Is it necessary to circumcise the foreskin if it is too long? The sooner the better? Be careful not to get a wasted operation!

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Summer vacation is a wonderful time for children to play, have fun and explore. However, at the same time, a special "team" has quietly grown, that is - the "Summer Circumcision Surgery Team."

At the clinic, parents of little boys rushed to ask questions: "Do all little boys need to be circumcised?" "The earlier the foreskin is circumcised, the better the penis will develop? "

Do these claims make sense? Today, I will explain the truth about foreskin so that you don’t have to worry about it anymore!

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What is phimosis and prepuce

The skin of the penis is thin, soft and extensible. It forms a double-layer circular fold in front of the penis neck, which surrounds the glans penis and is called the foreskin of the penis. It protects the glans penis from friction and stimulation, and has lubrication and secretion functions. The foreskin of the penis surrounds the foreskin opening at the front end, and is connected to the penis at the ventral midline by a skin fold called the frenulum of the foreskin .

In infants, the foreskin is long and can cover the entire glans penis. As the age increases, the foreskin gradually retracts, and the foreskin opening expands, revealing the glans penis. If the glans penis is still covered by the foreskin after adulthood, or the foreskin opening is too small to expose the glans penis, it is called prepuce is too long or phimosis .

Phimosis may be caused by genetics , developmental or nutritional deficiencies .

Phimosis is divided into two types: primary and secondary .

Primary phimosis can be seen in normal male newborns and infants, which is called "physiological phimosis" . In newborns, there is a slight epithelial adhesion between the inner foreskin and the glans penis, which is absorbed after a few months and the inner foreskin separates from the glans penis. At 3-4 years old, as the penis grows and develops and becomes erect, the foreskin retracts upward on its own, revealing the glans penis.

Secondary phimosis is mostly caused by trauma to the glans penis and foreskin, inappropriate circumcision surgery, repeated infections, etc. The foreskin opening will shrink due to scarring, the skin will lose elasticity, and the foreskin will not be able to retract upward to reveal the penis, so surgical treatment is often required .

What are the dangers of foreskin being too long and phimosis?

The main hazards of foreskin being too long are as follows:

① It is easy to accumulate smegma , leading to infection and inflammation, such as balanitis, balanitis, urethritis, etc.

② Affects sexual life : an excessively long foreskin will reduce sensitivity.

③ Increase the risk of penile cancer and cervical cancer . Smegma repeatedly causes penile inflammation, which is an important risk factor for penile cancer. In addition, the bacteria in smegma can be transmitted to the female genitals through sex, causing gynecological inflammation and even cervical cancer.

④ When the foreskin is too long and cannot be turned down after being turned up , it will cause blood and lymph return obstruction, leading to foreskin incarceration .

The main hazards of phimosis are as follows :

①Causes penis deformity and dysplasia , because phimosis will limit the growth space and external stimulation of the glans, causing the glans to become smaller or deformed.

②Cause sexual dysfunction .

How to judge whether the baby's foreskin is abnormal

As mentioned earlier, babies are born with physiological phimosis, and the process of gradual development to the point where the glans can be normally exposed may take several months or even years.

Methods for determining whether the baby's foreskin is abnormal include:

① Observe whether the baby has abnormal phenomena such as asymmetric urethral opening, urine retention, short range, etc. when urinating.

② Gently push the foreskin back to see if the glans penis is exposed and whether there is any abnormality such as redness, swelling, or secretions on the glans penis . Remember not to pull the foreskin forcefully to avoid injury.

Is it necessary to circumcise if the foreskin is too long ?

No, it depends on the situation.

The harm of excessive foreskin mainly lies in the smegma. Chronic irritation of the smegma and repeated attacks of balanoposthitis are important factors causing penile cancer .

Therefore, if the foreskin opening is wide and easy to turn up, and it is often turned over for cleaning to keep the local area clean, surgery is not needed ; but if the foreskin is too long and the opening is small, or if balanoposthitis occurs repeatedly, circumcision can be performed after the local infection is controlled, which is of certain significance in preventing penile cancer.

The earlier the circumcision is done, the better the penis will develop ?

No. First, as mentioned above, not all men need circumcision .

Secondly, the development of the penis depends on the level of androgen in the body , which is affected by genetics, nutrition, environment and other factors. The androgen level reaches its peak during adolescence, and the penis is basically mature at around 18 years old. Simple foreskin does not affect the androgen level or the development of the penis .

However, if the foreskin is too long and causes hypospadias or phimosis, it may affect the shape and function of the penis .

