The different styles of circumcision
In numerous cultures the circumcision of the male foreskin has a history of thousands of years. Even today, circumcision is performed not only for medical reasons (phimosis), but also for religious, cultural and aesthetic reasons.
However, not every circumcision is performed with the same technique. Depending on the type and style of a circumcision, the foreskin of the penis is removed either completely or only partially. If so much skin is removed that the glans is always completely exposed, it is called a radical circumcision. On the other hand, if only a part of the foreskin is removed, it is called a partial circumcision.
For a better understanding of which part of the skin is removed in which type or style of circumcision, you can see the sketches in this article. We distinguish here between the skin of the penis’s shaft (shown in green in the sketches), which in uncircumcised men passes behind the glans into the outer foreskin sheet (orange), which then curves inward and passes as the inner foreskin sheet (black) into a smooth mucous membrane.
To describe the different styles, the terms “high” & “low” or “tight” & “loose” have become established. If the scar is close to the glans the circumcision is called low, if the scar is higher on the shaft it is called high. Depending on how much skin is removed, one speaks of a loose or tight circumcision.
Thus, there are basically 4 different combinations: “high & tight”, “high & loose”, “low & tight” and “low & loose”:
High & tight circumcision
With a high & tight circumcision, the outer foreskin , as well as parts of the inner foreskin and the shaft skin are removed. The remaining part of the inner foreskin is then pulled back and sutured to the shaft (high) with the shaft skin.
Because the skin (inner foreskin), which was previously on the inside of the glans, is now on the outside, a characteristic different skin tone is seen with this variant.
High & loose circumcision
With a high & loose circumcision, the outer foreskin, as well as a small part of the shaft skin is removed. The previously inner foreskin is sutured back to the shaft skin. Since less skin is removed in this case – usually none at all from the inner foreskin – the scar is again more towards the body – high – but there is so much skin left that it lies in folds behind the glans rim.
Low & tight circumcision
With a low & tight circumcision, the entire foreskin – inner as well as outer part – is completely removed and the shaft skin is sutured directly behind the glans (low ). This type of circumcision is preferred by most, because the scarring in the case of a well done low & tight circumcision is minimal and hardly visible.
Low & loose circumcision
With a low & loose circumcision, only the inner foreskin is removed, the outer foreskin remains and is sewn back on directly under the glans (low). In this case, the remaining foreskin often goes slightly above the corona, so the penis head is not completely exposed in the non-erect state.
While men in the United States are more likely to be tightly circumcised, the low variants are more common in Europe.
A special procedure is the aesthetic circumcision. In the categorization above, this type of circumcision would probably be classified as “extra high”.
With this type, both the inner and outer foreskin are left intact, and instead, shaft skin is removed directly at the base of the penis. The foreskin is then pulled back and the shortened shaft skin is sutured directly back to the root of the penis. The sensitive areas of the foreskin are thus completely preserved, yet the glans is exposed.
Inclusion of the frenulum
Depending on the circumcision style and the individual case, the frenulum may also be included in the procedure. Problems caused by a too short frenulum of prepuce of penis (frenulum breve) can be aggravated by circumcision. Especially in the tight variants, the frenulum must be cut or completely removed.
Circumcision should be done by skilled hands in any case, as there are potential side effects even with a minor procedure like circumcision. Aesthetically unsatisfactory scarring, lymphedema, asymmetrical scars on the penis, loss of sensitivity, etc. can be the result of an incorrectly performed circumcision.