In males, the foreskin that covers the head of the penis (known as the glans) has no function in urination or reproduction. It can, however, cause discomfort and become infected easily during sexual activity if it's too tight or not properly cleaned. For these reasons, some men choose to have their foreskin removed completely as an adult by undergoing circumcision, while others choose to have it removed partially instead by undergoing preputioplasty, also known as circumcision reduction or less commonly as prepuce reduction.
Introduction:
Preputial surgery - also called phimosis repair or preputioplasty - is a simple procedure that's done to treat problems caused by a tight foreskin. If you have concerns about your prepuce, it's important to speak with your healthcare provider before seeking any treatment.
In some cases, phimosis will improve on its own as you age. In other instances, an underlying condition may be at fault and require additional care or treatment.
In a healthy, uncircumcised penis, only part of your glans - the rounded tip of your penis - is covered by foreskin. In some men, however, their foreskin can't be pulled back (retracted) over their glans. This condition is called phimosis and it can lead to inflammation and other complications if not treated properly.
If you suspect that you have phimosis, it's important to see your healthcare provider for a proper diagnosis. You may be referred to a urologist who specializes in male sexual health and treatment options for penile problems.
Definition:
A preputioplasty is a surgical procedure for correcting phimosis (tight foreskin) by widening a narrow opening in order to expose and straighten the tip of the penis (glans penis). A primary goal of preputioplasty is to preserve as much skin on your penis as possible.
In a preputioplasty, part of your foreskin will be used to widen your opening. Because foreskin is elastic, it can stretch enough to make your opening big enough for urine and semen to flow through without causing tearing or scarring. However, stretching your foreskin beyond its capacity could cause permanent damage.
It's common for physicians to perform preputioplasties in combination with other procedures for phimosis correction.
History:
To understand what a preputioplasty is, it's important to know where it came from. In 1907, Dr. Ladislas J Meduna was conducting research on epilepsy patients and trying to find new ways to treat them. After experimenting with injections of camphor oil as a means of inducing seizures, Dr. Meduna accidentally injected himself with potassium bromide instead of camphor oil.
Following his misstep, Dr. Meduna realized that he had stumbled upon a new treatment for epilepsy - one that didn't cause seizures but still had therapeutic value for patients. He named it preputioplasty because of its location on male genitalia.
While preputioplasty wasn't as effective for treating epilepsy as it was for treating hysteria, Dr. Meduna continued to experiment with ways to make it more effective. He eventually discovered that preputioplasties were most effective when performed on female patients; they could be used to treat both genital pain and hysteria with equal effectiveness.
Finally, after several years of experimentation, Dr. Meduna published his findings in a book titled Epilepsy and Hysteria: A New Treatment Based on Preputioplasty. He died shortly thereafter at age 37, but his work had already made an impact on medicine and would continue to do so for decades to come. Over time, preputioplasties were used less frequently until they were eventually replaced by other methods of treatment for hysteria and epilepsy.
Procedure:
In preputioplasty, an incision is made in a man's foreskin. Then, excess foreskin tissue and skin at the head of his penis are removed. Finally, stitches or staples are used to close both sides of the incision in his foreskin.
In most cases, a local anesthetic is used to dull any pain that might result from preputioplasty. A dressing will then be placed over his penis to protect it from injury until it has healed completely.
In some cases, additional tissue at either end of a man's foreskin will be removed in addition to excess foreskin tissue and skin. If so, his physician will likely use sutures or staples to close up both sides of each incision made in his foreskin.
Because preputioplasty heals quickly, a man can return to work or other normal activities within days of having it done. His dressing will need to be changed a few times until his incisions have healed. He'll also need to use another method of birth control, such as a condom, during sex for at least three months after preputioplasty. This helps prevent pregnancy from occurring while his incisions are healing.
Although a man's penis may appear healed on its surface soon after preputioplasty, his urethra still needs time to heal. This can take three to six months or more. It's vital that he refrain from sex until his urethra has healed completely.
As with most surgeries, there are some risks associated with preputioplasty, including infection and bleeding. It's also possible that a man will notice some slight asymmetry of his penis when it has healed after having undergone preputioplasty.
