Malaysian Chinese doctor travels the world for the perfect circumcision.

I'm a 48-year-old Chinese man from Malaysia. I work as a doctor.

When I was a teenager, I had a long foreskin. It would extend beyond the glans when flaccid, and even when erect, I could still pull it forward covering the glans. I also had preputial adhesions, which I managed to free over time by pulling it back one day, causing the glans to be raw and sore for a few days. The first time I saw the glans fully exposed, I felt curious, because as a young teenager, I never knew it was possible. When I masturbated, I didn't use any lubrication. I just held my penis in my hands and pumped the skin back and forth.

At the end of secondary school, around age 18, I was working part-time teaching tuition whereby junior secondary school students would come to my house for lessons. Around this time, I suddenly thought I want to be circumcised. I didn't have any clear reason. It wasn't about health or appearance. I didn't do any research regarding which doctor or clinic to choose from.

I just picked the nearest private clinic for the procedure. There was a clinic 15 minutes' drive from my house in Sri Serdang called Poliklinik Zul dan Rakan-Rakan. I went there alone and told the receptionist I wanted to be circumcised. They quoted me about 150 Malaysian Ringgit (USD34) for the procedure.

I presume it was Dr Zul, the clinic owner who saw me. He asked why I wanted to do be circumcised. I didn't know how to explain, so I said I wanted to convert to be a Muslim. That wasn't true but it was the only reason I could think of. In Malaysia, it's expected for male Muslim converts to be circumcised. I should've just said it was my personal choice, but as a teenager, I didn't know what to say. He asked if my parents knew. I said no. He didn't seem to mind and said he could do the procedure immediately. I waited in the reception area while they prepared. In the procedure room, Dr Zul came back with another man, his assistant. They asked me to remove my pants and lie down on the couch.

While examining me, they casually commented that it looked rather engorged and said I probably masturbated recently, which was true as I just did the deed before visiting the clinic. They started the procedure but didn't asked me to sign any consent forms, take any photos nor asked what type of circumcision I wanted or how much skin to remove.

They hung a surgical drape above my chest like a small curtain, so I couldn't see what they were doing. Probably to keep me from getting anxious. They started by giving local numbing injections. I could feel the needle pricks. They then tested the area and asked if I could still feel anything. The procedure was done entirely manually, no machines, no cautery. I could tell because there was no burning smell or sound from a electrocautery machine. After removing the skin by dorsal slit method, they said there was still a too much foreskin left and decided to remove more.

When they began stitching, I started feeling pain. They gave more numbing injections, but it didn't help much. The doctor said they had reached the maximum safe dose, so I just had to bear with it. Each stitch hurt. I kept saying "ouch" because I could feel the pricking (pardon the pun). After what felt like forever, they bandaged me up. I looked down and only saw a small part of the glans exposed beyond the bandage. In Malaysia, many practitioners return the excised foreskin to the patient for burial but in my case, they didn't return the excised skin. I don't recall being given any aftercare advice. I left wearing my pair of shorts.

At the payment counter, I collected medication for pain and swelling. As I walked out, I noticed other patients in the waiting area staring at me. Maybe they had heard me going "ouch!" loudly numerous times during the procedure and wondered what was going on. When I got home, I found I was alone as my parents were out. I masturbated out of arousal at the thought of finally being circumcised. Of course, I should have abstained from any sexual activities for the next several weeks but I wasn't aware as I wasn't given any advice nor well read. Over the next days and weeks, there was a lot of swelling, especially around the inner mucosal area. Some yellowish discharge appeared over the wound, which was quite worrying. The glans was also very sensitive because it had never been exposed frequently before, and now it was always rubbing against my underwear. That sensitivity faded after about two weeks.

I returned to the clinic for follow-up after some days and the doctor said everything is fine. As I was about to leave, the reception staff told me the circumcision fee was RM250 (USD57) as I'm considered an adult, and not the RM150 (USD34) they charged me earlier which was the price for children. That surprised me as I was suddenly asked to pay extra, but I paid without arguing. After healing, I saw that the result was high and too tight. Too much skin had been taken whereby hairy skin from the pubic and scrotal area had been pulled onto the shaft, covering about a third of it. I recalled during surgery, the doctor said more skin needed to be removed as too little was removed initially, but it turned out to be excessive.

Not only that, the freehand cut was very uneven. The left and right side of the penis had unequal amounts of inner foreskin remaining. The cut on the dorsal aspect was very wavy. The frenulum was preserved, which is typical of circumcisions in Malaysia. Frenulectomy is rare in Malaysia in routine circumcisions. Sensitivity was much reduced after circumcision, taking longer to cum (which is a good thing) and I had to use lubrication during masturbation. For years, I found the result unattractive and a turn-off. I didn't like looking at my own penis. I regretted going to that clinic and seeing that doctor.

Years passed and since then. I've had several sessions of penis enlargement filler and dydoe piercings inserted at the corona of the glans, which was removed sometime later after I grew tired of them, leaving tiny piercing holes. I learned about circumcision revision procedures and skin restoration. I bought a stretching device online. It was a black plastic band and looks exactly like a washer O-ring. You're supposed to pull your remaining foreskin forward and put it on, so that it pulls and stretches the remaining skin. But I didn't have enough skin remaining for it to latch on to, thus rendering it unusable. As I was unhappy with the results of my circumcision, I decided to have a revision. This time, I was determined to choose the best possible doctor, regardless of distance or cost.

