Circumcision: Definition, Procedure, and Cultural Significance

Circumcision is the surgical removal of the prepuce (foreskin)—the retractable skin covering the glans penis.

Procedure

• Neonatal: Clamp (Gomco, Mogen, Plastibell) or surgical excision; local anesthesia (dorsal penile nerve block, ring block, or topical). 5–10 minutes.
• Older child/adult: Surgical excision with sutures; general/regional anesthesia; longer recovery.

Indications

• Cultural/Religious: Judaism (brit milah, day 8), Islam (khitan, variable age), some African/Oceanic traditions.
• Medical: Phimosis, recurrent balanitis, BXO (balanitis xerotica obliterans), UTI risk reduction (infancy).
• Public Health: WHO recommends for HIV prevention in high-prevalence heterosexual epidemics (60% risk reduction).

Considerations

• Risks: Bleeding, infection, meatal stenosis, cosmetic dissatisfaction (<1–2%).
• Ethics: Bodily autonomy debates; AAP states benefits outweigh risks but not sufficient for routine recommendation.
• Hygiene: Retractable foreskin hygiene is effective alternative.