A tale of ‘undercuts’ … or not?

Dear Dr. G,

My name is Mark, and I’m 41 years old and I was circumcised when I was 20.

I had no idea about the different circumcision “styles” back then and the procedure I had can be described as “medium”.

There is some residual foreskin that covers almost half the glans when my penis is flaccid.

I was hoping there would be no foreskin covering the glans at all and it is tighter on erection.

I am not sure if a second surgery is possible or recommended. If so, is it painful?

Please advise.

Circumcision is the removal of the foreskin on a penis. Such intervention has been performed for centuries for a multitude of reasons – medical, religious, cultural and even social.

It can be done for medical reasons such as phimosis (an inability to retract the foreskin covering the head of the penis) and prevention of urinary tract infections.

One sixth of the world’s male population is circumcised and it has been reported that 77% of the male population in the United States has been circumcised. In countries with a predominantly Muslim and Jewish population, almost all males are circumcised as religion requires it.

Circumcision is generally a safe procedure, with minimal complications. Apart from the minor acute adversities such as bleeding and wound infection, the post-operative experience is generally uneventful. With so many procedures carried out worldwide, long-term complications such as too much or too little prepuce (foreskin) being removed are raised – albeit rarely. These are generally perceived as a mild cosmetic nuisance as the tight or loose foreskin may cause some bother to those affected.

However, the over-removal of foreskin is a rare but more serious complication. Insufficient skin covering can sometimes lead to break down of the wound and pain on erection and any overzealous skin excision may end up requiring reconstructive surgery using skin grafts.

On the other hand, an “incomplete” circumcision, when too little skin is removed, is more common with fewer long-term consequences. Apart from being cosmetically unpleasant, smegma can build up underneath the extra skin. In more troublesome cases, this leads to irritation, infection and adhesion of foreskin to glans.

Although the role of the foreskin in sexual performance is debated, there is minimal data to suggest it can impact erections and intervals of ejaculation. One study published in 2011 suggests that men with incomplete circumcision may suffer from premature ejaculation, as the prepuce harbours an erogenous zone that has sensitive network of nerves. In this study, the revision of the circumcision is effective in treating men with premature ejaculation, increasing the interval of ejaculation from 64 seconds to a whopping 731 seconds.

Generally, a second circumcision is a simple and relatively pain-free operation. The glans penis is often not as traumatised as the initial operation. A second-time procedure, with less remnant skin removal under local anaesthesia, is associated with effortless recovery.

Whether an “incomplete circumcision” is a “botched job” is subjective. A surgeon needs to estimate the length of skin to remove during the circumcision, leaving behind sufficient skin for cosmetic and functional purposes. Even for straightforward operations like circumcision, over- or underestimation can occur.

When Dr. G is put on the spot to address the issues of incomplete circumcision, his view is often: “You don’t really need to be a perfectionist to request for a revision circumcision. The realist will pursue something until it’s done right, especially for the pride and joy of his manhood.” On that note, I wish Mark luck in his prepuce revision!