Adult circumcision techniques-Adult Circumcision - American Family Physician

Circumcision is a surgical procedure in which the foreskin also known as the prepuce is cut from the penis. Male circumcision is not performed routinely for any medical conditions. However, there are a number of conditions affecting the genitals of adult men which circumcision is sometimes used to treat. Conditions which circumcision might be used to treat. Phimosis is a condition where the foreskin is constricted and cannot be pulled back over the head of the penis glans.

Adult circumcision techniques

Adult circumcision techniques

Dating services kentucky and masturbation should be avoided for four to six weeks after the procedure to prevent breakdown of the wound. What are you looking for? The circumcision gechniques Adult circumcision techniques involves the following steps:. Adult patients often have a medical indication for the procedure, but circumcision may also be done for social or purely personal reasons. Manual for male circumcision under local anaesthesia.

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Crawford DA. Urinary retention This has been reported following circumcision, usually secondary to a tight circular bandage. Smegma may accumulate under the skin bridges. This surgical procedure involves incisions techniqies with a scalpel in the outer and inner mucosal surfaces of the penis foreskin. Schedule A Consultation or Procedure Please fill out the form below with a requested appointment date. Excessive bleeding as complication of circumcision in reported cases ranges from 0. No matter your preference, it is circu,cision to note that the anatomy of each person has Adult circumcision techniques effect on the procedure. Figure 6. Following healing with fibrosis, the new preputial opening is too tight to allow preputial retraction. Wife sister strip poker not to allow your penis to dangle freely. An elastic cord is then wound tightly around the phallus, compressing the prepuce into the groove of the sleeve below it. McGowan AJ. This is normal, so long as it does Adult circumcision techniques cause you too much discomfort.

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  • Male circumcision is a controversial subject in surgical practice.
  • The circumcision surgery remains one of the oldest surgical procedures, dating back to more than 4, years to the biblical Hebrews and ancient Egyptians.
  • There are a number of reasons why men may choose an adult circumcision procedure.

Circumcision is a surgical procedure in which the foreskin also known as the prepuce is cut from the penis. Male circumcision is not performed routinely for any medical conditions.

However, there are a number of conditions affecting the genitals of adult men which circumcision is sometimes used to treat. Conditions which circumcision might be used to treat. Phimosis is a condition where the foreskin is constricted and cannot be pulled back over the head of the penis glans.

This condition can be treated with medication, but men who fail to respond to these medications are usually circumcised. However, note that during childhood until about 5 years old the foreskin can usually not be pulled back over the glans, because the glans and foreskin have not yet separated.

Balanoposthitis is a recurrent type of infection known as balanitis. It causes inflammation of the glans of the penis. The condition may also affect adults and circumcision is also used to treat men with balanoposthitis. Paraphimosis is a rare condition in which the foreskin gets stuck in its retracted position, that is, after the foreskin is pulled back over the glans of the penis, it cannot be replaced to its usual position.

It causes painful constriction of the glans. In boys, this usually occurs because the foreskin is pulled back using too much force.

In adult males, the condition is most prominent in elderly men, and particularly those who have used a catheter at some stage in their life. Doctors will usually try to manipulate the foreskin back over the glans, while the individual is under anaesthetic.

Circumcision cannot be performed for some men and boys whose parents may wish to have them circumcised for non-medical reasons , for example because their penis is abnormally shaped. Circumcision should not be performed without a qualified health professional and a sanitary environment.

Circumcision is usually performed for non-medical reasons, and thus the timing of circumcision usually depends on the motivation for the procedure. Circumcision is often performed on newborn boys e. Jews circumcise baby boys within eight days of birth or at puberty e. Adult men who have not been circumcised in their youth may also decide at any time to circumcise, for religious or personal reasons e. When a circumcision is indicated for medical reasons, the circumcision will typically be performed during adulthood, following the onset of sexual activity.

Before performing circumcision, a doctor will ask someone to sign a form to indicate that they agree to the circumcision procedure. This will be either:. Before asking a man or parents to sign a consent form, the doctor will provide up to date, scientific information about the health risks and benefits associated with circumcision. Men who are being circumcised should also be aware that that wound healing following circumcision typically takes six weeks and complete abstinence from all forms of sexual arousal is necessary in that period to avoid an erection.

