Different circumcision methods, explained: freehand, sleeve resection, ZSR, laser and more

As you would expect for one of the world’s oldest surgeries, there are a large variety of ways that a penis can be circumcised.

In adults, most methods of circumcision fall into two categories: “freehand” and “clamping”.

Freehand methods rely on the skill of the surgeon to produce a pleasing result, whilst clamping methods use clamps to semi-automate circumcision, resulting in more standardised, regular appearances. Circumcisions using clamps are also often faster, as they speed up the process.

There are pros and cons to both methods, and not all methods will be available where you live. In all cases, anaesthetic is used to numb the penis and foreskin.

“Freehand” methods

Clamp Forceps

Probably the most common form of freehand circumcision, clamps forceps is a very simple procedure. It is very similar to the traditional religious circumcision in both Islam and Judaism.

In this method, the foreskin is pulled in front of the head of the penis (glans) and clamped in place by forceps, before the foreskin is cut with a scalpel or surgical scissors. The cut is then combined through the use of stitches or glue.

Result: the clamps forceps method typically results in a higher circumcision style

Pros: straight cut; the glans is protected by the forceps during surgery; appropriate in cases of phimosis

Cons: result relies on the skill of the surgeon; higher blood loss than clamping methods; can require more stitches.

Sleeve resection

Think of the sleeve resection method as the opposite of a clamps forceps circumcision.

Instead of pulling the foreskin ahead of the penis, it is retracted to expose the glans.

Two rings are then cut around the shaft of the penis and the skin removed, before the remaining skin is cauterised to stop bleeding and re-attached using glue or stitches.

Note that as the foreskin needs to be fully retracted, this method is not possible if you suffer from phimosis.

Result: any circumcision style is possible using the sleeve resection method

Pros: choice of style

Cons: glans and frenulum are not protected; results depend on skill of surgeon; longer surgery; not compatible with phimosis

Laser circumcision

Laser circumcision is less of a separate method than it is an alternative tool to using a scalpel to cut the foreskin.

In a laser circumcision, a CO2 laser is used to cut the skin and simultaneously coagulate the blood, preventing blood loss.

It can be used in combination with the clamp forceps method, in which the foreskin is pulled out in front of the penis glans and clamped in place using forceps. This protects the glans and allows a laser circumcision to be performed on men with phimosis.

Laser circumcision must be completed either with glue or stitches to join the cut layers.

Result: choice of style, typically higher

Pros: simultaneously cuts and seals the incision; can be used in cases of phimosis; used in cases of haemophilia and other bleeding disorders

Cons: result relies on the skill of the surgeon;

Clamping methods

Shang ring circumcision

The shang ring method uses a single-use plastic ring. It was designed to reduce pain and shorten the circumcision procedure. It also removes the need for stitches or glue and requires no bandages.

This method utilises a clamping method to prevent bleeding, and it often results in a neat, even scar. It takes around five minutes to fit. When tightened, it automatically cuts of circulation to the foreskin, crushing and fusing the inner and outer foreskin.

Overhanging skin is trimmed off. To complete healing, the shang ring is worn for a further seven days, during which the overhanging layer of skin naturally falls off, leaving a neat circumcision scar.

Result: shang ring circumcisions commonly result in low and loose cuts.

Pros: no stitches or glue; quick and bloodless

Cons: must be worn for seven days, requiring a follow up visit to the surgeon to remove.

ZSR (stapler circumcision)

A ZSR stapler circumcision offers an almost-fully automated circumcision.

This method uses a single device to mount, cut and close the wound in a single procedure, reducing blood loss and speeding up the process.

A dome is placed over the glans, under the foreskin to protect the glans. A circular cutting lever then cuts the foreskin around the penis simultaneously, before automatically sealing the wound with surgical stables.

Result: medium high and loose

Pros: faster healing; no stitches; results in neat scar; decreased bleeding

Cons: staples must be removed by surgeon

Gomco clamp

The Gomco clamp is one of the most popular clamps in use and has been around since the 1930s. It is particularly popular for infant circumcisions in North America.

In a Gomco clamp circumcision, a bell or dome is placed over the penis glans underneath the foreskin. A plate with a circular hole is then placed over the top, so that the foreskin is sandwiched in between the two. The clamp is then tightened and left for five minutes; this cuts off circulation to the foreskin to prevent bleeding. After five minutes, the foreskin is cut away, the clamp is removed and the wound is sealed with either glue or stitches.

Result: typically low and tight

Pros: the glans is protected; bleeding is minimised

Cons: small risk of injury the glans

Mogen clamp (Pollock Technique)

Another popular clamping method, this is sometimes called the “Pollock Technique.”

This method is similar to the clamps forceps method, except that it uses a specially designed clamp to cut off blood flow to the foreskin.

When using a Mogen clamp, the foreskin is pulled in front of the penis glans and clamped in place. The clamp remains in place for five minutes in order to cut off circulation and prevent bleeding.

Once five minutes have passed, the foreskin is cut off. The clamp is removed and the skin is joined using skin glue or stitches.

Result: choice of style, typically higher

Pros: straight, even circumcision scar; can be used in cases of phimosis

Cons: does not protect the glans fully

What is the right method for me?

Not all circumcision methods are available in all countries, so your first step should be to narrow down the different techniques available to you.

Once you have a list of clinics and methods, make sure they are appropriate for you. For example, not all techniques can be used if you have phimosis.

After that, you can narrow down your preference based on what style of circumcision you’d like, as some methods result in higher, lower, looser or tighter circumcisions.