More Information

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Medical Conditions Requiring Circumcision


The term "phimosis" denotes a congenital or acquired narrowing of the opening of the prepuce; it is often associated with a foreskin of unusual length which is sometimes adherent to the glans penis. The narrowed orifice of the prepuce sometimes causes retention of secretions, resulting in irritation and balanitis. It may interfere with forceful voiding. The relation between phimosis and venereal ulcers is well established, and the retention of local secretions may be a precursor to the development of epitheliomas and papillomas. Paraphimosis is a common complication of unrelieved phimosis.


By definition, paraphimosis obtains when the prepuce with its narrow orifice has been fully retracted and cannot be drawn back over the glans. Swelliing occurs rapidly in collar form, affecting the mucous membrane behind the corona. When uncorrected, ulceration of the constricting band occurs. Pain and anxiety increase, and difficulty in voiding may result. Gangrene of the glans penis is rare, but it may occur.

Treatment consists of reduction by manipulation which should be accomplished as soon as possible; it is a painful procedure that often requires anesthesia. If manipulation as described proves unsuccessful, a dorsal slit must be performed. Unless circumcision is performed after the swelling and local inflammation disappear, recurrence may be expected.


To paediatric surgeons, the most obvious medical reasons for circumcision are balanitis (inflammation of the glans) and posthitis (inflammation of the foreskin). Both are very painful conditions.

Posthitis is limited to uncircumcised males. Balanitis is seen in 11-13% of uncircumcised men, but in only 2% of those who are circumcised

In boys the incidence of balanitis is twice as high in those who are uncircumcised, during infancy balanitis is caused by soiled diapers, playing and sitting in dirty areas, antibiotic therapy, as well as yeast and other micro-organisms. Balanitis caused by the group A haemolytic variety of Streptococcus is present exclusively in uncircumcised boys.

In balanoposthitis the entire front end of the penis becomes red, painful and swollen, often accompanied by a smelly discharge of pus. It tends to be associated with phimosis and inability to clean under the foreskin of young boys because the foreskin is still lightly attached to the penis beneath it.

Balanitis is a cause of phimosis, as discussed in the section on Physical Problems. Pathological phimosis can arise from secondary cicatrization of the foreskin orifice due to balanitis xerotica obliterans (BXO). Once thought to be rare, and a disorder presenting in adulthood, BXO is now regarded as common in young boys, in whom treatment by circumcision is advocated to prevent the complications that occur later in life.