A circumcision procedure, plus extra work to affect an improvement to voiding and other aspects of my HS

30 days prior to surgery

I went along with one of our HEA members to see a specialist urologist who carries out a lot of HS/ES work, penile reconstruction, etc.; I went more as a support but also to meet this particular surgeon who has a good reputation for this type of skilled work.

25 days prior to surgery

After meeting informally, I made an appointment to see this specialist and for the first time had a proper diagnosis of my HS condition and his prognosis based on the severity of the HS and also what might be appropriate at my point in life. I should say that recent, repeated bouts of mild balanitis were discussed along with the hooded foreskin that I have and which I dislike. Slight chordee was diagnosed too, something I had not realised I had. After discussion we mutually arrived at the same conclusion, the flatness of the glans would make it quite difficult to bring the head round into an acceptable shape, though this might well have been an option at an earlier age. We decided that I would go away and consider the option of circumcision with a trimming of the skin adhesions that held foreskin to the glans at each side. This would help the balanitis and also correct the slight chordee by releasing the head, letting it swivel up and allowing a better chance to void without hitting the cleft under the head; the result would be less spraying.

21 days prior to surgery

My wife and I have discussed the options and I have decided to go ahead with the procedure described above and will travel to the hospital in three weeks. Meanwhile I have checked out various adult circumcision sites (for the normal penis) some of these helped where others seem to be deliberately scary. I think each case needs to be dealt with personally, reasons for and against being considered and recorded faithfully.

1 day prior to surgery

Well, I have carried out all the things I need to do before travelling in, sorted what to take etc. A general anaesthetic will be used because of the time my surgeon needs to tidy up the skin adhesions etc; so I must not eat or drink for 9 hours before the designated time for the procedure. I have taken a couple of photographs today to illustrate the way the foreskin is fused on at the sides of the glans.

Operation day

My wife and I travelled in wintery conditions to get to the hospital at the appointed time and were met and dealt with very quickly by friendly people. Various tests were done, blood pressure taken etc; forms filled in, the usual sort of precautions before a GA is carried out. After being asked to dress in the usual backless number and being given a pair of paper knickers, we sat and waited a short while until the surgeon came in and went through exactly what he was going to do and checked that it met with my expectations. It is quite important that we were both singing from the same hymn sheet as they say. Another few minutes went by and the anaesthetist called in to explain what he was about to do and asked for any questions that I might have.

Half an hour later I was taken by a nurse and porter (walking) to the anteroom of the theatre, where I was met by the specialist nurse and anaesthetist; I was then wired up to the cardiology machine. We chatted while a canular and drip were fitted into a vein in the back of my hand; the induction would be IV to start with and then of course inhalation of an anaesthetic agent to maintain the anaesthesia. Not long after this was completed, I was given an IV infusion via the link and slipped of to sleep (I do not even remember this happening.) It seemed like a moment later when I woke and started a slurred chat with the recovery nurse. Perhaps half an hour later I was fully awake and ready to go back to my room; I had been away from the room for about 2 hours all told.

Well I was asked to slide off the trolley onto the bed and lie back and rest for a while, a light snack of sandwiches and juice has been ordered for me and I enjoyed this a little later. I had absolutely no sickness or feeling of sickness. I did look under the sheets to find my knickers around my knees and no dressing on the penis; one assumes it is not easy to dress an HS penis because of where the meatus is. Normally a dressing leaves the tip open for urinating. I adjusted the bits within the now drawn up knickers and noticed a very small amount of blood on my fingers, but no more than that. After blood pressure tests had been taken at regular intervals, I was allowed to leave and then relax as a passenger on the way home. I had been at the hospital some 6 hours in total.

Once home I put my feet up and looked at my penis; obviously there was swelling and bruising (think of an elephant’s foot J) but a very fine suture line and extremely fine stitches that could not be seen because of the swelling. I took one pain killer tablet at supper and a different one at bed time. There was no pain whatsoever due to an injection block given at the hospital, that would last for 8 hours. On the point of pain, I only took tablets on the first night although they were given to cover 14 days if necessary. I slept well and having arranged to keep the penis gently within a clean cloth, there was no bleeding; just a little discharge.

Post procedure day 1

The day started well and since there was only the slightest discomfort I discontinued the tablets and ate a light breakfast. I had to shower and keep the penis dry for the first 48 hours and that went well. I was able to lounge around in pyjamas and dressing gown all day with a clean cloth loosely around the wound to pick up any discharge (this was minimal.) No nocturnal erections.

Post procedure day 2

Another repeat of yesterday really, though I did take a picture * of the suture line since things were looking a little less swollen. No pain at all including when a number of partial nocturnal erections came during last night.

