Circumcision: my experience

[johnsmithzz1996]

Originally Posted by virgone

Actually it depends on the clinic.
The first clinic I went told me got to return aft 2 weeks for ring removal.

Only got to know from johnsmithzz1996 that Pulse wait for the ring to drop, and review in 3rd week.

The ring sibei painful, cuz kiap on ur penis head, esp when doc remove, so thats why he suggest just let it auto drop out by itself , save the pain haha, but moment drop out liao wont feel anything, have to see pref bah, if u dun mind abit pain then 2 week quick remove it then can start to pcc again liao

[johnsmithzz1996]

Originally Posted by virgone

I totally did not put gauze.
Just wear underwear so that it doesn't move too much.
Just endure a bit on the sensitivity on the head.

even i wear underwear cant even walk properly sia, esp lagi worse when colleagues jio to walk out to buy lunch, so i just put gauze on penis head then ok alr, just bring the powder in ur bag and spam it whenever u go toilet can alr.

[virgone]

Originally Posted by johnsmithzz1996

even i wear underwear cant even walk properly sia, esp lagi worse when colleagues jio to walk out to buy lunch, so i just put gauze on penis head then ok alr, just bring the powder in ur bag and spam it whenever u go toilet can alr.

I'm still ok with it.
Just some minor pain at time where the ring is, the part where the inner & outer skin met which are healing.

[DoctorTan]

There has been some discussion here on ShangRing circumcision. Would like to contribute my POV after having done circumcisions for 20 years. Apologies, this is going to be a long post.

First of all there was mention of someone having done circumcision by Dr Taufiq at PULSE clinic. I have worked with Dr Taufiq before and he is an excellent Doctor.

There are many ways to perform circumcision: Laser, Conventional, Device Assisted (like Shangring, Plastibell etc), Stapler etc. Ultimately, there are 2 surgical goals that need to be met:
1. Removal of the skin
2. Holding the skin edges together until they heal
So let's talk about each separately.

1. Removal of the skin

What I find needs most skill and experience begins even before surgery. That is to determine how much skin to remove, which part of the skin to remove (inner or outer skin) and the shaping of the skin (not all circumcisions is just one circle around the penis). Obviously all these decisions are influenced by why the circumcision is necessary (for infections or BXO the skin removal is different from for hygiene) and also the preference of the patient. Some people want to achieve a certain look (example: high and tight). One drawback of device assisted circumcision is that the amount, type and shape of skin removed is fixed. What I call a "cookie cutter" circumcision. What I do prior to surgery is I use a surgical skin marker to draw out the distal and proximal excision lines so that I know exactly what the final outcome would be after skin removal.

The actual removal of the skin can be done with a variety of instruments including scalpel, scissors, laser, electrosurgery etc etc. (There are also various surgical techniques like sleeve removal, forceps guided etc which I will not go through here) I prefer to use laser or electrosurgery as it stops bleeding at the same time it cuts. For the Shangring procedure, any instrument can be used because the ring effectively stops bleeding anyway.

2. Holding the skin edges together until they heal

There are several way to achieve this.

- Shangring
The Shangring device effectively takes the place of stitches. The hold the skin together preventing the wound from opening up and also preventing bleeding. After the ring drops off, a thin raw wound remains. This wound then takes another week or so to dry up and heal. The entire process takes 4 to 6 weeks.

Usually during the first week patients are very comfortable. However during the second week, parts of the skin may start to pull away from the ring. During this time there is a risk of pain and/or bleeding. Some patients are unable to tolerate the ring and request for it to be removed. The problem with this is that the skin may not have achieved enough tensile integrity. In other words, during morning erection, the wound may open up again.

- Staplers
I have never liked this. In my experience, staplers are very poor at controlling bleeding. Also it does not hold the skin together very well. Maybe because of the challenges, no major medical device company has ever made circumcision stapler devices.

- Stitches
This is my preferred method. First of all it gives me most leeway to style the wound. I can make sure the raphe (midline of the penis) aligns perfectly with the frenulum. With new stitching methods, we no longer get the "rail roading" effect. Healing is the fastest. I have patients who heal in as little as 10 days. I use only bio-absorbable sutures so there is no need for stitch removal. That said, stitching takes time. The procedure will take 45 mins vs Shangring which takes 15 mins. However I reassure patients that during the entire time they will feel absolutely nothing. Some patients are still nervous and prefer to do the procedure under general anesthesia (asleep). Honestly, I prefer this too. There is a anesthetist looking after the patient so that I can concentrate purely on the surgery.

