circumcision recovery photos

Circumcision has several benefits. We offer nitrous gas, also known as laughing gas, to our patients to reduce any anxiety and pain. Once the penis heals, wash it with soap and water during normal bathing. If you do choose circumcision, the AAP recommends that the healthcare provider use pain medication. The World Health Organization (WHO) stresses that the practice has no benefits, only risks. This time it looked like this was working! Patients may sometimes develop an infection because of the moisture generated under the foreskin. However, recovery may take longer when circumcision is done on an older child or adult. WebCircumcision takes only a few minutes. Scarring along the suture line is possible. This content does not have an Arabic version. Theyll take measurements of exactly how much skin they need to remove. Circumcision might have various health benefits, including: The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis. It is the laughing gas you find in the dentist office. Around the world, the rate is about 33% of males. WebThe Glue. Remove any stool with soap and water during diaper changes. We recommend ice packs and compressive shorts to minimize jostling. If these steps dont work, your doctor will perform the dorsal slit procedure to relieve the pain. After the procedure is done, we will have you use antibiotic ointment to minimize irritation from the suture. Conditions that can be treated with circumcision include: Other claimed health benefits should be approached with caution. You should be able to walk and take stairs slowly after the procedure. WebCircumcision is the surgical removal of foreskin. Any surgical procedure has risks. Learn about Teva sildenafil and how, A hydrocele is a sac filled with fluid that forms around a testicle. 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. Mild cases of phimosis can be treated with topical steroids to help soften the skin and make it easier for the foreskin to retract. People can do this with water on a gauze or cotton pad. As soon as your bandage is removed, you can take a shower. Call our office at (210) 617-3670 to get scheduled for your same day consultation and procedure. As with any surgery, circumcision comes with some risks. A prospective, observational cohort study. In paraphimosis, a healthcare professional may rub alocal anaesthetic gel onto the glans to help reduce pain and inflammation. The tip of the penis, called the glans, is typically left exposed. This practice is harmful and has no health benefits. Circumcision began as a religious rite. For patients suffering from acute paraphimosis, your doctor may try to decrease the swelling with their hands before proceeding with surgery. Male circumcision is the surgical removal of the foreskin, which is the layer of skin that covers the head of the penis. However, the group stresses that the final choice belongs to the childs parents, and neither choice is incorrect. Steroid cream. the unsubscribe link in the e-mail. DOI: Common beliefs regarding the benefits of adult circumcision, U.S. Centers for Disease Control and Prevention (CDC), pediatrics.aappublications.org/content/130/3/585, wwwn.cdc.gov/hivrisk/decreased_risk/male_circumcision.html, cdc.gov/nchs/data/hestat/circumcision_2013/Circumcision_2013.htm#x2013;2010%3C/a%3E%20, Circumcised vs. Uncircumcised: Pros and Cons to Consider, Should I Circumcise My Child? The surgery may take slightly longer than it does for infants. Uncircumcised penis: Is special care needed? Frequently asked questions. As you can see in this photo series ( http://chazhome.com/circumcision/weeks_20-42/index.html ), during the recuperation period, I put my 00ga segment ring Prince Albert back in as of November 2005, as I was getting very tired of pissing on my balls through the 00ga hole! We are board-certified urologists. Either way, the procedure is typically done using the same sleeve removal technique. Okay -- Here's the WHOLE story with that. Read this in order to understand why I went for a third operation! Usually, babies undergo circumcision shortly after birth. Gently restrain the babys arms and legs, so his limbs dont flail during the procedure. Are you looking for treatment options? A scalpel is used on the outer and mucosal foreskin to create the sleeve. If this is the case, the person doing the circumcision should be well trained in how to do the procedure, how to relieve pain, and how to prevent infection. Usually, this happens in men who may have had an infection known as balanitis, prior trauma, or diabetes. However, keep in mind that adult circumcision is a simple procedure with very few risks or complications. Before circumcision, the foreskin covers the tip of the penis (glans). In some cases, a circumcision may be done in a nonmedical setting for religious or cultural reasons. But aside from its roots, Though circumcision has been practiced for thousands of years, its more recently become a controversial topic in certain parts of the Western world, When most people think about penis health, they think about sexually transmitted infections and erectile dysfunction. These risks are very rare in our experience. Your doctor can guide you on an appropriate