II. Indications

  1. Routine procedure offered to parents in U.S.
    1. Supported by AAP as benefits outweigh risks
    2. Decision deferred to parental preference
    3. (2012) Pediatrics 130(3): 585-6 [PubMed]
  2. Jewish Tradition

III. Contraindications

  1. Chordee (ventral penile curvature)
  2. Hypospadias (abnormal ventral placement of the Urethral opening)
    1. Typically repaired with foreskin
  3. Buried penis (penis retracts into fat pad)
    1. Circumcision risks entrapping glans penis with post-procedure swelling

IV. Efficacy: Benefits

V. Complications: Miscellaneous

  1. Granulation tissue
    1. May appear as yellow adherent scab
    2. Common, normal healing response following Circumcision
  2. Redundant foreskin (too little foreskin removed)
    1. Risk of Phimosis or poor cosmetic result
  3. Excessive foreskin removed
    1. Presents as denuded area of the distal penile shaft below the glans penis
    2. Typically heals spontaneously by epithelialization without complication
  4. Infection (uncommon)

VI. Complications: Bleeding

  1. Management
    1. Initial measures
      1. Apply local pressure to area of bleeding for 5 minutes
      2. Apply Gelfoam wrap (speeds coagulation)
    2. Refractory bleeding
      1. Consult Urology
      2. Suture bleeding site
        1. Place superficial figure of eight Suture
        2. Exercise caution (especially on ventral surface) to avoid Urethral Trauma
          1. Suturing too deep can result in a urethrocutaneous fistula
      3. Consider blood dyscrasia
        1. Observe for Petechiae, Hematuria or Bright Red Blood Per Rectum
        2. Significant life-threatening bleeding may occur with conditions such as Hemophilia
          1. Circumcision related bleeding may be the initial presentation of Hemophilia
  2. Prevention of bleeding
    1. Avoid excessive manipulation of the penile frenulum (volar band at base of glans)
    2. Leave foreskin clamp (e.g. Gomco Clamp) on for 5 minutes during Circumcision
    3. Apply copious vaseline to Vaseline Gauze and leave applied to cut foreskin edge for 24 hours

VII. Resources

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Male Circumcision (C0008819)

Definition (MEDLINEPLUS)

Circumcision is the removal of the foreskin, which is the skin that covers the tip of the penis. In the United States, it is often done before a new baby leaves the hospital. There are medical benefits and risks to circumcision. Possible benefits include a lower risk of urinary tract infections, penile cancer and sexually transmitted diseases. The risks include pain and a low risk of bleeding or infection.

The American Academy of Pediatrics (AAP) found that the medical benefits of circumcision outweigh the risks. They recommend that parents make this decision in consultation with their pediatrician. Parents need to decide what is best for their sons, based on their religious, cultural and personal preferences.

Definition (NCI_NCI-GLOSS) Surgery to remove part or all of the foreskin (loose skin that covers the head of the penis).
Definition (NCI) Surgical removal of the penile foreskin.
Definition (MSH) Excision of the prepuce of the penis (FORESKIN) or part of it.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D002944
ICD9 64.0
ICD10 30653-00
SnomedCT 149775006, 72310004
English Circumcisions, Male, Male Circumcisions, Circumcision, Circumcision, Male, Male circumcision, circumcision, male circumcision, circumcisions, male circumcisions, Circumcision (procedure), Prepucectomy, Circumcision, NOS, Prepucectomy, NOS, Male Circumcision, Procedure;circumcision;M, circumcision procedure
Portuguese Circuncisão Masculina, Circuncisão
Spanish Circuncisión Masculina, circuncisión (procedimiento), circuncisión, prepucectomía, Circuncisión
French Circoncision masculine, Circoncision, Circoncision des hommes, Ablation du prépuce
Japanese 環状切除, カンジョウセツジョ, 包皮環状切除術, 包皮切開術, 環状切除術-包皮, 環状切開術-包皮, 割礼-男性, 包皮切除術
Finnish Ympärileikkaus
Czech obřízka u mužů, cirkumcize, cirkumcize u mužů, obřízka, Cirkumcize
Swedish Manlig omskärelse
Italian Circoncisioni, Circoncisione maschile, Circoncisione
Polish Obrzezanie u mężczyzn
Hungarian Circumcisio
Norwegian Omskjæring, mannlig, Cirkumcisjon, Omskjæring av menn
Dutch circumcisie
German Beschneidung, Zirkumzision