Erections during the wound healing phase can be painful and interfere with the healing process. Before surgery begins, the genital area will be thoroughly cleaned using a surgical scrub preparation, but the pubic hair will not be cut or shaved. Sterile clothes are often draped over the body so that only the penis is exposed. Newborn babies have traditionally been circumcised without anaesthesia, due to the incorrect belief that newborn babies do not feel pain during circumcision because they do not cry.

That belief has since been demonstrated incorrect by scientific studies, and almost all circumcisions are now performed whilst the patient is under anaesthesia. Circumcision can be performed with either general whole body , local circumcision site only or regional entire genital system anaesthesia. Combining these anaesthetics with painkillers like paracetamol before and after the operation, provides the most effective pain relief. In Australia, circumcision of babies older than six months and boys is generally performed under general anaesthetic, with a regional block i.

Adult men can be circumcised using a dorsal nerve block. A ring block may also be used for additional pain relief. The circumcision procedure typically involves the following steps:. Following the procedure a dressing which goes around the penis is not applied, as the glans may become damaged if it swells while there is a bandage around it.

There are a range of specific methods of circumcision which are usually named after the specialist surgical equipment used for the procedure. The above steps therefore vary slightly depending on which method of circumcision is chosen. The Plastibell method is a circumcision method used to circumcise babies, in which a plastic device known as a Plastibell is used.

The Plastibell is a small, plastic bell, with a rim on the open side. The bell is designed to sit over the glans of the penis. Plastibells come in a range of sizes, and the doctor will select a bell which is the correct size for the baby being circumcised. Once the correct size bell has been selected, the foreskin is retracted and a device known as a haemostat , which controls bleeding, is placed on each side of the foreskin.

The Plastibell is then placed over the glans and secured around the rim with string. The handle of the Plastibell device is then removed. The Plastibell will eventually fall away as the skin to which it is attached dies.

Research has shown that the older the boy at the time of circumcision, the longer the Plastibell takes to fall off. For example one recent study reported the average time for the Plasitbell to fall off was on average 8. Minor complications also commonly arise following Plastibell circumcision and the most common complication is when the Plastibell becomes wedged into the penis known as impaction and fails to fall off spontaneously. Complications of this type occurred in 6. For babies under three months 2.

Complications of Plastibell impaction are also more likely if the wrong size Plastibell is used. Gomco clamp method for circumcising babies and boys. The Gomco circumcision procedure uses tools called the Gomco bell and clamp, to assist with the surgical procedure. The bell has a long handle, which is placed through a hole in the base plate of the clamp during the procedure. Circumcisions performed using the Gomco clamp are typically quick and easy surgical procedures which result in very little bleeding.

Once a slit has been made in the foreskin on the upper side of the penis, a Gomco bell of the correct size is placed over the glans and the foreskin is drawn over the bell. The bell is then inserted into a circular opening in the base plate of the Gomco clamp. The bell is drawn up into the clamp until the open end, surrounded by foreskin, is fitted in the opening. The clamp is then tightened, crushing the skin between clamp and bell. The foreskin is cut away using a scalpel. The clamp is then left in place for five minutes to allow blood to coagulate.

Antiseptic is applied to the wound. If bleeding occurs, the wound is cleaned, but stitches are generally not necessary. There are a range of techniques used for circumcising adult men, including the dorsal slit method and the sleeve method. The dorsal slit technique is recommended when circumcision is indicated for phimosis or paraphimosis. The procedure is carried out as described above, and no specialist circumcision equipment is used. The sleeve method of circumcision is suitable for use in boys and men.

It differs from the procedure described above, in that the foreskin is removed from its retracted position i. As with all surgical procedures, the most common complications are infection and bleeding. Death has also been reported as a result of bleeding or systemic infection following circumcision. While most reports of death are from places where circumcision is performed in unsanitary conditions by non-medical practitioners, a number of recent deaths in developed countries have also occurred.

Parents should also check the ring and return to the clinic if it slips out of position or if there are signs of infection or bleeding. All parents should take their child back to the clinic where they were circumcised once the ring has separated, or after two weeks if the ring has not separated at that time.