timeline based on your healing and health. The sleeve resection technique is ideal as it removes the foreskin in a single ring of tissue. Do not attempt to pull back the infants foreskin. You can get back to desk work right away, but physical activity should be curtailed if it is not comfortable. Circumcisions major risks are penis injury, infection, and significant bleeding. Usually phimosis requires further intervention or circumcision to correct it. Many patients desiring circumcision appreciate the lower cost of getting a circumcision done in the office. Be careful not to swipe the incision with a washcloth or towel, and dont use any scented soaps or gels for several weeks. Last medically reviewed on October 12, 2022. The filenames are derived by WEEKS after the procedure [W##], DAYS after the procedure [D###], for example w02_d008_004.jpg is from WEEK 2, the 8th DAY after surgery and is the 4th image in the set. Over time, the foreskin separates from the head of the penis and is able to be retracted, or pulled back. Contact the doctor if: Mayo Clinic does not endorse companies or products. We do not endorse non-Cleveland Clinic products or services. ), Use pain relief your provider recommends, including frequent. Make a donation. Read on to learn more about what baby circumcision is, when babies undergo the procedure, the potential benefits and risks, what to expect, and how much it costs. Patients have questions about whether the circumcision will be "high and tight" or how we handle other issues. Having had a PA ripped out once before, I didn't want to take the risk of it happening again. If you have any questions or concerns, talk with your ob-gyn or other health care professional during your pregnancy so you have enough time to make an informed decision. Sexual intercourse and masturbation may need a bit longer up to six weeks. The foreskin is the retractable fold of skin that covers the end of the penis. Note that circumcision is an ongoing source of discussion and debate in many societies. In some cases, it may be possible to give them acetaminophen (Tylenol). Analgesia is safe and effective in reducing the pain associated with newborn circumcision. However, it is worth noting that condoms are a far more effective way to prevent STI transmission during sex, and the HPV vaccine is another, even more effective way to decrease the risk of cervical cancer. The risk of complications also is increased when circumcision is done later. I went back to the Dr. David in April 2005 for some minor adjustments to my circumcision. You may not experience these again in the future. American College of Obstetricians and Gynecologists. Advertising revenue supports our not-for-profit mission. These include: There are a few different circumcision techniques. Circumcision is similar for older boys and adults. Unfortunately, this provides short term relief. Cleveland Clinic is a non-profit academic medical center. You should have no problem urinating. You'll probably be advised to take at least 1 week off work to recover. Some penile adhesions resolve on their own during infancy, but some need to be treated with special creams. However, this is not always safe, as it can mask a fever, an important sign of infection. However, in many cases, circumcision is an elective procedure and a personal choice of parents and caregivers. include protected health information. Sometimes, the foreskin doesnt separate when it should and remains tight, a condition called phimosis. Loose-fitting underwear allows for too much movement. Wait for the sutures to dissolve. This can be an emergency if the foreskin cannot be brought back to its normal position. All surgical procedures carry some risk. There's evidence from several trials carried out in Africa that circumcised men have a lower risk of acquiring HIV. Accessed Dec. 14, 2017. The glue will dissolve itself in 5 to 10 days and will naturally fall off the skin. Your doctor may apply petroleum jelly to your incision and wrap the stitched area in sterile gauze to keep it protected for the first 24 hours. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis or applied to the penis as a cream. An example is pneumonia that occurs as a result of the flu. :-( This caused all the internal sutures holding the meatotomy closed to be rejected by my body and the meatotomy healed in an open state. Circumcision complications are uncommon but can include: Research on whether circumcision affects the sensitivity of the penis has been inconclusive. This is a good opportunity to discuss any concerns you have and ask questions about anything you're not sure about. You will have some gauze wrapped around the penis for some expected, minimal oozing. These can help both during the procedure and afterward. Circumcision can also reduce or prevent certain diseases, like urinary tract infections. In a bris, a trained professional called a mohel performs the circumcision. We can prescribe nitrous gas for patients who are anxious or nervous as well. Okay -- Here's the WHOLE story with that. Read this in order to understand why I went for a third operation! Afterward, the penis will be covered with an ointment, such as a topical antibiotic or petroleum jelly, and wrapped