Chapters from the urology ward. All names have been changed to preserve anonimity.
Staff nurse Pip Weston showed Alex to an empty bed at the window end of the ward. As a staff nurse, she had worked on the men’s urology ward for 3 years, before that, as a trainee she had worked on c***drens wards. Pippa had a good idea what he was in for. Most boys between the ages of f******n and 20 came in for either Hypospadias or phimosis investigation and operations. Alex was a tall slender lad of about sixteen. he had a shock of ginger hair, and was just entering late puberty.
Alex was given a gown and asked to take his clothes off and slip on the gown, as the doctor would be around in 10 minutes or so. Pip went back to the nurses’ station and had a quick look at his notes. Inside the file were a hand written essay, and a couple of colour photos. Sure enough, Alex had a very tight phimosis. She also noted that he had a long juvenile foreskin. On the file was the note that conservative treatment be used, circumcision was not to be considered. She knew that this would mean stretching the foreskin under general anaesthetic. Sometimes a small cut was made to release the tight phimotic ring. Some patients elected for complete circumcision. Different surgeons had different methods and offered different advice to parents and patients.
Nazreem Khan was surgical registrar, specialising in urology. Naz had been at St Margaret’s hospital for just over a year. He had an easy day today, just a few referrals before the busy afternoon clinic, an older man with prostrate enlargement, a call to the c***dren’s ward, a diabetic man with serious thrush and phimosis but his first surgery of the day was Alex. He picked up the file and reminded himself Alex’s case. He asked Pip if Alex was ready, then they went to his cubicle. He introduced himself to Alex, and asked if he was comfortable. Naz asked Alex to lie back on the bed, as he needed to examine him. He slipped on a pair of latex gloves, and moved the gown aside. Pip watched as Naz, lifted Alex’s penis, stretched the foreskin forward and then reversed the pressure to retract the foreskin. She was surprised how long his foreskin was, within seconds, Alex’s penis started to erect, Naz stretched the skin down to the point where the ring of dartos muscle strained against the glans revealing the meatus. Naz felt his own penis involuntarily begin to erect. He was secretly quite jealous. He himself had been circumcised at the age of ten in a religious ritual. He was now well aware of the nerve damage inflicted by the operation. He would have given anything for his own penis to have a similar foreskin to that he now manipulated
By now Alex’s penis was quite erect and the foreskin retracted as far as it would comfortably go. It allowed a small bead of the underlying glans to burst through the preputal opening. Pippa looked on, she had seen many cases of phimosis, most allowed the glans to emerge, but the foreskin would remain stuck in the coronal grove. I Alex’s case the opening at the tip was much too small to allow the glans to emerge
The differences between men’s penises never ceased to amaze her. A professional interest. Her thoughts flashed back to the early phase in her marriage when she and her husband had lots of experimental sex, she loved the way that his penis erected and then with her gentle pressure the foreskin slipped down to reveal the shinny reddish purple head. And how the head expanded as the skin slipped into the grove beneath. She remembered that the foreskin had stretched over time so that on erection the skin retracted without any help. Sex had become routine now, she realised that she hadn’t seen her husband penis for more than a year. Her thoughts evaporated as Naz released the foreskin and drew it forward to its normal position. He marvelled that even erect there was still two centimetres of overhang. ‘That’s brilliant’ Naz told Alex, ‘The staff-nurse will get you prepared, what we will do is just open you up enough to pop the head out and make it easier for you to keep clean We’ll take you down to the theatre in an hour of so. Have you got any questions? Alex asked in a quiet voice if he will have any stitches, Naz then drew a small picture on the file showing and explaining that he would make two tiny cuts on the side, each cut would have two stitches, “ I will make them as small as I can, so no scars” Naz then left Pip to sort out the detail and arrange the theatre slot. A thought flashed through his head, a small expanding ring with a groove that sat within the prepuce would apply the constant tension needed to stretch the prepuce. A device like that could be a more conservative treatment with no surgery needed. He would discuss it with the consultant.
Pippa asked Alex if he wanted go to the bathroom ‘you need to have a wee and then have a good wash down there’, Alex went into the bathroom He didn’t really need a wee but he tried. When it came it was a slow trickle not like the morning rush that came out in all directions and made such a mess. He hoped that having his foreskin opened would stop the rows from his mum about the occasional misshap as he missed the pan. Sometimes his urine came out sideways, sometimes it went on the floor. He wondered of he would still be able to make himself cum by squeezing the tip. It was something he could hide from his mum as the beads of cum that he produced stayed under his foreskin. He went back to his cubicle wondering what was wrong with the man in the next bed. He had a pipe running into his pyjamas.
A few minutes later Pippa gave Alex the premed, ‘this will make you relaxed and sl**py’. She held his hand for a brief moment. She knew he was embarrassed and that he was scared and apprehensive. She whispered, so that the man in the next bed could not overhear that his was one of the easiest ones she had seen, and it will go like clockwork. Was there anything he was worried about Alex whispered to her will I still get wet dreams. Pip knew that he was asking her if he would still be able to masturbate, she smiled at him and whispered of course he would and probably be better. She gave his hand a tight squeeze and went to confirm the theatre slot.
