So is this situation very common?
Song Weidong: Very common, many patients complained of pain during erection after surgery because of the presence of surgical wounds. In order to reduce the pain and congestion caused by erection, let the patient take estrogen at night, through estrogen to inhibit erection, before sleep with Valium to promote sleep, is very effective and necessary method.
Moderator: What are the cases where there is no surgical indication but special care is also needed? What should the family do?
Song Weidong: In fact, in addition to children after circumcision parents are more concerned, many adults do not want to tell others after the surgery, many are their own care. In fact, the key to this care is to understand what is normal, what is abnormal, how to deal with it, and whether to see a doctor. The doctor will clearly tell the patient about all these related situations after the surgery.
If you return home after the procedure and see that blood keeps oozing from the dressing or that the penis is very swollen and dark, you should go to the hospital in this case. There are very few patients who cannot urinate after circumcision. We should remember that if you cannot urinate normally after 6-8 hours, you should go to the hospital for catheterization or other treatment.
Moderator: Is there a psychological effect?
Song Weidong: There may be psychological reasons.
Moderator: It is best to go to the hospital to check any situation?
Song Weidong: Yes, if you see a lot of edema or secretions after surgery, you should also go to the hospital to see.
The host: we have almost introduced the basic knowledge and surgery, we are now concerned about the problems of netizens, now there is a netizen said my penis head wrapped very strong, can only show a little, do not know how to do, in this case he should talk to whom this matter? Should we do this surgery?
Song Weidong: Nowadays, many patients, especially adult patients, understand the knowledge of male medicine, mostly from newspapers, magazines, television, the network to obtain, of course, may be more or less with some advertising color. I still recommend that these patients go to a regular hospital to find a doctor to consult.
Moderator: First diagnose?
Song Weidong: Yes, first diagnose the situation, to clarify the need to deal with, like the case of the netizen just now, may be the circumcision, I think the first thing to look at the hospital, after a clear diagnosis, to take appropriate treatment methods.
Moderator: A netizen asked about the need to go to the hospital to do some treatment after surgery, he said this to change the medicine for a few days? What treatments are done?
Song Weidong: I just mentioned that the third day after the surgery to the hospital, a change of dressings and gauze, by the way, to observe the wound situation, in general, do not need to play a drip, after the surgery, oral antibiotics for a few days is enough.
The host: so it is recommended that male friends do surgery or as you just said must first communicate well, so as not to cause unnecessary impact. Now there is a netizen asked him to do this surgery has been a month, the inner plate of the foreskin swollen more powerful, then this situation should be how to do?
Song Weidong: The question raised by this netizen is quite common, we did more than 400 cases of circumcision in less than a year last year and found that many patients had edema of the inner plate after surgery, but when swelling occurs it must be distinguished whether this swelling is edema of the foreskin or lymphoma of the foreskin?
Moderator: This is more specialized?
Song Weidong: Yes, this is more professional, should go to the hospital to see, of course, you can identify, simple identification method is: foreskin edema, the inner plate of the skin is thin, transparent, pressure when there is a depression. In the case of lymphoma, you can feel a localized leather-like sensation when pressing, simply put, it is like a rubber-like sensation, the previous lymphoma is also called “rubber swelling”, rubber swelling is not too obvious depression, but very elastic.
Oedema in the short term after surgery may be due to several reasons, one is that the surgery has cut off part of the superficial veins, resulting in poor venous return. The post-operative dressing is too tightly wrapped, resulting in poor localized reflux. Another reason is that the foreskin itself has a stenotic ring, and the stenotic area is not completely cut, and after surgery, the stenotic ring still exists, resulting in poor venous return. In general, poor lymphatic return will lead to lymphoma and poor venous return will lead to foreskin edema.
Moderator: Then this netizen said that there is a bulge under the skin at the left side of his foreskin suture, I wonder if it is a lump, if this happens what is it?
Song Weidong: How many days after his surgery?
Moderator: It’s just about half a month or so.
Song Weidong: like this case, he said there is a bulge under the stitches of the left prepuce, which should be considered whether there is post-operative blood leakage, the formation of small local hematoma. Of course, the post-operative hematoma has to be slowly mechanized and may be much better after it is slowly absorbed. It is recommended that this patient apply local heat to promote the absorption of the hematoma.
Moderator: If the circumcision is cut unevenly on both sides, such as one side more than the other, then in this case ……?
Song Weidong: This is the problem of the surgeon mastering the “degree”, simply if the foreskin is long on one side and short on the other, as long as the erection does not cause the penis to bend there is no great impact, no need for special treatment. If the patient is for cosmetic purposes, it is a different story.
Moderator: That is too many cases?
Song Weidong: Yes, it’s not a big problem in general.
The impact of circumcision on sexual life
The host: When this surgery is done, you just said that the foreskin has some function in sexual life, so what is the impact on sexual life after the surgery is done?
Song Weidong: You are now asking this question is very good, recently I also read a lot of literature, there is a foreign report, of course, this is only a reference, they have statistics of some patients, after circumcision patients and uncircumcised men compared, sex life more use of lubricants. This suggests that the local friction may be higher in circumcised people.
Moderator: Is that the main problem?
Song Weidong: Yes.
Moderator: A netizen asked whether circumcision will cause impotence?
Song Weidong: No. There are individual reports that circumcision generally does not damage the nerves, and the so-called damaged nerves are only superficial nerves, which do not play a major role in the erection process. The vascular damage is also superficial. So this superficial nerve and blood vessel damage will not cause major problems.
Moderator: Is it the peripheral nerve problem?
Song Weidong: After circumcision, the local sensation is a little numb and the sensitivity is not the same as before surgery, which may happen and will slowly recover. But like I said earlier, the surgery itself has nothing to do with erectile dysfunction. The erectile dysfunction is mostly psychological, these people feel traumatized and feel that after circumcision, his erection will not work, this should be treated differently from the surgery itself.
Moderator: Not used to it?
Song Weidong: Hey, psychological erectile dysfunction may exist.
The host: that is not a psychological state like this what are the possible side effects?
Song Weidong: such patients, since they think they have erectile dysfunction, then you should go to a specialist hospital to find a specialist to assess whether you are psychological or not, after the assessment you are not psychological and then analyze other causes.
Moderator: I should say that the psychological factor is relatively large?
Song Weidong: Yes, it is larger.
Song Weidong: This is a very interesting question. In the past, premature ejaculation was thought to be due to a low threshold of sensory excitement in the penis, and it was easy to reach orgasm, which in men means ejaculation. The head of the penis, especially the location against the coronal sulcus, is the most richly distributed nerve endings and is a very sensitive place. It is easy to stimulate these places to reach orgasm. The circumcision, circumcision usually wraps these sensitive places, so these places are more sensitive and easier to get excited when stimulated. So many people think that circumcised people are prone to premature ejaculation due to the lack of local exposure of the penis head and the penis feeling too sensitive. In fact, it is not true, there are many circumcised men who do not have premature ejaculation. After circumcision the head of the penis is exposed, the coronal sulcus is also exposed, and after the contact of underwear and so on, the sensitivity decreases, making the head of the penis not so sensitive when it is sexually stimulated. Can premature ejaculation be improved by this? At present, there are no systematic and in-depth