Finally, according to the physiological characteristics of children and the developmental process of the pathological process, those who really need surgical treatment are generally recommended to undergo surgery at the age of 5-10 , that is, preschool and school age are the best time for surgery. Children of this age group have good self-control ability, relatively weak nerve sensitivity and sensitivity to pain, and relatively low discomfort from surgical treatment.

Spring and autumn are the most suitable time periods for circumcision . Autumn is known as the best season for circumcision because of the dry weather and less inflammation after surgery.

When should circumcision be performed ?

You can't have your foreskin circumcised whenever you want. As mentioned above, those with simple foreskin hyperplasia do not need surgery.

However, surgery is required in the following situations :

① Foreskin is too long: If sexual discomfort often occurs or balanitis recurs , surgical intervention is required.

②Phimosis : Basically all patients with phimosis need to undergo circumcision surgery.

③ Phimosis : refers to the foreskin being stuck during erection and unable to return to its original position, which may cause ischemia, pain, edema and even necrosis of the glans penis. It is a surgical emergency and requires timely manual reduction. If the reduction fails, a dorsal narrow ring incision of the foreskin should be performed.

④ Foreskin cyst : Due to infection, trauma, congenital abnormalities, etc., one or more cystic structures are formed under the foreskin. If the cyst is large or affects the quality of life, surgical treatment is also required.

What should I pay attention to after circumcision ?

Circumcision is a common male surgical procedure. Although it is simple, due to the rich nerve and blood supply in this area, it may cause complications such as bleeding, infection, edema, and rupture if not handled with care.

Here are some common post-operative precautions:

▶ 1. Rest and activity : You need to get enough rest after surgery and avoid strenuous activities and physical labor to avoid affecting wound healing. Appropriate light activities can help promote blood circulation, but avoid excessive exercise and strenuous activities.

▶ 2. Keep the wound clean : Edema, bleeding or infection are most likely to occur after surgery, especially during nocturnal erections. After surgery, the wound should be cleaned regularly with saline or a cleaning solution recommended by the doctor to keep it dry and clean. Avoid touching the wound with your hands to avoid infection. When urinating, try to lean forward with the urethra opening pointing vertically downward to avoid urine flowing onto the gauze, and wipe off the residual urine.

▶ 3. Dietary precautions : Do not eat irritating foods within two weeks after circumcision surgery, drink less alcohol, and you can appropriately supplement with meat, milk, eggs and other foods to promote wound healing.

▶ 4. Wear loose underwear : After the operation, you should choose loose and breathable underwear, and avoid wearing underwear that is too tight or rubs against the wound, which is conducive to wound healing and comfort.

▶ 5. Avoid sexual intercourse : Adults should avoid sexual intercourse after surgery, at least until the wound is completely healed and the doctor confirms that sexual intercourse can be resumed.

▶ 6. Observe the wound : The wound should be observed regularly after surgery. If there is any abnormality, such as redness, swelling, bleeding, exudation, etc., consult a doctor in time.

▶ 7. Do not scratch the wound : Avoid scratching the wound after surgery to prevent infection and wound dehiscence.

▶ 8. Regular follow-up : After surgery, you should follow the doctor's advice for regular follow-up to ensure that the wound recovers well.

In short, after circumcision, you should pay attention to rest, cleanliness, anti-inflammatory, hemostasis, avoid erection and sexual life. If you feel any discomfort or abnormality, you should go to the hospital for examination and treatment in time.

in conclusion

First, because the foreskin of the penis continues to develop physiologically after birth, physiological phimosis does not require surgery;

Secondly, simple foreskin does not require surgery; thirdly, foreskin that is long and accompanied by recurrent infections or discomfort during sexual life, almost all phimosis and foreskin incarceration, and larger foreskin cysts require surgical treatment.

In addition, the development of the penis is mainly affected by androgens, and normally developed foreskin and simple foreskin hyperplasia will not affect its development.

Therefore, the statements such as "does foreskin need to be circumcised if it is too long" and "the earlier the foreskin is circumcised, the better the penis will develop?" are inaccurate. We need to remind everyone that if you think your child's foreskin is too long, you should seek medical attention in time to assess whether surgery is needed.

Author: Meng Yao, Ph.D., Doctor of Medicine, Zhongshan Hospital, Fudan University

Reviewer: Wang Wei, deputy chief physician of Urology Department, Shanghai Fifth People's Hospital

The article is produced by "Science Refutes Facts" (ID: Science_Facts). Please indicate the source when reprinting.