Male circumcision

Male circumcision is the surgical removal of the prepuce (foreskin) from the penis for medical, cultural, or religious reasons. Medical indications for circumcision include refractory balanoposthitis, recurrent urinary tract infections, and pathological phimosis. Elective circumcision is commonly performed during the neonatal period because of social norms and/or religious laws. Circumcision can decrease the risk of urinary tract infections, certain sexually transmitted infections, penile cancer, and some penile inflammatory disorders. In countries with high rates of HIV transmission, male circumcision is recommended as a preventative measure. The decision to circumcise male infants should be made on a case-by-case basis, based on social norms, parental preference, and individual medical benefit.

• Medical indications ^[1]
  • Recurrent and/or refractory balanoposthitis
  • Recurrent UTIs
  • Pathological phimosis and paraphimosis
  • Prevention of HIV transmission in countries with high infection rates ^[2]
  • Queyrat erythroplasia
• Elective
  • Customarily performed during the neonatal period because of social norms and/or religious laws (e.g., in Judaism and Islam)
  • Cosmetic reasons

• Procedure ^[3]
  1. Use an adequate aseptic technique (e.g., sterilize the penis with chlorhexidine gluconate).
  2. Manage pain (e.g., with a regional nerve block).
  3. Estimate the amount of foreskin to be removed.
  4. Dilate the preputial orifice to better visualize the glans.
  5. Free the inner preputial epithelium from the glans epithelium.
  6. Place the circumcision device (e.g., Gomco clamp) and leave in situ until hemostasis is achieved.
  7. Remove the foreskin.
• Benefits
  • Decreased risk of UTIs during infancy
  • Decreased risk of acquiring certain STIs, such as HIV and HPV
  • Decreased risk of penile cancer
  • Decreased risk of some penile inflammatory disorders (e.g., balanitis)
• Contraindications
  • Bleeding diathesis (e.g., hemophilia)
  • Prematurity
  • Congenital penile anomalies (e.g., hypospadias, epispadias)

• Bleeding: due to injury of the cut dermal edges or frenular artery
• Infection (rare)
  • Wound infection
  • Bacteremia
• Surgical injury
  • Urethral and/or glans injury
  • Inadequate skin removal
  • Abnormal scarring
  • Fistulas
  • Meatal stenosis

We list the most important complications. The selection is not exhaustive.