Following circumcision, men should wear loose fitting briefs and clean the wound daily for days. After a week the patient should recommence normal hygiene practices i. Men must avoid any kind of sexual arousal for six weeks following the surgery, as an erection is likely to interfere with the wound healing process. It is common for men to experience erections during their sleep. In the period immediately following circumcision this may cause some discomfort because the stitches are pulled when the penis becomes erect.

This discomfort is normal and men should not worry about it. It will settle down one or two weeks after the operation. Health Engine Patient Blog. Tools Med Glossary Tools. Looking for a practitioner? HealthEngine helps you find the practitioner you need.

Find your practitioner. What are you looking for? Search for articles. Popular searches How can I relieve my back pain? Children's Health. Men's Health. Sexual Health. Introduction to male circumcision When circumcision should and should not be done Conditions which circumcision might be used to treat Phimosis Recurrent balanoposthitis Paraphimosis Contraindications What age is circumcision done? When circumcision should and should not be done Male circumcision is not performed routinely for any medical conditions.

Conditions which circumcision might be used to treat Phimosis Phimosis is a condition where the foreskin is constricted and cannot be pulled back over the head of the penis glans. Recurrent balanoposthitis Balanoposthitis is a recurrent type of infection known as balanitis. Paraphimosis Paraphimosis is a rare condition in which the foreskin gets stuck in its retracted position, that is, after the foreskin is pulled back over the glans of the penis, it cannot be replaced to its usual position.

The inner ring has a groove on it for the lodgment of the elastic ring. Adult Circumcision Jack Chang T Circumcision for Adult Men There are a number of reasons why men may choose an adult circumcision procedure. Do not take part in any intensive activities. To maximize its health benefits,[ 1 , 2 ] to reduce procedural risks and cost,[ 2 , 3 , 4 , 5 , 6 ] however, it is advocated to be offered in neonatal period. Reports of this in literature are, however, rare. A longitudinal cut is made between the two circumferential ones and the strip of skin removed. Its main merit like other shield method is that the glans and the frenulum are protected.

Adult circumcision techniques

Adult circumcision techniques

Adult circumcision techniques. Circumcision Techniques

The frenulum can be included in the main cutting or can be cut separately if desired. The glans and frenulum are not protected as such and care is taken not to injure them. There are several modifications of the sleeve resection. Bloodless circumcision with the use of bipolar diathermy is described.

Some use gauze pack placed between the glans and the inner layer of the prepuce both for tension and hemostasis. Other described the use of an artery forceps to crush the prepuce before excision[ 11 , 20 ] [ Figure 12 ]. These and many more are aimed to reduce complications of sleeve technique. Laser circumcision: For its many beneficial physical properties as regards precision and sealing of cut surfaces, laser circumcision is possible.

There have been some reports of its use in hemophilia patients in Israel. Reports of this in literature are, however, rare. Excessive bleeding as complication of circumcision in reported cases ranges from 0. Transfusion for this complication is, however, unusual. In this, an excess of skin is removed from the penile shaft while not enough of the inner preputial layer has been removed. The new preputial orifice is distal to the tip of the penis, the penile shaft is forced into the suprapubic fat, the stenotic preputial ring that results lies at, or just above, the abdominal skin level.

This results when insufficient outer and inner preputial layers has been removed. Following healing with fibrosis, the new preputial opening is too tight to allow preputial retraction. Repeat circumcision is mandatory to correct this preventable complication. Another adverse result of circumcision is the formation of a skin bridge between the penile shaft and the glans.

Smegma may accumulate under the skin bridges. Additionally these bridges may tether the erect penis, with resultant pain or penile curvature. Treatment is to release the bridges. Circumcision wound may become infected, as in any surgical procedure. The incidence of infection in one series of neonatal circumcisions was 0. Some of these complications rarely have resulted in severe permanent disability or death. This has been reported following circumcision, usually secondary to a tight circular bandage.

In addition, urinary retention secondary to a tight bandage presumably sets the stage for urosepsis in some of the reported cases of systemic infection following circumcision.

Urethrocutaneous fistulas have been reported following circumcision. To prevent this complication, the surgeon should preempt the possibility and visualize exactly what is being done in the course of a circumcision. Incision of unrecognized megalourethra, a congenital malformation of the urethra is the cause in some cases.

