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1- Introduction

2- Anatomical Overview

3- Procedure

4- Clinical Significance


Circumcision is a surgical procedure that involves the removal of the foreskin, the retractable fold of skin covering the tip of the penis. It is one of the oldest and most common surgical procedures worldwide, with cultural, religious, and medical significance.

© image from moore clinically oriented anatomy

Anatomical Overview

In an uncircumcised penis, the prepuce covers all or most of the glans penis. The prepuce is usually sufficiently elastic for it to be retracted over the glans. In some males, it fits tightly over the glans and cannot be retracted easily (phimosis) if at all. As there are modified sebaceous glands in the prepuce, the oily secretions of cheesy consistency (smegma) from them accumulate in the preputial sac, the space between the glans and prepuce, causing irritation.
In some males, retraction of the prepuce over the corona of the glans penis constricts the neck of the glans so much that there is interference with the drainage of blood and tissue fluid. In persons with this condition (paraphimosis), the glans may enlarge so much that the prepuce cannot be drawn over it. Circumcision is commonly performed in such cases.
Circumcision, surgical excision of the prepuce, is the most commonly performed minor surgical operation on male infants. Following circumcision, the glans penis is exposed (see Fig. 6.61B). Although it is a religious practice in Islam and Judaism, it is often done routinely for nonreligious reasons (a preference usually explained in terms of tradition or hygiene) in North America. In adults, circumcision is usually performed when phimosis or paraphimosis occurs.


  • Preparation:

    • Before the circumcision, the healthcare provider reviews the procedure with the patient (or the patient’s parent or guardian, in the case of infants) and obtains informed consent.
    • The patient may be given local anesthesia to numb the area and reduce discomfort during the procedure. In some cases, general anesthesia may be used, particularly for older children or adults.
  • Positioning:

    • The patient is positioned comfortably on an examination table or surgical bed, typically lying on their back with their legs spread apart.
    • The genital area is cleaned and sterilized to reduce the risk of infection.
  • Surgical Technique:

    • There are various techniques for performing circumcision, including:
      • Surgical excision: The healthcare provider uses a scalpel or surgical scissors to remove the foreskin. Any bleeding vessels are typically cauterized or sutured to control bleeding.
      • Clamp or device-assisted circumcision: A specialized clamp or device may be used to secure the foreskin before it is removed. The clamp is then applied, and the excess foreskin is cut away.
      • Laser circumcision: Laser technology may be used to perform the circumcision, with the laser cutting and sealing the foreskin simultaneously.
  • Post-Procedure Care:

    • After the circumcision is completed, the surgical site is typically covered with a sterile dressing or gauze.
    • Instructions are provided for caring for the circumcision site, which may include keeping the area clean and dry, applying petroleum jelly or antibiotic ointment to the site, and avoiding strenuous activity or swimming for a certain period.
    • Pain management measures, such as over-the-counter pain relievers or prescription medications, may be recommended to manage any discomfort or pain following the procedure.
  • Follow-Up:

    • The patient is usually scheduled for a follow-up appointment to monitor the healing process and ensure that there are no complications.
    • Any concerns or complications, such as excessive bleeding, infection, or abnormal swelling, should be promptly reported to the healthcare provider for evaluation and management.
  • Cultural or Religious Practices:

    • In some cases, circumcision may be performed as part of cultural or religious practices, often by trained religious practitioners using specific techniques and rituals.

Clinical Significance

  • Hygiene and Infection Prevention:

    • One of the primary medical reasons for circumcision is improved genital hygiene. Removal of the foreskin reduces the risk of smegma accumulation, which can harbor bacteria and contribute to infections.
    • Circumcision has been associated with a lower risk of urinary tract infections (UTIs) in infancy, particularly during the first year of life. UTIs can lead to serious complications if left untreated.
  • Reduced Risk of Sexually Transmitted Infections (STIs):

    • Studies have suggested that circumcision may reduce the risk of acquiring certain sexually transmitted infections (STIs) in males, including HIV, herpes simplex virus (HSV), human papillomavirus (HPV), and syphilis.
    • The removal of the foreskin may decrease the surface area available for viral and bacterial colonization, making it more difficult for pathogens to establish infection.
  • Prevention of Penile Problems:

    • Circumcision may lower the risk of certain penile problems, such as phimosis (tight foreskin) and paraphimosis (inability to retract the foreskin), which can cause pain and discomfort.
    • Balanitis, inflammation of the glans penis, is also less common in circumcised males due to improved hygiene and reduced susceptibility to infection.
  • Preventive Healthcare Practices:

    • Some healthcare organizations recommend circumcision as a preventive measure against certain health conditions, such as penile cancer. Circumcision has been associated with a lower incidence of penile cancer, particularly in regions where the prevalence of circumcision is high.
    • While penile cancer is rare, circumcision may offer some protective benefits against this malignancy.
  • Cultural and Social Considerations:

    • Circumcision holds cultural, religious, and social significance in many communities around the world. It is often performed as part of religious rituals or cultural traditions, and it may serve as a marker of identity or affiliation.
    • In some societies, circumcision is considered a rite of passage or a symbol of maturity, masculinity, or cleanliness.
  • Debates and Controversies:

    • Despite its potential medical benefits, circumcision remains a topic of debate and controversy. Some argue that the medical benefits do not outweigh the risks and ethical considerations, particularly when performed without the individual’s consent.
    • Others contend that circumcision should be a personal or parental choice, balancing medical evidence with cultural, religious, and individual beliefs.
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