Adapted by CIRCLIST from an original image © 2003 W.B.Saunders

The existence of the Buck’s Fascia is crucial to circumcision in any style other than fully loose. It is the Buck’s Fascia, not the shaft skin of the penis, that holds in place the internal structures of the phallus. Because the layer of subcutaneous fat (coloured yellow in the drawing) is not firmly anchored to the shaft skin, considerable longitudinal movement of the shaft skin is possible. Put simply, the shaft skin isn’t attached other than to the skin of the abdomen and, via the foreskin, to the sulcus. Everything between is as mobile as the sleeve of a pullover on an arm, capable of being shortened and then tensioned along its own length by virtue of being unattached to what’s underneath.

During a tight circumcision, much of the shaft skin is removed. That’s what produces the tightness. The Buck’s Fascia must not be cut; it is vital that it continues to perform its function of encasing (especially) the erectile tissue. The tighter the circumcision, the greater the strain on the Buck’s Fascia in the post-operative period. Whilst the shaft skin may have been considerably shortened during the circumcision, the erectile tissues remain untouched and only the Buck’s Fascia exists to keep them in place.

Breaching the Buck’s Fascia does occur, for example, in some categories of hypospadias repair surgery. But that is a much more specialised operation, always done under general anaesthetic and always involving a specialist in urology. More humble circumcisers should regard the Buck’s Fascia as sacrosanct - never to be breached in the course of their work.

Only during a fully low and loose circumcision, one where no shaft skin at all is removed, will the circumcision procedure not encounter the Buck’s Fascia.

The following resources were used in the preparation of this web page:

A Pictorial and Video Guide to Circumcision Without Pain : Adv Neonatal Care 3(2):50-64, 2003.

Demonstration surgery by Sunathrone Biomedical, Kuala Lumpur 2006, attended by CIRCLIST representatives.

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