Alex was dozing when the trolley came to take him to theatre. The next thing he knew he was in the anaesthetic room. Naz looked down and said that well be done in no time and with that a syringe full of bliss entered Alex’s hand. Within 2 minutes, he was d****d and prepped.
The theatre nurse was Angie. She swabbed Alex’s belly, penis and scrotum with betadine. She paid attention to his foreskin, and pushed down on it until the glans was visible, his semi erect penis responded to her attention,. She wondered why it was always ginger headed boys who had tight foreskins, it must be a genetic thing. She loved the soft silky feel of his skin, even through the latex gloves. Once she had finished, Naz took her place and made the final mental note on where to open the prepuce. The first thing was to erect the penis He gave a shot into the shaft of the penis. In a few moments the bl**d supply would produce the lasting erection that would be essential. A limp penis was not so easy to work on..
Naz pushed down on the foreskin so that the tight ring was exposed, He slipped a f***eps between the glans and tightened up to crush the tissue. He repeated the process on the other side. His cut would be 5MM long. He would make 2 cuts one at 4 o’clock and one at 8 o’clock. He made the cut on the fist side. There was no bl**d, the f***eps had done their work. He cut the second side, this time a trace of bl**d emerged. He held the swab against it for a moment. Then he retracted the released prepuce. It slipped easily down the shaft, exposing the glans. The glans was a livid reddish colour, as the skin slipped down below the sulcus, plaques of smegma and mucous were revealed running around the rim and extending over the glans in places. Can we clean him up please he asked the nurse. She had done this before, in most cases the newly revealed glans had traces of smegma trapped beneath. Some cases there were lumps. In this case, the plaque was stuck to the glans she used a swab to wipe away the mucus, she thought this was probably semen, after a few swabs, the glans was clean, Naz then began the restoration. With fine suture he closed up the cuts transverse to the way he had made them, He put two small sutures in each side. Then he checked the movement of the foreskin. It slid up and over the glans it still closed over the tip, but retracting the foreskin was no longer difficult. Good result he thought. He cut two strips of micropore withdrew the foreskin and applied the tape to maintain the position. His final act was to look at the hole in the tip of the penis to ensure there was no pin-hole deformity. Some times in boys with Alex’s condition the hole at the tip could be too small. As it was Alex was fine.
Alex was sent to recovery, within 10 minutes he was awake and moved back to the ward.
Pippa kept an eye on him and as he woke up she sat with him. She knew that the first instinct would be to draw his foreskin forward. It was a natural urge, she didn’t want him to open the stitches by tugging against the micropore. As Alex woke Pippa gently told him that he was back on the ward, it had all gone well and not to touch it for a while, He would be sore. He still had an intense erection, and his newly exposed glans was excited and super sensitive, the colour had become deep purple
Can I look at it he asked. Pip held back the cover. His penis felt so strange to him. He looked at his glans, I didn’t know I would look like this he commented. Pippa explained that he had tape the hold the skin back just so as to keep an eye on the stitches. Pippa noticed the shape and colour of the glans, still very juvenile. Her thoughts flashed to the unhealthy colour of the old man in the next cubi
cle. His greyish, leathery skin with the pronounced flared rim often seen in circumcised men. She knew that it could cause painful intercourse without enough lubrication. She thought of the one time she had sex with a circumcised man, how difficult it seemed for him to climax. How rough he had to be with himself and her in order to ejaculate.
Naz had been on clinic during the afternoon, and had slipped away to see how his surgery had gone
He smiled at Alex and said it had gone really well and that he would find every thing easier now. (One of the things that he had noted in the file was how his mother was concerned that he would be able to wee strait.). Naz had a last look at Ales’s penis gently moved the foreskin back a touch to confirm the cuts were tight. There should be no visible scar in 3 months. He was pleased with his handiwork. If only he could do the same for himself he thought.
Back in the clinic, a young Muslim boy was led in by his mum. We want to have him circumcised. How much will it cost? The mother asked, Naz looked at the boy, sad that his closest friend, his mum was arranging to cut off the most sensitive part of his body. ‘The usual fee for private circumcision is £700. We don’t do this under the NHS’ The arrangement was made for the secretary to make the necessary arrangements. Can I just take a quick look at him, He needed to ensure there were no underlying problems such as hypospadias. Or deformity. The boy dropped his trousers, his mum told him to show his wee-wee The boy presented a classic penis. His mum said to show the end, with that the boy retracted his prepuce. Naz said that there was no medical need to circumcise him and that it was not the best thing for a man. No, we want him done. Sadly Naz noted the file, the boy dressed and his mum led him out.
Alex was dis-charged at 5pm.He was given a letter for his GP, and a sheet of paper with care instructions. He was to have the check up in three weeks. As he came to say good bye, Pippa smiled at him and quietly wished him good luck