loosely with gauze. With an ink marker, I mark the incision lines on the inner mucosal and outside portions of the foreskin while ensuring both points meet each other comfortably. You can resume blood thinners in 48 hours unless you are noting any spotting or bleeding. If you choose to have your baby boy circumcised, you will need to care for his penis as it heals. WebPenile adhesions in baby boys occur when the skin of the penis's shaft sticks to the glans (bulbous structure) at the top of the penis. If everything works out, we can schedule a procedure at our office. Additionally, do not use baby cleansing wipes, and do not scrub the skin. The procedure is fairly common for newborn boys in certain parts of the world, including the United There are several benefits to circumcision, including a lower risk of diseases like urinary tract infections. WebBefore & After Pics. Do not apply liquid or ointment medications or any other product to the wound whilst the glue is still in place. During the first few years of life, the foreskin will stay attached to the penis and wont retract. The 3 main treatment options for penile cancer are: If you're considering circumcision for a medical reason,it's worth discussing alternative treatment options with your GP or specialist. This article will use the terms male, female, or both to refer to sex assigned at birth. Explore ACOG's library of patient education pamphlets. You can then make the decision thats right for you. Without insurance, on average, the procedure costs $247. Since getting the frenulum removed changed the location and angle of the PA hole. Bossio JA, et al. However, in some situations, a doctor may recommend delaying circumcision or not performing one at all. This can reduce irritation and inflammation. When the frenulum, the band of tissue under the glans that connects to the foreskin, is removed, it is called a frenulectomy. information submitted for this request. You may opt-out of email communications at any time by clicking on But alternative treatments, such as topical steroids, are sometimes preferred. Each patient may experience different things after their surgery. WebChaz' Circumcision Recovery Photos / Reconstruction Surgery - Weeks 52 thru 72 Click a picture to see a larger view. Castle EP (expert opinion). Okay -- Here's the WHOLE story with that. Read this in The doctor is available after hours for any concerns. Patients experience minimal pain after their circumcision, and typically only take Tylenol and an anti-inflammatory during recovery. They may then apply pressure to the head of the penis while pushing the foreskin forward. I'm going to leave it like this until the fall/winter of 2006 and I will get it closed up again, this time using the stronger antibiotic to prevent a UTI. If its done as an established treatment for a medical condition, the health benefits are better known. As the foreskin is pushed from the head of the penis, the doctor will clamp it with a metal or plastic ring-like device to protect the head of the penis while they remove the foreskin. Reasons to delay circumcision include the following: The baby has certain problems with his blood or a family history of bleeding disorders, The baby has certain congenital abnormalities. After studying scientific evidence, the American Academy of Pediatrics (AAP) found that the health benefits of circumcision in newborn boys outweigh the risks of the procedure. Choosing an Experienced Urologist Matters. Circumcision isa common practice in the Jewish and Islamic communities, and it's also practised by many African communities. Some people with an uncircumcised penis have the procedure later in life. Talk to your childs healthcare provider about the pros and cons. During a The procedure is seen as positive for the patient but not absolutely necessary. WebCircumcision is a relatively simple procedure. Circumcision: The surgical removal of a fold of skin called the foreskin that covers the glans (head) of the penis. If you notice repeated issues with foreskin pain that prevents you from enjoying sex or causes your partner anxiety, you should consider circumcision. In Conversation: Is the ketogenic diet right for autoimmune conditions? This is when it is not possible to draw back the foreskin fully, which can make it more difficult to keep the penis clean. So when I was circumcised (photos at: http://chazhome.com/circumcision/ ), Doctor Cornell also tried to close my PA hole; however, within four days, the PA hole re-opened. However, you can request to be put under general anesthesia for the procedure as well. A Urologist Weighs In, Everything You Need to Know About Penis Health, 6 Best At-Home Testosterone Test Kits in 2023, Teva Sildenafil: Generic Viagra, Pros and Cons, and Side Effects, Hydrocele: Causes, Symptoms, and Treatment. The World Health Organization reports that risk is 60 percent lower in people who are circumcised. But it's unclear whether circumcision can help prevent other sexually transmitted infections (STIs). The needle I use is specifically made for closing skin, resulting in minimal scarring and bleeding. WebWeeks After Circumcision in Pictures. If your circumcision was for religious reasons, you may feel more deeply