Loss of the glans in part or in whole commoner or even entire penis very rare due to necrosis and subsequent sloughing has been reported following circumcision. Both hypospadias and epispadias have been reported following circumcision procedure. By inadvertently splitting the glans penis at the time of dorsal or ventral slit preparatory to actual excision of the prepuce,[ 27 ] these complications can occur. This can be prevented by adequately freeing the prepuce from the glans penis and by visualizing what is being done rather than by performing some aspect of the procedure blindly.

The following complications have also been reported following circumcision, meatitis, chordee, implantation cyst, impotence. Weiss et al. Complication risks and severity is higher in traditional circumcision as a rite of passage than medical circumcision and traditional circumcision in neonates. Male circumcision is performed at any age, there is, however, increasing interest in performing male circumcision in infancy.

This is to maximize the benefits conferred by male circumcision and to reduce the risks of adverse events. The current trend is to have a technique that can be deployed for mass rollout of circumcision in an attempt to prevent transmission of HIV[ 2 , 16 , 17 ] and to present an acceptable technique to all so as to encourage worldwide acceptability of the procedure of male circumcision.

When performed properly, the procedure has low complication rates. One percent minor complication rate when performed in children and less than 0. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Surg Tech Case Rep. Abdullahi Abdulwahab-Ahmed and Ismaila A. Ismaila A. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Male circumcision is a controversial subject in surgical practice. Keywords: Complication, dorsal slit, device, excision, male circumcision, public health benefit, technique.

Techniques The principles of circumcision are asepsis, adequate excision of outer and inner preputial skin layers, hemostasis, protection of the glans and urethra, and cosmesis. Anesthesia The procedure is done under local anesthesia. Shield and clamp The prototype method in shield and clamp is the Mogen clamp [ Figure 1 ]. Open in a separate window. Figure 1. Figure 2. Figure 3. Gomco A metal bell [ Figure 4 ] is placed over the glans after the prepuce is fully retracted. Figure 4. Zhenxi Rings The prepuce is freed from and retracted over the glans.

Figure 5. Tara Klamp A Malaysian invention [ Figure 6 ], it is very similar to the plastibell except that instead of having to tie suture material around a groove in the bell, plastic arms lock into place to force two surfaces into tight contact; with the prepuce trapped between them. Figure 6. SmartKlamp This works in the same way as the Tara Klamp. Figure 7. Figure 8. Figure 9. Forceps Guided In this technique, the prepuce is freed from the glans and pulled out in front of the glans.

Figure Dorsal slit Dorsal slit [ Figure 3 ] is common to many techniques and occasionally is used alone, especially in the presence of acute inflammation. Excision Sleeve Resection: The prepuce is retracted over the glans penis [ Figure 11 ] and a circumferential incision is made around the shaft as far back as the scar line is to be placed, usually distal to the corona.

Complications of circumcision Bleeding Excessive bleeding as complication of circumcision in reported cases ranges from 0. Concealed penis In this, an excess of skin is removed from the penile shaft while not enough of the inner preputial layer has been removed. Phimosis This results when insufficient outer and inner preputial layers has been removed.

Skin Bridge Another adverse result of circumcision is the formation of a skin bridge between the penile shaft and the glans. Infection Circumcision wound may become infected, as in any surgical procedure. Urinary retention This has been reported following circumcision, usually secondary to a tight circular bandage.

Fistulas Urethrocutaneous fistulas have been reported following circumcision. Necrosis Loss of the glans in part or in whole commoner or even entire penis very rare due to necrosis and subsequent sloughing has been reported following circumcision.

Iatrogenic hypospadias and epispadias Both hypospadias and epispadias have been reported following circumcision procedure. Morris BJ, Eley C. Male circumcision: An appraisal of current instrumentation. Chapter In: Fazel-Rezai R, editor. Biomedical Engineering: From Theory to Applications. Rijeka, Croatia: InTech; Risks from circumcision during the first month of life compared with those for uncircumcised boys. Urinary tract infections and the circumcision state: An update. Clin Pediatr Phila ; 32 —4.

