Clinical Review

Medical aspects of male circumcision

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39385.382708.AD (Published 06 December 2007) Cite this as: BMJ 2007;335:1206
  1. Padraig Malone, consultant paediatric urologist,
  2. Henrik Steinbrecher, consultant paediatric urologist
  1. 1Southampton University Hospital, Department of Paediatric Urology, Southampton SO16 6YD
  1. Correspondence to: P Malone pat.malone{at}suht.swest.nhs.uk
  • Accepted 24 October 2007

Summary points

  • 1 in 6 males in the world ends up being circumcised

  • The medical indications to circumcise prepubertal boys are rare

  • There are many relative indications for circumcision in childhood, but the evidence of benefit needs to be carefully appraised

  • The medical indications to circumcise adults are similarly rare

  • Controversy continues about the health risks of preserving an intact foreskin because of lack of evidence and of clear randomised trials

  • Complications of circumcision are well documented and can be drastic

  • Nearly all circumcisions are carried out for cultural or religious reasons

Why should I read this review?

Circumcision is the commonest surgical procedure in males, because routine infant circumcision is practised in many countries for religious and cultural reasons. It originated over 15 000 years ago, being performed for religious, ritualistic, and cultural reasons, and it was not until the 19th century that the procedure was “medicalised.” It is one of the most controversial surgical interventions: proponents claim benefits such as improved hygiene and reduced risks of infection (urinary and sexually transmitted) and of penile and cervical cancer, whereas opponents deny or minimise these benefits and cite substantial complication rates and reduced penile sensation. Many parents and patients have firmly held beliefs, placing medical workers under extreme pressure at times when dealing with requests for circumcision. It is vital for all medical staff to be aware of the various indications for circumcision and the operative techniques and their complications to cope with these consultations with an evidence base.

This review concentrates solely on the medical indications for circumcision and does not address the issues of routine, religious, or ritual infant circumcision. It highlights clinical conditions frequently referred for circumcision but which are normal physiological variants and do not require surgery. It also lists the absolute medical indications for circumcision and the complications of the procedure. The various surgical …

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