Post procedure day 3

Being passed the 48 hr point I was able to take a bath with no oils or cleaning substances in there at all, just a safe temperature of water; I shampooed and washed before getting in. You can imagine the any slight scabbing would be softened though I only spent a couple of minutes in there. After the bath the usual loose, clean white cloth picked up any discharge or loose matter (this was my idea) though I did not try specifically to remove any scabbing. Each day I kept a clean cloth in my underpants as a cushion so to speak. Apart from avoiding any knocks to the area I can do things ok. Evening bath taken with much the same effect as this morning,

Post procedure day 4

The best thing to record is that last night the nocturnal erections were normal and did not cause too much stress, though things felt tight; there was no breakdown of the suture line. Today’s morning bath went well and the suture line is much clearer of scabbing etc and dry in the normal sense; the swelling is less though the bruising is more or less all along the shaft now, though fading. I had the usual short bath before bed and a good night’s sleep. Nocturnal erections were more noticeable, I suppose I would not normally wake but now I do.

Post procedure day 5

Swelling is much less and the bruising is fading a little more now. The suture line can now be seen much better, this is tucked in behind the coronal ridge, and very fine stitches appear all along the line. Where the outer and inner skin has been cut and sewn there is no discolouring at all, just either side, where the skin was separated from the glans, is it a little red with a scab and slight discharge. I am going into this sort of detail to let folks know that up to now there has been no real discomfort.

Post procedure day 6

Swelling is continuing to reduce and bruising has taken on the yellow look as it fades, the shaft skin is now clear of the coronal ridge and things look good. There is no scabbing on the suture line and just a small area on the right hand side that is a little sore; it looks like a burn blister. I bathed normally today and used no soap or cleansing agent on the area. More nocturnal erections and for longer, though the tightness is not uncomfortable. I have no need of the ‘cloth’ in my underpants and am letting the sore bit dry up as I go about a fairly normal day.

After a day out and about, I had no discomfort and noticed the sore parts are reduced in size and can hardly be felt. Bath and bed now.

1 week post procedure

I have decided to take another photograph this morning and will do the same at 2 weeks post op; and 3 weeks when things should be more or lass back to normal as far as looks are concerned. A close up shows the extremely fine stitching which is supposed to dissolve by the 3 weeks mark. There is nothing to report other than any previous sore areas are not so sore today and have reduced further in size; I am able to carry on with my daily routine, work etc and no one would know that one week ago I had had a surgical procedure. Swelling continues to reduce and the shaft skin is now clear of the coronal ridge, when flaccid. There is no undue tightness when erect.

2 weeks post procedure

During last week there has been a settling of the skin around the suture line and the stitches are now easily visible though extremely fine with no knots to be seen, just short ends protruding here and there along the suture line and on either side of the glans. I can walk about without the sensitivity being an issue but the ends of the sutures prickle a little.

The photograph shows a continuation to normality, bruising is completely gone and the image shows what is, in my opinion, a much better cosmetic look and of course no sign of balanitis. During the 2 years just prior to the procedure, daily cleaning of the penis never quite guaranteed freedom from this itchy condition. I never had the problem when younger and I do not use shower gels etc.

3 weeks post procedure

Today was the follow up visit to the specialist; photographs before I went, just for the record. During the last week there has been a feeling of normality, just a little friction from my underwear on the coronal ridge. The sutures are still there and prickle a little but I see no place to release them; the hot baths are fine but not dissolving the suture material.

The specialist was very happy with the healing and general result, in that respect we both agree. I do not have to return to the consulting rooms and sometime soon the sutures will all be dissolved or will have come out. We may attempt gentle sexual intercourse or some alternative.

Conclusions

Were the expectations on my part fulfilled?

Yes on all counts. Firstly the cosmetic aspect, which must have been at the back of my mind; the result means that I am now happier with the look and would not mind changing in front of other men, family swims etc. Also rather surprisingly my wife prefers the new cleaner look, ‘the extra skin’ (hood) as she puts it, was not as nice to look at as the appearance now.

Voiding without spraying is a lot better; I did not realise until the urologist pointed it out, but I had a habit of using both hands, holding the sides of the head and tilting to give a decent stream. This worked better on some days than others. Now that the head is not affected by the slight chordee, I can hold the shaft and still produce a better stream than before. The meatus is not so stretched now, and this must help.

Balanitis. No sign of anything at all, the area is bathed normally (as always) and ends up clean and dry.

One thing in conclusion; that is the feel of the bare glans. Naturally it is sensitive near the ridge which was covered most of the time but not much different towards the tip or underneath because that was exposed previously. It is early days of course but I believe that there will be a different sensation when indulging in intercourse, more on that later if pressed.

Would I recommend this procedure to a person affected by distal HS? Yes I would. In my opinion the benefits far outweigh the slight discomfort and I would say that I should have looked into a diagnosis and options, much earlier in life. The dorsal appearance is much improved and that is half of the problem; the underneath/meatus is more or less as before but that is a view not normally seen anyway.

John – February 2009