So inconclusion, there are many ways to do a circumcision. See a good Doctor who can discuss with you the various methods and why which one is good (or not so good) for you. Then make an informed decision on what is the best method to achieve what you want to achieve.

A quick note on insurance. I have seen many different insurance policies used by my patients. Some cover 100%. Some have a co-pay of 5% to 30%. Some have a cap. Some do not cover at all. The best thing to do is to speak to your agent and find out the details of your policy. There are also companies out there that are so called "insurance claims specialists" who can help you with this.

Hope the above has been helpful

[virgone]

Originally Posted by DoctorTan

There has been some discussion here on ShangRing circumcision. Would like to contribute my POV after having done circumcisions for 20 years. Apologies, this is going to be a long post.

First of all there was mention of someone having done circumcision by Dr Taufiq at PULSE clinic. I have worked with Dr Taufiq before and he is an excellent Doctor.

There are many ways to perform circumcision: Laser, Conventional, Device Assisted (like Shangring, Plastibell etc), Stapler etc. Ultimately, there are 2 surgical goals that need to be met:
1. Removal of the skin
2. Holding the skin edges together until they heal
So let's talk about each separately.

1. Removal of the skin

What I find needs most skill and experience begins even before surgery. That is to determine how much skin to remove, which part of the skin to remove (inner or outer skin) and the shaping of the skin (not all circumcisions is just one circle around the penis). Obviously all these decisions are influenced by why the circumcision is necessary (for infections or BXO the skin removal is different from for hygiene) and also the preference of the patient. Some people want to achieve a certain look (example: high and tight). One drawback of device assisted circumcision is that the amount, type and shape of skin removed is fixed. What I call a "cookie cutter" circumcision. What I do prior to surgery is I use a surgical skin marker to draw out the distal and proximal excision lines so that I know exactly what the final outcome would be after skin removal.

The actual removal of the skin can be done with a variety of instruments including scalpel, scissors, laser, electrosurgery etc etc. (There are also various surgical techniques like sleeve removal, forceps guided etc which I will not go through here) I prefer to use laser or electrosurgery as it stops bleeding at the same time it cuts. For the Shangring procedure, any instrument can be used because the ring effectively stops bleeding anyway.

2. Holding the skin edges together until they heal

There are several way to achieve this.

- Shangring
The Shangring device effectively takes the place of stitches. The hold the skin together preventing the wound from opening up and also preventing bleeding. After the ring drops off, a thin raw wound remains. This wound then takes another week or so to dry up and heal. The entire process takes 4 to 6 weeks.

Usually during the first week patients are very comfortable. However during the second week, parts of the skin may start to pull away from the ring. During this time there is a risk of pain and/or bleeding. Some patients are unable to tolerate the ring and request for it to be removed. The problem with this is that the skin may not have achieved enough tensile integrity. In other words, during morning erection, the wound may open up again.

- Staplers
I have never liked this. In my experience, staplers are very poor at controlling bleeding. Also it does not hold the skin together very well. Maybe because of the challenges, no major medical device company has ever made circumcision stapler devices.

- Stitches
This is my preferred method. First of all it gives me most leeway to style the wound. I can make sure the raphe (midline of the penis) aligns perfectly with the frenulum. With new stitching methods, we no longer get the "rail roading" effect. Healing is the fastest. I have patients who heal in as little as 10 days. I use only bio-absorbable sutures so there is no need for stitch removal. That said, stitching takes time. The procedure will take 45 mins vs Shangring which takes 15 mins. However I reassure patients that during the entire time they will feel absolutely nothing. Some patients are still nervous and prefer to do the procedure under general anesthesia (asleep). Honestly, I prefer this too. There is a anesthetist looking after the patient so that I can concentrate purely on the surgery.

So inconclusion, there are many ways to do a circumcision. See a good Doctor who can discuss with you the various methods and why which one is good (or not so good) for you. Then make an informed decision on what is the best method to achieve what you want to achieve.

A quick note on insurance. I have seen many different insurance policies used by my patients. Some cover 100%. Some have a co-pay of 5% to 30%. Some have a cap. Some do not cover at all. The best thing to do is to speak to your agent and find out the details of your policy. There are also companies out there that are so called "insurance claims specialists" who can help you with this.

Hope the above has been helpful

Thanks Doc. Very informative.

[noobie69]

Qn for bros who have been circumcised for a period of time already, does the penis head look any different?

