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Circumcision Surgery

Surgical Removal of the Foreskin for Religious, Cultural, or Medical Indications

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Circumcision Surgery?

Circumcision is one of the oldest and most commonly performed surgical procedures worldwide, with approximately 30% of males globally circumcised; rates vary widely by region and culture.

Performed for religious (Islam, Judaism), cultural, prophylactic (HIV/STI prevention, hygiene), or medical reasons (phimosis, paraphimosis, recurrent balanoposthitis, balanitis xerotica obliterans, recurrent UTI in infants).

Multiple techniques: device-based (Plastibell, Gomco clamp, Mogen clamp, Mogen-style ring) for newborns; classical surgical excision (sleeve, dorsal slit, freehand) for older children and adults.

WHO and CDC endorse adult male circumcision as part of HIV prevention strategy in high-prevalence areas, with relative risk reduction of approximately 60% for female-to-male HIV transmission.

Symptoms

Phimosis (medical indication): inability to retract foreskin in older child or adult; pathological if causing voiding difficulty, recurrent balanitis, or BXO
Paraphimosis: foreskin retracted and unable to be reduced, leading to glans edema and ischemia (urological emergency)
Recurrent balanoposthitis: repeated infection of glans and prepuce requiring repeated antibiotic courses
Balanitis xerotica obliterans (BXO/lichen sclerosus): white sclerotic changes of foreskin and glans causing phimosis and meatal stenosis
Recurrent urinary tract infections in infants
Frenulum breve: short frenulum causing pain or bleeding during intercourse
Cosmetic and personal preference reasons

Risk Factors

Religious or cultural background (Islam, Judaism, certain African and Pacific cultures)
Pathologic phimosis: BXO accounts for the majority of medically indicated circumcisions in older children
Recurrent balanoposthitis from poor hygiene, diabetes mellitus, immunosuppression
HPV infection of the glans/foreskin
Personal or family preference for prophylactic circumcision
Contraindications: hypospadias (foreskin needed for repair), epispadias, micropenis, buried penis, ambiguous genitalia, bleeding disorders, prematurity (relative)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Inability to retract foreskin in child older than 4–5 years or in adult with symptoms
  • Recurrent balanoposthitis or UTI in infant or child
  • Paraphimosis (urological emergency requiring immediate reduction)
  • Balanitis xerotica obliterans (BXO) with sclerotic foreskin changes
  • Postoperative complications: bleeding, infection, meatal stenosis, glans injury, cosmetic concerns
  • Adult circumcision for religious or prophylactic indications: pre-procedural counseling and evaluation

Treatment Methods

01
Preoperative evaluation: history (bleeding disorders, family history of bleeding), physical examination, assessment of penile anatomy (rule out hypospadias and other anomalies that contraindicate circumcision), informed consent, and discussion of risks and benefits
02
Topical steroid trial (betamethasone 0.05% twice daily for 4–8 weeks): may resolve physiologic phimosis in 70–80% of children, avoiding surgery
03
Newborn circumcision: dorsal penile nerve block or ring block, sucrose pacifier; device-based techniques (Plastibell ring, Gomco clamp, Mogen clamp) commonly used; outpatient procedure
04
Plastibell technique: ring placed over glans, sutured tightly to prepuce; ring falls off in 5–10 days as foreskin necroses; advantages include hemostasis without sutures
05
Gomco clamp: foreskin pulled through clamp and excised over the bell; provides hemostasis through compression; widely used in US
06
Mogen clamp: foreskin clamped at desired level and excised flush with clamp; rapid procedure but higher risk of glans injury if not used carefully
07
Classical surgical circumcision (older children, adults): sleeve technique with two parallel incisions on skin and mucosa, excision of intervening tissue; or dorsal slit followed by freehand excision; absorbable sutures for closure
08
Anesthesia for older patients: local anesthesia (dorsal penile nerve block with bupivacaine or lidocaine without epinephrine), regional anesthesia (caudal block in pediatric patients), or general anesthesia
09
Postoperative care: petrolatum or antibiotic ointment to glans, cool compresses for swelling, oral analgesia (acetaminophen, NSAIDs), avoidance of straddling activities and intercourse for 4–6 weeks in adults
10
Complications (1–3% overall): bleeding (most common), infection, meatal stenosis (1–10%), excessive or insufficient skin removal, glans injury, urethrocutaneous fistula, adhesions, scarring
11
Adult circumcision specific considerations: longer recovery (4–6 weeks), erection-related discomfort with healing, sexual function discussions, postoperative scarring
12
Long-term follow-up: assessment of cosmesis, urinary stream, sexual function in adults; meatal stenosis monitoring
13
Benefits: reduced UTI risk in infants (10-fold), HIV/STI risk reduction, penile cancer prevention (rare), HPV-related disease reduction, improved hygiene

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.