Circumcision: removing the foreskinCircumcision: foreskin ko nikalna

Yeh kya hai aur kyun kiya jata hai

Foreskin aam tor par peeche ho kar penis ka sira (glans) khol deti hai. Circumcision ki tibbi wajuhaat mein shamil hain:

• Tang foreskin (phimosis) jo peeche nahi hoti, jis se dard, safai mein mushkil, ya peshab ki dhaar ka phail jana hota hai,
• Sira aur foreskin ka baar baar infection ya soojan (balanitis),
• Jild ki bimari se foreskin ka daagh (jaise balanitis xerotica obliterans, jise lichen sclerosus bhi kehte hain),
• Foreskin ka sira ke peeche phans kar phool jana (paraphimosis),
• foreskin ke tang hone se sakhti ya jinsi taluq ke dauran dard, ya jild ka phat jana.

Bohat se mard kisi tibbi masle ke baghair zaati, saqafati ya mazhabi wajuhaat se operation karwate hain. Yeh bhi jaiz intikhab hai aur yeh guide us ko bhi shamil karti hai.

Tang foreskin ke mutabadil mein steroid cream, halka phailana, ya aisa operation jo foreskin ko nikale baghair chora kare (preputioplasty) ho sakte hain. Aap ka doctor batayega ke yeh munasib hain ya nahi.

Bachon aur chhote larkon ka circumcision mukhtalif hota hai aur us umar ke maahir karte hain. Agar larke ko hypospadias ho to kisi bhi circumcision se pehle surgeon ko dikhana zaroori hai (dekhein hypospadias ki guide).

Procedure se pehle

• Muaina: doctor foreskin ka muaina karta hai aur peshab ka test kar sakta hai (dekhein peshab ke tests ki guide). Koi infection ho to pehle us ka ilaaj hota hai.
• Team ko sugar (diabetes), khoon patla karne wali dawaon, khoon behne ke masail aur allergies ke baare mein batayein. Apne taur par koi dawa band na karein.
• Bay-hoshi: circumcision local anaesthetic (penis ki jad mein sunn karne wale injection) ya poori bay-hoshi mein hota hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi. Poochhein ke kitni khaal nikali jayegi aur khatrat kya hain. Isay wapas nahi kiya ja sakta.
• Baad ke liye dheela, aaramdeh underwear saath layein.
• Qeemat, operation kahan hoga aur aap kab ghar ja sakte hain, yeh bhi poochh lein.

Procedure ke dauran

Anaesthetic ke asar ke baad surgeon ehtiyaat se foreskin nikalta hai, khoon ko roktaa hai, aur khaal ke kinaron ko aam tor par ghulne wale taankon se jorta hai. Halki dressing lagayi ja sakti hai. Yeh chhota operation hai, aam tor par aik ghante se kam, aur zyadatar mard usi din ghar chale jate hain.

Procedure ke baad aur recovery

• Dard, soojan aur neel aam hain aur bohat zyada dikh sakte hain. Jagah aam tor par aik do haftay mein theek hoti hai, aur jild poori tarah bharne mein kuch haftay lagte hain.
• Dard ka ilaaj: aam dard ki dawayein aam tor par kaafi hoti hain.
• Dheela underwear pehnein aur zakhm saaf rakhein. Roz paani se aahista dhoyein aur thapthapa kar sukha lein. Dressing ke baare mein jo mashwara ho us par amal karein. Taanke aam tor par kuch haftay mein ghul jate hain.
• Aap aam tarah peshab kar sakte hain. Shuru mein jalan ho sakti hai.
• Khaas hissay ki sakhti kuch haftay dardnaak ho sakti hai, khaas tor par subah.
• Jinsi taluq aur masturbation: zakhm poori tarah bharne tak ruk jayein, aam tor par chaar se chhe haftay, ya jaisa mashwara ho.
• Sargarmi: chand din aaram karein. Jaisa mashwara ho kuch haftay cycling aur zor wali kasrat se parhez karein. Bohat se mard aik haftay mein daftar ke kaam par wapas aa jate hain.

Mumkina khatrat

• Aam: chand din dard, soojan, neel aur thora sa khoon.
• Kam aam: zakhm ka infection, khoon jis ke liye theatre wapas jana ya dressing badalni pare, aur zakhm ke kinaron ka halka sa khul jana.
• Ghair aam: zyada ya kam khaal ka nikalna, daagh ya khaal ka tang challa, sira aur shaft ke darmiyan khaal ke pul, aur sira ke mehsoos hone mein tabdili (kuch mard hassasiyat mein kami ya zyadati mehsoos karte hain).
• Bohat kam: peshab ki nali ke khulne ka tang ho jana (meatal stenosis), penis ke sira ko chot, ya anaesthetic ke khatrat.
• Yeh hamesha ke liye hai. Foreskin wapas nahi lagayi ja sakti.

