Circumcisions

Circumcision
Intervention
A circumcision performed in Central Asia, c. 1865–1872
ICD-10-PCS	0VBT
ICD-9-CM	V50.2
MeSH	D002944
OPS-301 code	5-640.2
MedlinePlus	002998
eMedicine	1015820
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Male circumcision is the removal of the foreskin from the human penis. In the most common procedure, the foreskin is opened, adhesions are removed, and the foreskin is separated from the glans. After that, a circumcision device may be placed and then the foreskin is cut off. Topical or locally injected anesthesia is used to reduce pain and physiologic stress. For adults and children, general anesthesia is an option and the procedure may be performed without a specialized circumcision device. The procedure is most often an elective surgery performed on babies and children for religious or cultural reasons. In other cases it may be done as a treatment for certain medical conditions or for preventative reasons. Medically it is a treatment option for problematic cases of phimosis, balanoposthitis that does not resolve with other treatments, and chronic urinary tract infections (UTIs). It is contraindicated in cases of certain genital structure abnormalities or poor general health.

The positions of the world's major medical organizations range from considering elective circumcision of babies and children as having no benefit and significant risks to having a modest health benefit that outweighs small risks. No major medical organization recommends either universal circumcision of all males or banning the procedure.Ethical and legal questions regarding informed consent and human rights have been raised over the circumcision of babies and children for non-medical reasons; for these reasons the procedure is controversial.

Evidence supports that male circumcision reduces the risk of HIV infection among heterosexual men in sub-Saharan Africa. Therefore, the WHO recommends considering circumcision as part of a comprehensive HIV prevention program in areas with high rates of HIV such as sub-Saharan Africa. Evidence for a health benefit against HIV for men who have sex with men is less clear. Likewise, the effectiveness of using circumcision to prevent HIV in the developed world is also unclear. Circumcision is associated with reduced rates of cancer causing forms of human papillomavirus (HPV),UTIs, and cancer of the penis. Prevention of those conditions is not a justification for routine circumcision of infants. Studies of its potential protective effects against other sexually transmitted infections have been unclear. A 2010 review found circumcisions performed by medical providers to have a typical complication rate of 1.5% for babies and 6% for older children, with few cases of severe complications. Bleeding, infection, and the removal of either too much or too little foreskin are the most common complications cited. Complication rates are higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or in older children. Circumcision does not appear to have a negative impact on sexual function.