Glossary of circumcision

Adhesions

At birth, the foreskin is usually attached to the head of the penis generally known as 'adhesions'. It separates at a later stage. These adhesions can be separated by a doctor before circumcision, but are otherwise left to resolve themselves by the time a boy reaches the age of 4-5. It also can occur abnormally due to scarring and inflammation (balanitis) of the foreskin. 

Balanitis

This is a condition that occurs due to inflammation of the foreskin. It is also called balanoposthitis if the head of the penis and foreskin is affected. It may be caused by infection, trauma or irritants. Infective balanitis is commonly caused by bacteria or fungi (yeasts) which thrive in the warm, moist, dark conditions under the foreskin.
Frictional trauma, accidental wounds or scarring cause fissures, erosions or localized areas of damage to the foreskin. After sexual activity, attrition of the frenulum sometimes occurs.

Ballooning

Swelling of foreskin due to urine collecting within it due to tight foreskin from which urine cannot come out as fast as it comes into it from the bladder. If the foreskin is very tight (phimosis), the back pressure on the bladder can cause strain to that bladder, ureters and kidneys, which can be affected.

Circumcision

Circumcision is an operation to remove the foreskin. The foreskin is the sleeve of skin around the tip of the penis. It is also called the prepuce of the penis. It is performed for religious, cultural and medical reasons such as phimosis (tight foreskin), paraphimosis (foreskin stuck beyond the head) and balanitis xerotica obliterans.
Circumcision may be performed at any age but is most often done in the first six months when it is a safe, simple, cost-effective and almost painless procedure.

Corona

The raised rim at the back of the head of the penis. Circumcision exposes the corona in most cases.

Coronal Sulcus

The 'groove' behind the corona at the back of the glans.

Dorsal side

'On the upper surface' of the penis.

Fold

The end of the uncircumcised penis, where the outer skin folds inward and forms the moist mucosal area.

Foreskin (also called prepuce)

The prepuce is the part of the skin of the penis covering the head of the penis. It has two layers, the outer normal skin and the inner moist mucosal area. The presence of a foreskin can lead to phimosis, paraphimosis, balanitis, urethritis, retained smegma (normal dried secretion of the inner layer of the foreskin), a higher risk for penile and cervical cancer, and a higher risk for sexually transmitted diseases including AIDS.

Frenulum (also called frenum or fraenum)

A fibrous cord of connecting tissue on the underside of the penis joins the back of the glans to the inner foreskin, much like the frenum of the tongue. It is generally recommended that it be removed during circumcision.

Frenulum Breve

The condition in which the frenulum is very short and tight. A frenulum breve prevents the normal complete retraction of the foreskin and may distort the glans during erection, it thus inhibits normal sexual activity. In some cases, it can lead to impotence as the sufferer suppresses erections due to the pain they cause.  A short frenulum can rip during sexual activity with painful and very bloody consequences.

Glans

The bulbous head of the penis. The primary area of sexual sensitivity to touch. In the uncircumcised, the glans is generally covered by foreskin when the penis is flaccid although the amount of this coverage varies between men from 'complete with overhang' to 'none at all’. During an erection, the foreskin should slide back to uncover the glans to allow it to be fully stimulated but often the foreskin is too tight or long and fails to fully retract. Circumcision permanently bares the head of the penis.

Hypospadias

A condition in which the urethra opens onto the underside of the shaft of the penis instead of at the tip of the glans. 

A boy with hypospadias should not be circumcised until after the hypospadias has been assessed by a paediatric urologist and any corrective action taken. This is because part of the foreskin is normally used in the repair.

Meatus

The opening of the urethra at the end of the glans.

Neonate

One-month-old child.

Infant

One-year-old child.

Paraphimosis

A condition in which the foreskin, having been drawn back behind the glans (often with some difficulty) is too tight to return to covering the glans. The trapped foreskin causes the glans to swell more and a vicious circle sets in. It is imperative that the swelling of the glans be reduced immediately and the foreskin replaced otherwise surgical intervention will be necessary to prevent loss of the glans.

Once paraphimosis has occurred it is almost certain to recur and this can be avoided by circumcision as soon as the swellings from the paraphimosis have resolved completely.

Penis

The male organ of sexual intercourse and the organ through which urine is passed.

Phimosis

A condition in which the foreskin is too tight. If ballooning of the foreskin occurs during urination at any age then phimosis exists.
The foreskin of an infant may be bonded to the glans by adhesions and thus unable to retract the foreskin. In boys under 5 years old, this is not in itself an indication of phimosis. In the older child, teenager or adult, phimosis is present if the foreskin cannot be freely, easily and painlessly retracted to uncover the whole glans and coronal sulcus both when flaccid and when erect. The only sure and reliable cure for phimosis is circumcision.

-plasty

A word ending means' repair of', e.g. frenuloplasty = repair of a frenulum if torn.

-plexy

A word ending meaning 'fastening of', e.g. orchidopexy = fastening an errant testicle into the scrotum.

Prepuce

see Foreskin

Scar Line

The line where the mucosal skin remaining from the inner layer of the foreskin meets the outer skin on the shaft of the penis following circumcision. This may be anywhere from immediately behind the corona of the glans to several centimetres back along the shaft. The actual surgical scar is usually hard to see but its location is often marked by a distinct colour change between the shaft skin and the former inner lining of the foreskin. This can give the impression of high and low cuts of the circumcision.

Scrotum

The pouch behind the penis which the testicles reside inside it. The scrotum lengthens and contracts with changes of temperature so as to keep the testicles at a constant temperature below body temperature to keep their proper functions.

Skin Bridge

An occasional complication of circumcision is which part of the remaining skin heals by attaching to the glans, forming a 'bridge' of skin. A skin bridge is a result of an incomplete circumcision in which too little foreskin has been removed and failure to use a non-stick ointment (such as Vaseline) during the early stages of healing. Skin bridges should be treated as soon as possible after the main circumcision has completely healed by cutting through them under topical or local anaesthetic.

Smegma

A white cheese-like substance that collects in the coronal sulcus and under the foreskin of the uncircumcised. It is composed of excess lubricant from Tyson's Glands, sweat, stale urine, dead skin cells and collected debris. 

If not cleaned away at least daily, smegma can become a breeding ground for bacteria which turn it yellow and cause it to smell significant. The bacteria can cause balanitis as well as contribute to other more serious diseases of the penis. Smegma has been implicated in genital cancers.

Stitch Tunnel (Suture Tunnel)

An occasional complication of circumcision in which 'tunnels' remain in the skin from where sutures were. These are more common in dark-skinned people. They are normally caused when the skin around a suture heals very quickly without the suture having first dissolved. The pockets formed by the two layers of skin tend to collect dirt and can be susceptible to infection. The skin on the outside of the tunnel can easily be cut off under topical or local anaesthetic so as to remove the blemish.

Suture

A surgical stitch. The suture material is designed to be very strong whilst being tolerated well by the body.  We use a self-dissolving one that allows the stitch to come out in about 2-3 weeks.

Testicles (Testes)

The soft organs, consisting primarily of tightly coiled tubes, lie in the scrotum (sac) in which sperm are generated and which also produce male hormones.

Tysons Glands

These are secretory glands that are symmetrically located on either side of the frenulum. They produce an oily lubricant for the foreskin.

Uncircumcised

Prepuce or foreskin is present after birth. Also sometimes called uncut or intact. A few boys every year are born without any foreskin or with a very short foreskin and thus although uncircumcised have the appearance and all the benefits of being circumcised.

Urethra

The tube in the ventral portion of the penis through which urine and semen pass.

Ventral

'On the lower surface'.

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