IWAN IRAWAN K

M A LE
C IR C U M C IS IO N
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EX TER N A L M A LE S EX U A L
A N ATO M Y
Penis
Shaft

Frenulum

Corona

Urethral Meatus
Glans

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Internalstructureofthepenis:
cross-section

Fig 5.1b Interior structure of the penis: (b) cross section of the penis 5
 Penis : Penampang melintang

Kulit

F.Buck
N.Dors.-
-penis

C.C.P.
C.C.U.

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Externalpenile structures

Corona: the rim of the

penile glans
Frenulum: thin strip of skin
connecting the glans to
the shaft on the underside
of the penis

Both are highly sensitive

areas to the touch

Fig 5.2 This figure, a view of the underside of the penis, shows
the location of the corona and frenulumtwo areas on the penis
that harbor a high concentration of sensitive nerve endings. 7
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flaccid erect

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 Turkishboycircumcised
atpuberty

JewishMohelperformsritual
circumcision
Circumcision in
Other Cultures

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Circum cision
Circumcision: surgical removal of the foreskin
of the penis.

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PHIMOSIS-
- Phimosis is overdiagnosed.
- Physiological adhesions are present
between foreskin and glans upto 6
years of age.
True phimosis in boys with scarring of
prepuce which is not retractable.
Balnitis Xerotica Obliterans(BXO)
Treatment- Circumcision

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 IN D ICATIO N S-
Infants & young boys-
-social & religious
-Phimosis
- paraphimosis
-BXO
-Balanposthitis
-Recurrent UTI
-Trauma (Zip injury)
Adults-
-Balanoposthitis
-Ca Penis for Radiotherapy
-Difficulty in intercourse

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CO N TRAIN D ICATIO N -

Hypospadias

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P EN IS S IZ E C A N
S O M ETIM ES B E
P R O B LEM ATIC

Priapus - Roman God of

fertility from the entrance
to the House of Vettii -
Pompeii (circa 60 A.D.)

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Somepeoplebelievethat
circumcisionistraumatic
fortheinfantboy

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Foreskin fully forward

Foreskin being pulled

back

Foreskin pulled
back

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TECH N IQ U E-

INFANTS- Gullitone method

ADULTS- 3 Artery forceps method
PLASTIBEL METHOD

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 ANAESTHESIA-
Ideal- General anesthesia
also Local Anesthesia in Adults.

POSITION-
Supine

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1.3 ARTERY FO RCEPS M ETH O D

1. Parts are prepared, painted and drapped.

2. Small sized mosquito forcep is passed between
prepuce and glans to separate the adhesions. Prepuce
is retracted. Smegma is cleaned with betadine.
3. 3 small sized artery forceps are applied at 2,6 and 12
o clock position.
4. Prepuce is clamed at 12 oclock position with straight
artery forceps and removed.
5. Prepuce is now cut over this groove involving both
skin and mucosa.
6. Now prepuce is cut on both sides from 12oclock
position to 6 oclock position.

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7. Haemostasis is achieved with chromic
catgut. We ligate Dorsal vein of penis,
Frenular veins.
8. At 6oclock position Figure of 8 stitch is
taken and simple sutures are taken at
12, 3, 9 oclock position.
9. Dressing is done.

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LIDOCAIN ONLY (WITHOUT
EPINEPHRINE)

!
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Klik disini
untuk melihat
video sirkumsisi

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MethodsofModern theGomcoclamp
Circumcision 29
ThePlastibelldevice

MethodsofModern
Circumcision
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theMogenclamp

MethodsofModern
Circumcision
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 Self-reported sexualsatisfaction am ong w om en w ho had sexual
intercourse before and after their partners circum cision

Characteristics Relative level of sexual satisfaction (after versus before P- Value

males circumcision) n%
Less Same More Total

All 13 (2.9) 255 (57.3) 177 (39.8) 455 (100)

Age

15-24 4 (2.5) 80 (50.3) 75 (47.2) 159 (100) P=0.14

25-29 4 (2.6) 90 (58.8) 59 (38.6) 153 (100)

30+ 5 (3.8) 85 (63.9) 43 (32.3) 133 (100)

Religion

Catholic 11 (3.4) 178 (54.9) 135 (41.2) 324 (100) P=0.09

Protestant 1 (1.3) 56 (70.9) 22 (27.9) 79 (100)

Muslim/None/Saved/Other 1 (2.4) 21 (50.0) 20 (47.6) 42 (100)

Education

None/Primary 12 (3.6) 195 (58.0) 129 (38.4) 336 (100) P=0.25

Secondary /Tertiary 1 (2.9) 60 (55.1) 48 (44.0) 109 (100)
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THANK YOU

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