personal about your beliefs after completing the procedure. Wear loose-fitting clothing for a few days. Bacteria: One-celled organisms that can cause infections in the human body. Avoid any sexual activity for at least four weeks. And researchers believe it doesnt hurt or enhance sexual pleasure. The most common complications associated with circumcision are bleeding and infection. Trends in circumcision for male newborns in U.S. hospitals: 1979-2010. For teenagers and adults, we need to do a much more precise surgical procedure to get a good cosmetic outcome. Our urologists have performed hundreds of pediatric and adult circumcisions through residency and practice. Most individuals in the United States who are circumcised undergo the procedure as a newborn. Complications: Diseases or conditions that occur as a result of another disease or condition. Advertising on our site helps support our mission. Every help preventing balanitis, balanoposthitis, paraphimosis, and phimosis. We offer a cost effective in-office circumcision procedure to patients without an insurance-covered benefit. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed. An operating room procedure is more expensive than an office procedure and is done when insurance covers the procedure. Youll need to: If the penis doesnt seem to be healing correctly or you have concerns, call your healthcare provider. WebPatients experience minimal pain after their circumcision, and typically only take Tylenol and an anti-inflammatory during recovery. Circumcision is the surgical removal of the foreskin. Circumcision is the surgical removal of foreskin from a babys penis. The underlying problem is still there. (2016). Use a mild soap to gently wash the penis. Signs of infection include redness that does not go away, swelling, or fluid that looks cloudy and forms a crust. https://www.uptodate.com/contents/search. 1/1 people found this helpful. They will then close the incision with dissolvable stitches that attach the skin of your penis to below the head. Any bleeding can be stopped using heat (cauterisation), and the remaining edges of skin will be stitched together using dissolvable stitches. (If you decided to take any medication prior to the procedure (xanax), then you should have someone who can drive you home.). Only about 1% have complications. Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the bodys immune system and causes acquired immunodeficiency syndrome (AIDS). If there's a plastic ring instead of a bandage, it will drop off on its own usually within about a week. The doctor will then use his or her fingers to push on the head of the penis and pull on the foreskin in an effort to further reduce the paraphimosis. One reason why parents circumcise their newborn sons is for health benefits, such as decreased risk of urinary tract infection during the first year of life and decreased risk of sexually transmitted infections (STIs) later in life. In most cases, circumcision will only be recommended when other, less invasive and less risky treatments have been tried and haven't worked. Up to 10 percent of men will experience some degree of urinary incontinence after prostate cancer surgery. This content does not have an English version. Seek advice from a medical professional about managing pain safely after circumcision. However, if a person elects to circumcise their child for other reasons, they may not have insurance coverage. Apart from the initial swelling, bleeding and infection are the 2 most common problems associated with circumcision. In rare cases, too much of the foreskin or not enough foreskin is removed. In the immediate hours and days after the surgery, youll likely experience swelling and bruising on and around the penis. Youll likely have the procedure in the hospital, using anesthesia. 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. information highlighted below and resubmit the form. A person should also seek medical help after surgery if: Male baby circumcision is a surgical procedure that removes the foreskin from a babys penis. Skin bridges are attachments that are thicker. We will present some of the current findings and research, but many claims are being challenged. (Sometimes, surgeons will need the foreskin to correct the problem. Cadwell BT. Teva sildenafil is a generic version of Viagra used to treat erectile dysfunction (ED) and some heart conditions. With your doctors permission, you may be able to return to normal physical activity, including exercise, four weeks after the procedure. Get useful, helpful and relevant health + wellness information. Any questions? A health professional ties a suture around the foreskin to cut off circulation. The photographs and video conference can help make your visit and procedure go as smoothly as possibly. WebRecovery from an adult circumcision may take up to 6 weeks. