Should You Get Circumcision with Keloid Concerns?

Circumcision vs. Keloid

DEAR Doctor:
1.
I am unable to expose the glans when erect; it feels stuck, and it has never been exposed when not erect either.
I have always felt that it would get stuck.
Strictly speaking, my glans has never been exposed in my life, and of course, I have never cleaned it, but I have also never experienced inflammation (my penis has never been uncomfortable).
Do I really need a circumcision? Will this procedure be covered by health insurance? (I believe this is a medical condition, and I have heard that only medical conditions are covered.)
2.
I have a severe keloid tendency, with many keloids left on my chest and shoulders from acne.
After circumcision, what is the likelihood or certainty that I will develop keloids? (Could you share the proportions you have observed in your clinical experience and the impact of postoperative keloids?) I have seen keloids from ear piercings that are excessively large, and I am worried that my keloids will also be excessively large after circumcision! My keloids often itch, and I am also afraid that my penis will itch after the procedure...
that would be difficult to manage! Thank you.

p2p, 20~29 year old female. Ask Date: 2006/09/29

Dr. Xu Weikai reply Urology

Hello, in general, circumcision is not covered by the National Health Insurance in Taiwan.
Except for some special circumstances, most cases require out-of-pocket expenses.
If the glans cannot be exposed during an erection, surgical treatment is generally recommended.
Keloids are more commonly found on the chest, and while I personally have not seen them on the foreskin, theoretically, it is possible, although the likelihood is low.
If you are concerned, I recommend using laser cutting, which rarely results in scar tissue; however, the downside is that it is not covered by insurance and is very expensive.
This is a response from Dr.
Hsu Wei-Kai, Director of Urology at Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2006/09/29

More Info

When considering circumcision, especially in the context of keloid concerns, there are several important factors to weigh. Based on your description, it seems you are experiencing phimosis, a condition where the foreskin cannot be retracted to expose the glans (head) of the penis. This condition can lead to hygiene issues and potential complications, even if you have not experienced inflammation or discomfort thus far.
1. Medical Necessity for Circumcision: Given that you have phimosis, circumcision may be medically indicated. This procedure can help alleviate the concerns associated with phimosis, including the risk of infections and difficulties with hygiene. In many healthcare systems, including those in the United States, circumcision performed for medical reasons may be covered by insurance. However, coverage can vary based on the specific insurance plan and the healthcare provider's assessment of the necessity. It would be best to discuss this with your healthcare provider to understand your options and any potential costs involved.

2. Keloid Concerns: Keloids are raised scars that can occur after skin injuries, and individuals with a predisposition to keloids may be at higher risk for developing them after surgical procedures. Since you have a history of keloids, it is crucial to discuss this with your surgeon. The likelihood of developing a keloid after circumcision can vary significantly among individuals. While some patients with keloid-prone skin may develop keloids after circumcision, others may not experience this complication at all.
In clinical practice, the incidence of keloid formation after circumcision in patients with a known history of keloids can range from 10% to 50%, depending on various factors, including the surgical technique used, the location of the incision, and individual healing responses. It is essential to have a thorough discussion with your surgeon about your concerns. They may suggest techniques to minimize the risk of keloid formation, such as using specific suturing methods or post-operative care strategies.

3. Post-Operative Care: After circumcision, proper wound care is vital to minimize complications, including keloid formation. Your surgeon may recommend specific ointments or silicone sheets to help manage scar formation. Additionally, monitoring the surgical site for signs of infection or abnormal healing is crucial. If you notice any unusual symptoms, such as increased itching or swelling, you should contact your healthcare provider promptly.

4. Psychological Considerations: It is also worth considering the psychological impact of the procedure. Some individuals may experience anxiety about the surgery itself or concerns about the aesthetic outcome. It may be beneficial to speak with a mental health professional or a counselor who can help you navigate these feelings.

In conclusion, circumcision may be a necessary step for you due to phimosis, but it is essential to address your concerns about keloid formation with your healthcare provider. They can provide personalized advice based on your medical history and help you weigh the risks and benefits of the procedure. Always ensure that you are fully informed and comfortable with your decision before proceeding with any surgical intervention.

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