In November 2022, I searched online and found Dr Michael Read of the Gold Coast Vasectomy & Circumcision Centre, in Gold Coast, Australia. I saw his website and watched his YouTube videos where he explained the procedure. He seemed confident and knowledgeable, even though there weren't many reviews about him online or on forums like RealSelf.com. I contacted him via email to enquire about revision circumcision and penoscrotal web surgery. He informed that he didn't offer penoscrotal web surgery, but I still made an appointment to see him that same month for the revision circumcision. The cost for the procedure was to be AUD2500 (USD1630).

At the clinic, Dr Read was very informative, kind, and accommodating. He examined my penis and recommended a low and tight revision circumcision with frenulum removal. He planned to remove most of the inner mucosa along with the irregular parts of the shaft skin. The inner mucosa had many stitch marks and tunnel scars from the first circumcision. He explained that those marks were caused by the use of large, irregular absorbable suture. In contrast, he would use fine, absorbable sutures to avoid stitch marks and scarring. I told him my concern: removing too much skin during his revision surgery would worsen my penoscrotal web and pull more pubic hair onto the shaft. Thus I requested minimal excision of the inner mucosa and shaft skin, just enough to remove the irregular edges and create a more linear scar. I agreed to the frenulum removal though. After the consultation, I was asked to sign a consent form and photos of my penis were taken. Dr Read marked my penis with a surgical marker and used a ruler to measure precisely how much skin needed to be removed, ensuring the result would be uniform on all sides.

He inserted an intravenous cannula into my arm to start the procedure under sedation. The next thing I knew, the procedure was already done and I couldn't recall a single thing. Dr Read told me that everything had gone smoothly, and saw that my penis was bandaged up. After resting for a while, I was allowed to return to my hotel. Over the next few days at the hotel, I took my prescribed painkillers, prophylactic antibiotics and anti-swelling medication. A couple of days later, I returned to Dr Read's clinic for a follow-up.

When the bandage was removed, I saw that the penis was swollen and bruised (as expected) but the irregular circumcision scar was mostly gone. In its place was a more linear-looking scar, which was definitely much more aesthetically pleasing. There were nearly 20 very fine stitches. This time around, I refrained from masturbation or any sexual activity for nearly 6 weeks. Most of the sutures has fallen off by then. The outcome of the surgery was a more linear scar. It wasn't perfectly symmetrical all around and very tiny, faint stitch marks from Dr Read's stiches are still visible to this day but it was a significant improvement compared to my previous results. The frenulum had been excised and, in its place, there is now a small, thin scar. I noticed that much of the sensitivity in this area is now gone. I read online that frenulum removal doesn't usually affect sensitivity, as most of the nerves are located behind the frenulum rather than on it. However, I experienced a significant reduction in sensation where the frenulum used to be.

My original circumcision, 20 years on in 2015	Marking up for dydoe piercings at age 38.
How it looks now, after circumcision revision and Korean surgery.	Frenulum removed in the revision and scar from the penoscrotal surgery.

I had been searching for a solution to my penoscrotal webbing, and I thought that the best place to undergo the surgery would be South Korea, as it is well known for its plastic surgery expertise. In March 2023 (3 months after my revision circumcision in Australia), I visited Stantop Urology Hospital in Seoul. I chose to see their most senior and experienced doctor, Dr Kim Dori. Dr Kim didn't speak English but we had translator staff. I wanted to have a penoscrotal web surgery done, as well as a top-up of hyaluronic acid (HA) fillers for the penile shaft to enhance its size.

I also asked Dr Kim about penis lengthening procedure. He recommended the V-Y flap technique, without cutting the suspensory ligament. He explained that cutting the ligament can have adverse consequences, such as lowering the erection angle. The V-Y flap technique involves making a Y-shaped incision over the pubic area, just distal to the penis. It can add about 1 to 2 centimeters in flaccid length. He also recommended pubic liposuction to improve the appearance of length and anchoring the root of the penis via internal sutures for added support. I agreed to all of the procedures in addition to 15 of milliliters of HA fillers.

The procedure was performed that same afternoon under general anaesthesia, as a day case. After waking up from surgery, I rested in the hospital for a while before heading back to my accommodation. Over the next few days, there were signs of infection at the surgical site. It became red, warm, and started developing thick yellow slough. I was required to come in for daily dressings and I was given intramuscular antibiotics on two of those days.

The final outcome was much of the penoscrotal webbing was removed, but I believe the results could be nicer if more webbing was removed. The sutures Dr Kim used were coarse, which led to a thick, hypertrophic scar at the V-Y flap incision site. For the penoscrotal webbing incision, there is also a noticeable scar. A whitish line about 10 cm in length runs from the underside of the penis to the scrotal area, which is still visible to this day.

So, how do I feel about my circumcision journey? I've never regretted being circumcised. I like the appearance of a penis with the glans exposed. However, I do regret choosing the doctor with poor skills when I was 17, which led to very poor results and unhappiness for many years. Back then, devices like the ZSR didn't exist, but had it been available, I would have gladly chosen that option. A guillotine procedure would have given me a much cleaner and more uniform scar compared to the freehand circumcision that I endured. I'm glad I eventually had the revision circumcision in Australia. While the results aren't perfect, they're a significant improvement from before. I'm also happy I went through with the penoscrotal web surgery as it made a big difference, despite leaving some visible scarring. For anyone considering circumcision, I would say: go for it, but choose your doctor carefully. I recommend a high and tight style, which gives better sensitivity and a more aesthetically-pleasing result. I personally like the two-tone appearance. I'd also suggest keeping the frenulum, as it plays a role in sensitivity.

TH Chen         

Editor's comment. It is the area under the frenulam that is sensitive. A hefty frenulum will reduce sensitivity and so will a substantial scar. The ideal is to have smooth skin over that area and and back as far as 1912 Sir William Whitla, in his encyclopaedic 'A Dictionaty of Treatment' recommended just that.