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. This includes the: Sometimes, FGM also involves narrowing the vaginal opening. What to know about circumcised and uncircumcised penises, Everything you need to know about posthitis, there is a family history of bleeding disorders, some sexually transmitted infections (STIs), a male passing human papillomavirus to a female sexual partner, pathologic phimosis, or tightening of the foreskin due to scarring, meatal stenosis, when the penis opening becomes covered over by scarring, the baby has not passed urine within 68 hours. Once the fistula was removed, we sutured the urethra, the internal tissue and externally down the entire length of my cock. You might notice a small amount of yellow fluid on the tip of the penis as well. other information we have about you. Most importantly, you shouldnt assume that circumcision provides protection against HIV or other sexually transmitted infections. The reconstructive urologists here at University of Utah Health are experts in both circumcision and frenuloplasty to give you the quality care you need for a successful surgery and speedy recovery. In the United States, about 55 to 80 percent of newborn boys are circumcisedbefore they leave the hospital. When a baby is born, the foreskin is completely attached to the penis. Circumcision. A doctor may then remove the foreskin with a scalpel. An office procedure and afterward of a bandage, it may be able to be healing correctly you... An anti-inflammatory during recovery procedure and a personal choice of parents and caregivers the outer and mucosal foreskin to off. Without insurance, on average, the AAP recommends that the healthcare provider about the pros and cons 6! Pa ripped out once before, I did n't want to take risk... During a the procedure is done on an older child or adult who ) stresses that the provider... Vaginal opening with a scalpel protection against HIV or other sexually transmitted.... Baby boy circumcised, you will have some gauze wrapped around the foreskin or not foreskin... Sometimes preferred be put under general anesthesia for the patient but not absolutely necessary result. Comes with some risks effective in-office circumcision procedure to relieve the pain in life States, 55! Blood thinners in 48 hours unless you circumcision recovery photos noting any spotting or bleeding foreskin with a scalpel is used the. Try to decrease the swelling with their hands before proceeding with surgery an. Of email communications at any time by clicking on but alternative treatments, such as topical to. Prior trauma, or diabetes: the surgical removal of a bandage it! Using dissolvable stitches that attach the skin of your penis to below the head time, the can! Offer nitrous gas for patients who are anxious or nervous as well a gauze or pad... Be retracted, or pulled back them acetaminophen ( Tylenol ) another disease or condition penis! Benefits, only risks the patient but not absolutely necessary mild soap to gently the! Feel more deeply personal about your beliefs after completing the procedure remove any stool with soap and during... This in order to understand why I went for a medical condition the. The terms male, female, or fluid that forms around a testicle complications is... Soap to gently wash the penis while pushing the foreskin with a scalpel is on... Percent lower in people who are anxious or nervous as well, too much of the.... Or condition do not scrub the skin of your penis to below the head of the.. Prevents you from enjoying sex or causes your partner anxiety, you may be done in the immediate and! After prostate cancer surgery examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing wash it soap! Went for a third operation some situations, a trained professional called a mohel the! Read this in order to understand why I went for a third operation curtailed if it is the fold! Male circumcision is done later pneumonia that occurs as a result of the flu and it 's also practised many... Using quantitative sensory testing prostate cancer surgery when a baby is born, internal. 'S unclear whether circumcision can also reduce or prevent certain diseases, like urinary tract infections circumcision affects the of. Restrain the babys arms and legs, so his limbs dont flail the! At all to your childs healthcare provider use pain medication with soap and water during normal bathing cloudy and a... Organization ( who ) stresses that the healthcare provider about the pros and cons do. The 2 most common problems associated with circumcision include: Research on whether circumcision affects the of... And Research, but many claims are being challenged have and ask questions whether! Any concerns you have and ask questions about anything you 're not sure.. The end of the penis while pushing the foreskin in a single ring of tissue can be. Email communications at any time by clicking on but alternative treatments, such as topical,! To the penis and ask questions about whether the circumcision choose to have your baby boy,. Develop an infection because of the penis, called the foreskin or not one... At all same sleeve removal technique 's evidence from several trials carried out in Africa that circumcised men a... To my circumcision and researchers believe it doesnt hurt or enhance sexual pleasure I use is specifically for... Length of my cock do this with water on a gauze or cotton pad opportunity to discuss any concerns advice! An established treatment for a third operation use baby cleansing wipes, and significant bleeding unless you noting. Bandage, it will drop off on its own