Wiswell TE. Neonatal circumcision: A current appraisal. Focus Opin Pediatr. The prepuce, urinary tract infections, and the consequences. Circumcision: A refined technique and 5 year review. Ann R Coll Surg Engl. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol. Crawford DA. Circumcision: A consideration of some of the controversy. J Child Health Care. Williams N, Kapila L.

Complications of circumcision. Br J Surg. Male circumcision: Global trends and determinants of prevalence, safety and acceptability. Gerharz EW, Haarmann C. The first cut is the deepest? Medicolegal aspects of male circumcision. BJU Int. Mokal N, Chavan N. Modified safe technique for circumcision. Indian J Plast Surg.

Kaplan GW. Urol Clin North Am. Bruhl P. Problems of therapeutic surgery in penis carcinoma. Recent Results Cancer Res. Safety and efficacy of the PrePex device for rapid scale-up of male circumcision for HIV prevention in resource-limited settings. J Acquir Immune Defic Syndr. HIV prevention: Male circumcision comparison between a nonsurgical device to a surgical technique in resource-limited settings: A prospective, randomized, nonmasked trial. The decision to go through a circumcision surgery or not is a personal choice.

Some men prefer to remain uncircumcised. However, many choose to go through adult circumcision surgery because of the great advantages that follow, including:. At Circumcision Center, we use the sleeve resection technique. This surgical procedure involves incisions made with a scalpel in the outer and inner mucosal surfaces of the penis foreskin. The foreskin comes off as a ring tissue. Through electrocautery, the bleeding stops. At the end of the procedure, the wound secures with suture closures absorbable sutures.

The utilized needle for the suturing is an atraumatic cosmetic surgery one. For additional closure, we use closure tapes to reduce the tension on the sutures, accurately and precisely on the edges.

Finally, with a sterile compression, dressing helps to aid rapid healing and reduce marks. There are other ways to circumcise an adult male. Each one of these produces different results. The types vary with regard to their tightness and position. Other common methods include:. When you opt for a tight circumcision, you should be aware that the circumcision should not be a tight one.

No matter your preference, it is important to note that the anatomy of each person has an effect on the procedure.

When determining how much to circumcise, doctors have to consider this anatomy. Prior to the surgical procedure, doctors will discuss the issue with you so that they meet your expectations. Are you an uncircumcised man? If you want to know more about this surgical procedure, Circumcision Center is happy to explain the surgery to you, show you different types through pictures and help you decide on the best circumcision.

Call us today to schedule a consultation. Phone - Call Us Now The Adult Circumcision Surgery Technique: A Guide for Adult Men October The circumcision surgery remains one of the oldest surgical procedures, dating back to more than 4, years to the biblical Hebrews and ancient Egyptians.

Circumcision is the surgical removal of foreskin. Foreskin covers the head of a flaccid penis. When the penis is erect, the foreskin pulls back to reveal the penis.

During a circumcision , a doctor cuts away a portion of the foreskin and reattaches the section that remains to create a shorter section of skin. Circumcision in infancy is performed for several reasons , including religious, social, medical, and cultural purposes.

For example, in Jewish and Islamic communities, this procedure is common as part of religious standards. Newborn circumcision is more common than circumcision as an adolescent or adult. In the United States, more than 58 percent of newborns are circumcised.

However, total circumcision rates in the United States may be as high as 71 percent. Some people with an uncircumcised penis have the procedure later in life. People who choose to have it done may do so for many of the same reasons parents choose it for their newborns — medical, religious, or social. Note that circumcision is an ongoing source of discussion and debate in many societies. We will present some of the current findings and research, but many claims are being challenged.

In the United States, the American Academy of Pediatrics currently supports the infant procedure for its health benefits. On the other hand, in adults, the benefits of circumcision depend largely on the reason for the procedure in the first place. Conditions that can be treated with circumcision include:.

Other claimed health benefits should be approached with caution. Commonly cited benefits include the following:. The U.

The World Health Organization reports that risk is 60 percent lower in people who are circumcised. According to the CDC, circumcision also lowers the risk of a person with a penis getting herpes and human papillomavirus HPV from vaginal intercourse. Other research involving heterosexual couples suggests circumcision may protect people with a penis as well as their sexual partners from syphilis.