I heard that the penis head won't look as pinkish anymore and becomes more of a dull colour after it's been rubbed raw (due to lack of protection) and the layer of dead skin falls off.

I have been considering circumcision for hygiene purposes but not sure if it still looks good cosmetically.

[airman]

I had my circumcision at Changi Hospital in the 1980s when I was 20 years not because of hygiene purposes but purely for the few weeks of mc when I was in the air force.

Now I am 60 years old and so far it has been good and glad that I had undergone the procedure.

[johnsmithzz1996]

Originally Posted by noobie69

Qn for bros who have been circumcised for a period of time already, does the penis head look any different?

I heard that the penis head won't look as pinkish anymore and becomes more of a dull colour after it's been rubbed raw (due to lack of protection) and the layer of dead skin falls off.

I have been considering circumcision for hygiene purposes but not sure if it still looks good cosmetically.

The penis head look damn nice bro.. my gf now non stop keep want bj me haha, cuz cleaner and looks more nice, with mushroom head showing. I would say i think not as sensitive as before, good n bad also , i got to change the way i pcc, but can fk longer haha.

[gralo]

thanks doc

[IamGood]

Originally Posted by johnsmithzz1996

Hi, just did my circumcision about a week ago, using the shang ring method. So far was way less pain or less scary than what i expected, will be sharing my healing process for bros who are keen to undergo this surgery too. Been considering this for the longest time, due to phimosis and sometimes tight when having sex. Always kenna infection cuz difficult to clean.

Pre surgery

Doc will put numbing cream into penis area (most painful i feel) then wait 30min for numbing effect.


During surgery

Lie down close eye n let doc do his stuff, within 5-10min done already. Can even drive back no issue, no pain or anything just sensitive.

Post surgery

Very not used to having penis glans being exposed, not much bleeding, just got to get used to having a cute small ring on ur penis. Walking pee shower all ok, just sensitive penis glans when touch pants/underwear. Just put a small gauze / cloth on penis head to avoid much contact with pants/underwear.

Rested 2-3 days, and 3rd day itself i go back to work already, today day 5, would all closed up n heal, just waiting for ring to drop out by itself in 2/3 weeks time.

Sorry why applying numbing cream is painful? I think of going to pulse for shang

Btw the shang ring got any metal parts at the hinge? Scarly need go thru metal detector how ar

[virgone]

Originally Posted by IamGood

Sorry why applying numbing cream is painful? I think of going to pulse for shang

Btw the shang ring got any metal parts at the hinge? Scarly need go thru metal detector how ar

I don't find the numbing cream painful, more like a bit of discomfort. It's like the chili effect.

The most painful however is the time when the ring is about to drop, and after that, the 2 weeks of recovery period.

Shang ring doesn't look like got metallic parts.

I've got to agree with johnsmithzz1996, that it's worth to do it, your other half will appreciate it more.

[IamGood]

I asked both pulse and dtap, both say circumcision no medisave or insurance claimable.

[virgone]

Originally Posted by IamGood

I asked both pulse and dtap, both say circumcision no medisave or insurance claimable.

That's because both are not Day Surgery.
It's chicken & egg.

If you want to have medical claim and opt for Day surgery, in the end you pay more as well. Cos for Day Surgery, the centre charges about $2k+ more, and it doesn't mean that your insurance can cover full claim.

Insurance coverage depends on the Surgical code.

[yqz7]

Originally Posted by virgone

That's because both are not Day Surgery.
It's chicken & egg.

If you want to have medical claim and opt for Day surgery, in the end you pay more as well. Cos for Day Surgery, the centre charges about $2k+ more, and it doesn't mean that your insurance can cover full claim.

Insurance coverage depends on the Surgical code.

Actually what does it mean by pay more?
You mean the actual costs of the procedure is higher? But if you can claim most of it via insurance and medisave the out of pocket (cash or credit card) should be lower for a patient who chooses not to claim - overall cost is lower but then you will pay it all yourself?

[IamGood]

Originally Posted by yqz7

Actually what does it mean by pay more?
You mean the actual costs of the procedure is higher? But if you can claim most of it via insurance and medisave the out of pocket (cash or credit card) should be lower for a patient who chooses not to claim - overall cost is lower but then you will pay it all yourself?

I think he meant this
If u have a deductible, u may end up paying more even if u claim. Bcos the cost of a day surgery incl GA is much higher than u go to a clinic and done in 15min.
Troublesome to go hospital and all. Just pay 2k with immediate appt and done with. 2k will not make me rich or poor.