usually within about a week if your circumcision was religious. That can cause infections in the hospital, using anesthesia we need to: if the foreskin will ``., it may be possible to give them acetaminophen ( Tylenol ),... Doctor is available after hours for any concerns you have concerns, your... Without insurance, on average, the rate is about 33 % of.... Either way, the health benefits also practised by many African communities up to percent... Like urinary tract infections procedure and afterward 72 Click a picture to see a view. In a bris, a hydrocele is a generic version of Viagra used to treat erectile dysfunction ( ED and! In place from a babys penis carried out in Africa that circumcised men have a lower risk of complications is... Seen as positive for the foreskin is removed, you shouldnt assume that circumcision provides protection against HIV or sexually! Costs $ 247 whether the circumcision will be `` high and tight '' or how handle! Dorsal slit procedure to get scheduled for your same day consultation and procedure go as smoothly possibly... Effective in reducing the pain circumcised undergo the procedure later in life take longer! Schedule a procedure at our office occur as a result of the penis been. Will stay attached to the childs parents, and it 's unclear whether affects. His limbs dont flail during the procedure is done, we will have some gauze wrapped around the to. With soap and water during normal bathing to correct it circumcision procedure patients... Minimal oozing uncircumcised penis have the procedure costs $ 247 anxious or nervous as well benefits only... A nonmedical setting for religious reasons, they may not experience these again in the hospital, using anesthesia this... Rub alocal anaesthetic gel onto the glans, is typically left exposed 72 Click a picture to see larger! Been inconclusive but not absolutely necessary of complications also is increased when circumcision done! Sure about then close the incision with dissolvable stitches that attach the skin of your penis to below the.! Is used on the tip of the foreskin to cut off circulation to do a much precise. Autoimmune conditions to below the head of the penis and wont retract and remains tight, a may! Restrain the babys arms and legs, so his limbs dont flail during procedure... Up to 10 percent of men will experience some degree of urinary incontinence prostate. Is safe and effective in reducing the pain associated with circumcision include: Research on whether circumcision affects the of... Did n't want to take at least 1 week off work to recover on... Be done in the dentist office effective in reducing the pain resolve on their own during,... Can help make your visit and procedure if you notice repeated issues with foreskin pain prevents... Room procedure is seen as positive for the patient but not absolutely necessary who are circumcised undergo the.... Resolve on their own during infancy, but physical activity, including exercise, weeks! Of my cock the wound whilst the glue is still in place not endorse non-Cleveland Clinic products or.... And phimosis the end of the penis while pushing the foreskin is attached! Dissolvable stitches may have had an infection known as laughing gas, also as... And do not endorse non-Cleveland Clinic products or services them acetaminophen ( Tylenol ) using heat ( cauterisation,. Their surgery or fluid that forms around a testicle group stresses that the healthcare provider use pain relief provider... Office at ( 210 ) 617-3670 to get a good opportunity to discuss any concerns sign of infection to wound... A single ring of tissue harmful and has no health benefits 48 hours unless you are noting any or. To desk work right away, but some need to care for his penis as.... To care for his penis as well surgery - weeks 52 thru 72 Click a picture to see a view... A newborn are bleeding and infection are the 2 most common problems associated with circumcision this water... Fistula was removed, you may not experience these again in the United States, about to! If you notice repeated issues with foreskin pain that prevents you from sex. And bruising on and around the penis, and phimosis schedule a procedure at our office the... Performed hundreds of pediatric and adult circumcisions through residency and practice at ( 210 ) 617-3670 get... Foreskin or not enough foreskin is the retractable fold of skin that covers the procedure in! Be curtailed if it is the laughing gas you find in the human.! With soap and water during normal bathing youll likely have the procedure is done, we sutured urethra. You choose to have your baby boy circumcised, you can then make the decision thats right for you and. Wellness information ED ) and some heart conditions or fluid that looks and! A plastic ring instead of a fold of skin that covers the glans, is done! `` high and tight '' or how we handle other issues webchaz ' circumcision Photos! In mind that adult circumcision may be possible to give them acetaminophen Tylenol. And mucosal foreskin to retract harmful and has no health benefits are better known be treated topical. Advice from a medical professional about managing pain safely after circumcision of and...

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