Glossary and Explanation of Medical Circumcision Terms.

Glossary of Terms

During development in the womb the foreskin is not differentiated from the glans penis until a late stage. At birth the foreskin is thus usually still attached to the underlying glans by tissues generally known as ‘adhesions’, but more correctly called synechia. These adhesions can be broken down by a doctor with a blunt probe, as is necessary before infant circumcision, but are otherwise best left to resolve themselves.

There should be no adhesions remaining by the time a boy reaches the age of 5, by which time he should have been taught to retract his own foreskin daily for washing and every time he urinates. Any adhesions still remaining by the onset of puberty must be broken down to allow proper development and hygiene of the penis.

Balanitis

Inflammation of the foreskin or the glans. The condition should more properly be called balano-posthitis. Balanitis strictly means inflammation of the glans and posthitis means that of the prepuce. It may be caused by trauma, irritants or infection. Infective balanitis is commonly caused by bacteria or fungi (yeasts) which thrive in the warm, moist, dark conditions under the foreskin. Poor hygiene, retained soap or detergent, retained smegma or inadequate drying may cause an irritant balanitis.

Frictional trauma and accidental wounds cause fissures, erosions or localized area of damage. Postcoital erosion of the frenulum is not uncommon.

Ballooning

A condition caused by phimosis in which urine cannot escape from the tip of the foreskin as fast as it is fed into it from the bladder. The foreskin thus swells up with the pressure of the urine inside it and the infant usually cries with the resultant pain. The backward pressure placed on the bladder can cause damage to that organ and can also put additional strain on the kidneys which can easily be permanently damaged.

Circumcision

Minor surgery to remove the prepuce, or foreskin, of the penis. It is performed for religious reasons in some communities but primarily for medical reasons such as improved hygiene and sexual pleasure, and the elimination of problems of phimosis, paraphimosis and balanitis.

Circumcision may be performed at any age but is most often done neonatally when it is quick, simple, cheap and almost painless.

Corona

The flared rim at the back of the glans. This is the most sensitive part of the penis. After circumcision it is normal for the corona to expand to a diameter significantly greater than that of the penile shaft. Circumcision allows full stimulation of the corona during sexual activity.

Coronal Sulcus

The ‘groove’ behind the corona at the back of the glans.

Dorsal

A medical term meaning ‘on the upper surface’.

-ectomy

A word ending meaning ‘removal of’, e.g. appendectomy = removal of the appendix.

Fold

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

Foreskin (also called prepuce)

Prepuce, the part of the skin system of the penis covering the glans. The outer skin folds inward at the end of the foreskin. From this fold on to where it joins behind the glans is the moist mucosal area. The foreskin is a remnant of earlier stages of evolution (much as the appendix is) where it was necessary to protect the glans from abrasion from undergrowth and tree branches. Now that man travels on 2 legs rather than 4 and is generally clothed the foreskin serves no further purpose. The presence of a foreskin can lead to phimosis, paraphimosis, balanitis, urethritis, retained smegma, 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 which 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 covering varies between men from ‘complete with overhang’ to ‘none at all’. During 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 glans allowing full stimulation during sex.

Haemophiliac

A male whose blood does not clot properly due to a genetic defect. (Women can carry the defective gene, but do not show the symptoms of haemophilia.) Conventional surgery on a haemophiliac can result in considerable loss of blood and is thus to be avoided as far as possible.

High

When used to describe the position of the circumcision scar line, this is taken to mean closer to the base of the penis and further from the glans.

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 assesses by a urologist and any corrective action taken. This is because tissue from the foreskin is normally used in the repair. The urologist can complete the circumcision at the end of the repair operation.

-itis

A word ending meaning ‘inflammation of’, e.g. appendicitis = inflammation of the appendix.

Meatus

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

Neonatal

Soon after birth, newborn.

Paraphimosis

A condition in which the foreskin, having been retracted 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 a paraphimosis has occurred it is almost certain to recur and this should be prevented by circumcision as soon as the swellings from the paraphimosis have resolved completely.

Penis

The male organ of sexual intercourse. It is also 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 a phimosis exists.

The foreskin of an infant may be bonded to the glans by adhesions and thus inability to retract the foreskin in boys under 5 years old 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 while glans and coronal sulcus both when flaccid and when erect. The only sure and reliable cure for phimosis is circumcision.

-plasty

A word ending meaning ‘repair of’, e.g. frenuloplasty = repair of a torn frenulum.

-plexy

A word ending meaning ‘fastening of’, e.g. orchidoplexy = fastening an errant testicle into the scrotum.

Prepuce

see Foreskin

Restoration

Restoring the coverage of the glans through either surgical or non-surgical means. The restoration process is long and complicated and the restored ‘foreskin’ has few of the attributes of the original except that it very loosely covers the glans to a greater or lesser extent.

A very small number of circumcised men blame their lack of self-esteem on their circumcision and believe that if they can only get back their foreskin all will be well with them, they thus ‘restore’ their foreskin by stretching it longitudinally over a considerable period of time. Because their disorder is psychological rather than physical the presence of a semblance of a foreskin again satisfies their desires and they claim increased sexual pleasure.

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.

Scrotum

The pouch behind the penis which houses the testicles. The scrotum lengthens and contracts with changes of temperature so as to keep the testicles at as constant a temperature as possible.

Skin Bridge

An occasional complication of circumcision in which part of the remaining skin heals by attaching to the glans, forming a ‘bridge’ of skin. A skin bridge is the result of an incomplete circumcision in which too little foreskin has been removed and failure to use a non-stick ointment (like 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 which collects in the coronal sulcus and under the foreskin of the uncircumcised. It is composed of excess lubricant from the 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 significantly. The bacteria can cause balanitis as well as contributing 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 skin from where sutures were. 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.

Stretching

The practice of the non-surgical restoration of the foreskin through stretching over a considerable period of time.

Surgical Knot

A surgical knot is a double knot made with suture material such that it will not slip or come untied.

Suture

A surgical stitch. Suture material is designed to be very strong whilst being tolerated well by the body. There are two types of suture material: a self-dissolving one which allows the stitch to come out in about a week; and a non-absorbable type, which has to be removed by the doctor, that is used where the stitch needs to hold for longer periods.

Testicles (Testes)

The soft egg shaped organs, consisting primarily of tightly coiled tubes, lying in the scrotum in which sperm are generated and which also produce male hormones.

Tysons Glands

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

Uncircumcised

The original state of the penis before circumcision. 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

A medical term meaning ‘on the lower surface’.