Buttonhole Circumcision

Buttonhole Circumcision, by means of a dorsal transverse incision at the level of the glans rim, is most often performed as an Afrian Masaai tribal ritual. It can, of course, be performed on any male. While the penis is flaccid, its circumference in the sulcus (the groove just behind the glans rim) is measured using a piece of thread or thin string and an ink-pen to mark it. This length is divided by 3, and carefully marked. Ideally a piece of thin flat wood (a tongue-spatula, for example) is used to protect the glans and indicate where the incision is to be made. The foreskin is skinned back, the spatula is placed with its end 2-3 mm (1/10 inch) behind the glans rim, and the foreskin is drawn forward over the glans and the spatula and tensioned sufficiently to produce the desired tightness.

A cut is then made across the foreskin onto the spatula at a level just forward of the end of the spatula, ensuring that a slit is made through both layers of foreskin. The cut should be of a length equal to 1/3 the diameter of the penis. The glans is then pushed through this slit. The foreskin now hangs below the glans, and should be drawn back as far as possible. Healing is normally rapid, and the technique ensures that, if there is an erection during healing, the incision line is drawn together. As with the longitudinal dorsal incision “circumcision” of the Philippines and Melanesians, when healed, the foreskin tends to shrink, especially if the operation is done before the rapid penis-growth of puberty, but it will always be present in the form of a swelling under the glans. When done on the mature adult, as shown below, it often leaves an excess amount of foreskin, and would be considered unattractive in non-tribal societies.


From side left, unhealed, with some swelling	From right, healed, some inner foreskin showing through the slit	Showing the displaced foreskin fully	Displaced foreskin inside out, healing incomplete


Foreskin re-covering glans, showing healed slit	Standing, flaccid penis from front showing bare glans and unobtrusive displaced foreskin (shaft-skin still slightly swollen)	Standing, penis semi-erect from left showing foreskin inside out and shaft-skin displaced back under penis

CIRCLIST Home Page	Medical Terms & Penile Anatomy	Considering Circumcision?	Styles & Results of Circumcision	Instruments & Techniques
CIRCLIST Home Page	Personal Preferences & Experiences	Rites & Practices Around the World	Circumcision Discussion Group	Circumcision Resources