Anesthesia:
With circumcision, it's typically either a local anesthetic (numbing a small area) or general anesthesia (putting you under). Getting circumcised under local anesthetic doesn't mean you aren't getting general anesthesia; it means that your doctor thinks you can handle more.
If your doctor doesn't offer general anesthesia, you'll be put under local anesthetic. You may feel a pinch when your doctor gives you a shot of local anesthetic to numb your penis. Some patients say that getting a shot doesn't hurt much at all - it just feels like their penis is falling asleep. Others say that it stings more, and they think it might be more painful than being circumcised without any anesthesia at all!
After your penis is numb, you'll probably feel some tugging as your doctor pulls on it. At first, you may feel some pressure. Later, you might feel stinging or burning sensations.
Your doctor might gently scratch or pinch your inner thigh or groin to see if you can feel it. This test tells your doctor that your penis has been numbed properly and that he or she can go ahead with circumcising you without hurting you too much.
When should I get circumcised?
Some parents decide to have their sons circumcised soon after birth - either as a religious ceremony or just because they want their sons to look like other males in their family. This practice has declined in recent years, though. Most doctors recommend waiting until your son is at least six months old.
Risks and complications:
Although preputioplasty is not associated with high levels of risk or complications, it does involve general anesthesia and a surgery performed under general anesthesia always carries risks. The possibility of surgical complication includes injury to blood vessels, nerves, or tissues.
In rare cases, these complications can cause permanent loss of sensation or function. It should be noted that although most patients do not experience significant problems following preputioplasty surgery, recovery time tends to be quite lengthy as it's a major procedure.
Surgery to correct phimosis is usually done with local anesthesia, but if you have pain or discomfort, your doctor may prescribe a general anesthetic. Local anesthesia is associated with minimal risk, but general anesthesia carries a small risk of serious complications.
At home, you'll need to follow your doctor's instructions and avoid strenuous activity until your discharge instructions say it's okay. Discomfort and swelling are common during recovery and may last a few weeks. You may notice scarring or discoloration of your penis in some cases.
The primary risks of phimosis surgery are bleeding and infection. These risks increase if you have another medical condition that impairs blood clotting or increases your risk of infections, such as diabetes. As with any procedure, there's a risk that preputioplasty won't correct your phimosis problems.
It's important to keep in mind that serious complications are rare. Still, any surgery carries risks and you should be aware of them before proceeding with phimosis surgery. Before scheduling preputioplasty, discuss potential complications with your doctor so you can make an informed decision about whether or not you want to move forward with preputioplasty.
Recovery period:
You'll want to take it easy for four to six weeks after your surgery - no penetrative sex, heavy lifting, or aggressive sports. At that point, you can gradually return to sexual activity, but start with a few minutes of foreplay and work up from there. Lubricant will make everything go more smoothly.
After six weeks, you can start more serious sexual activity, but doctors advise keeping an eye on your sutures - if they begin to separate or loosen, that's a sign you're pushing yourself too hard. If it happens, wait another week or two before having sex again.
After a year, your doctor should recheck how things are healing and, if all's well, remove your sutures. Depending on how you take care of yourself and whether or not you want to keep it up after that point, there's no reason why you shouldn't continue with sex for years afterward.
How to choose your doctor?
This step, arguably, is one of your most important - after all, it's who you'll be working with throughout your entire procedure. It's crucial to have an open dialogue with your doctor to make sure you're both on board with a treatment plan that suits your specific goals and body type. During your initial consultation, speak candidly about what you envision as a result of surgery.
If you have concerns about certain elements of your procedure, such as scars or recovery time, be sure to bring them up at your consultation. Discussing these things will help ensure you're both on board with a treatment plan that suits your specific goals and body type. Your doctor should also be equipped to answer any questions you may have regarding potential downtime, specific healing times and even diet restrictions during surgery.
It's also a good idea to have an open dialogue with your doctor regarding any other physical conditions you may have, such as high blood pressure or diabetes. These factors may influence your procedure and will definitely factor into your post-op recovery process. Make sure you feel comfortable discussing these things with your doctor.
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