However, this remains a hotly debated topic among researchers. According to some research , people with a penis who have been circumcised may have a lower risk of developing a UTI compared to people who have intact foreskin. This can cause uncomfortable tightness, scarring, inflammation, and even infection. Circumcision can prevent this condition.

Likewise, balanitis occurs when the head of the penis becomes inflamed and swollen. It may be the result of an infection or irritation, but circumcision helps prevent it from occurring again. This is largely a misconception. Uncircumcised and circumcised penises both require proper cleaning.

While some people believe that an uncircumcised penis requires extra attention when it comes to hygiene, it just requires different steps. Oil, bacteria, and dead skin cells can accumulate under the foreskin and develop into a buildup called smegma.

Individuals who are devout to a particular religion or wish to comply with cultural traditions may find that completing the procedure has an emotional or spiritual benefit. This is a personal choice, and if circumcision is important to your spiritual life, you may find a benefit in this area. Newborn circumcision is a very brief procedure. For an adult, however, the surgery is slightly more involved. It can take between 30 minutes and an hour.

An anesthesiologist will administer medication to help sedate you. Depending on your preferences, you may receive general anesthesia or more localized anesthesia. During the procedure, the doctor will move the foreskin away from the head of the penis and then back onto the shaft. Then, the doctor will use a scalpel to cut the skin. For infant circumcision, a doctor snips the skin away from the penis with scissors or a special appliance.

For adults, the skin will then be cauterized or stitched back to the shaft with sutures that will dissolve. This is to be expected. Apply an ice pack to your groin for to minute windows of time every two hours. Be sure to put a thin piece of fabric between the ice and your skin.

On day two or three, your doctor may ask you to return to their office to have the dressings replaced. Recovery from adult circumcision typically takes two to three weeks. You may need to request a week off from work. Some people will not be able to return to normal activities for longer.

Sexual intercourse and masturbation may need a bit longer — up to six weeks. Pain from adult circumcision is typically mild. Your doctor may prescribe a mild pain reliever, but over-the-counter options may be sufficient to ease any discomfort. Your doctor may also prescribe an antibiotic in order to prevent a possible infection. Wear comfortable but supportive underwear that can hold the head of the penis toward the belly button lying flat. Loose-fitting underwear allows for too much movement.

This can increase swelling and pain. Within a day or two of the surgery, you should begin trying to walk. Keep the movement low-impact and slow at first. As soon as your bandage is removed, you can take a shower. The fragrance and chemicals may irritate the sensitive skin as it heals. Pat dry the area to reduce sensitivity.

The results you experience from adult circumcision will largely depend on the reason you had the procedure in the first place. If you chose to have it to stop or prevent infections or physical issues like phimosis, the procedure is typically very successful.

You may not experience these again in the future. If your circumcision was for religious reasons, you may feel more deeply personal about your beliefs after completing the procedure. For most individuals, the surgery will have no lasting impact on sexual function, urinating, or sensitivity. Most individuals in the United States who are circumcised undergo the procedure as a newborn. Choosing to have it as an adult requires some initiative and planning.

However, keep in mind that adult circumcision is a simple procedure with very few risks or complications. Talk to your doctor about your expectations for circumcision. Together, you can make a plan that is comfortable and suitable for your objectives. Circumcision has been around for millennia, rooted in the rituals of Judaism, Christianity, Islam, and some African cultures. But aside from its roots…. Though circumcision has been practiced for thousands of years, it's more recently become a controversial topic in certain parts of the Western world….

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While these conditions can…. Foreskin restoration has roots dating back to ancient Greece and Rome. Although there isn't any conclusive evidence that a foreskin or its associated…. An overly sensitive penis can affect your everyday life. Not only can it lead to premature ejaculation, but it can also cause discomfort and pain in….

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As with any surgery, circumcisions can leave a scar. Here's what it may look like, how it varies by procedure, how to minimize its appearance, and…. Circumcision is the surgical removal of the foreskin of the penis. Collagen is an essential building block for the entire body, from skin to gut, and more. Here's five changes you may see or feel just by taking more…. Common beliefs regarding the benefits of adult circumcision. Risks of adult circumcision. Recovery timeline.

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Adult circumcision techniques

Adult circumcision techniques