Follow-up aur nateeje

• Follow-up: kuch haftay baad bharne ka muaina ho sakta hai, ya team phone par rabta kar sakti hai.
• Nikali gayi khaal laboratory bheji ja sakti hai agar foreskin ghair mamooli lagi ho. Poochhein ke nateeja kab aur kaise milega.
• Agar aap ko jild ki bimari ho jaise balanitis xerotica obliterans to follow-up ki zaroorat ho sakti hai, kyunke yeh penis ke sira ya peshab ke khulne ko mutasir kar sakti hai.
• Agar dhaar patli ya kamzor ho, ya dard ho to apne doctor ko batayein (dekhein penis ke dard ki guide).

Aam sawalaat

What it is and why it is done

The foreskin normally pulls back to uncover the head of the penis (the glans). Medical reasons for circumcision include:

• A tight foreskin (phimosis) that will not pull back, causing pain, difficulty cleaning, or a spraying stream,
• Repeated infection or inflammation of the head and foreskin (balanitis),
• Scarring of the foreskin by a skin condition (such as balanitis xerotica obliterans, also called lichen sclerosus),
• The foreskin getting stuck behind the head and swelling (paraphimosis),
• pain with erections or sex because the foreskin is too tight, or tearing of the skin.

Many men have the operation for personal, cultural or religious reasons, with no medical problem. That is a valid choice and this guide covers it too.

Alternatives for a tight foreskin may include a steroid cream, gentle stretching, or an operation that widens the foreskin without removing it (a preputioplasty). Your doctor will say if these are suitable.

Circumcision of babies and young children is different and is done by specialists for that age. If a boy has hypospadias, a surgeon must see him before any circumcision (see the hypospadias guide).

Before the procedure

• Examination: the doctor examines the foreskin and may check your urine (see the urine tests guide). Any infection is treated first.
• Tell the team about diabetes, blood thinners, bleeding problems and allergies. Please do not stop any medicine on your own.
• Anaesthetic: circumcision is done under a local anaesthetic (numbing injections at the base of the penis), or a general anaesthetic. Follow the instructions about eating and drinking.
• You will be asked for consent. Please ask how much skin will be removed, and about the risks. It cannot be undone.
• Bring loose, comfortable underwear for afterwards.
• Ask about the cost, where it will be done and when you can go home.

During the procedure

With the anaesthetic working, the surgeon carefully removes the foreskin, controls any bleeding, and stitches the edges of the skin together, usually with dissolving stitches. A light dressing may be put on. It is a short operation, usually under an hour, and most men go home the same day.

After the procedure and recovery

• Soreness, swelling and bruising are expected and can look dramatic. The area usually settles over a week or two, and the skin takes a few weeks to heal fully.
• Pain relief: ordinary painkillers are usually enough.
• Wear loose underwear, and keep the wound clean. Wash it gently with water daily, and pat it dry. Follow any advice about the dressing. The stitches usually dissolve in a few weeks.
• You can pass urine as normal. It may sting at first.
• Erections can be sore, especially in the morning, for a couple of weeks.
• Sex and masturbation: wait until the wound has fully healed, usually around four to six weeks, or as advised.
• Activity: take it easy for a few days. Avoid cycling and strenuous exercise for a few weeks, as advised. Many men return to desk work within a week.

Possible risks

• Common: pain, swelling, bruising and a little bleeding for a few days.
• Less common: a wound infection, bleeding that needs a return to theatre or a dressing change, and the wound edges opening slightly.
• Uncommon: too much or too little skin taken, a scar or tight ring of skin, skin bridges between the head and the shaft, and a change in how the head feels (some men notice reduced or increased sensitivity).
• Rare: narrowing of the opening of the urine tube (meatal stenosis), injury to the head of the penis, or the risks of the anaesthetic.
• It is permanent. The foreskin cannot be put back.

Follow-up and results

• Follow-up: you may be seen after a few weeks to check healing, or the team may arrange a phone call.
• The removed skin may be sent to the laboratory if the foreskin looked unusual. Ask how and when you will get the result.
• If you have a skin condition such as balanitis xerotica obliterans, you may need follow-up, as it can affect the head of the penis or the urine opening.
• If you notice a narrow or weak stream, or pain, tell your doctor (see the penile pain guide).

Common questions