Circumcision  -  Introduction

The foreskin and the glans develop as one structure. Natural separation of the two structures occurs gradually during childhood. The age at which the foreskin becomes retractable differs for each child. It may take until the age of 17 or beyond. This is normal. Forcing the foreskin to retract may cause pain, bleeding, scarring, infection, and adhesions. Therefore, the foreskin of a child should be retracted only by the child himself when he is ready to do so.

Most indications for circumcision in adults are for phimosis. Other men may suffer from recurrent infections of the foreskin or experience splitting and pain during intercourse. A full circumcision may not always be necessary.


Phimosis is a name given to the condition where the foreskin is unretractable. We must distinguish normal (physiological) unretractability from abnormal (pathological) unretractability. Physiological unretractability of the foreskin is found in nearly all new-born infants, and becomes increasingly uncommon with advancing age. It is not an indication for circumcision.

Pathological phimosis is scarring and obstruction of the opening of the foreskin. This may be found in diabetes, and in a localised skin condition called balanitis xerotica obliterans (BXO), in which the skin is thickened, white, and hard. BXO refractory to conservative treatment may require circumcision. The medical literature contains many reports showing that some cases of phimosis can be treated effectively by topical steroid applications or by conservative surgery.

Conservative Treatments

Conservative treatments such as steroid creams or by a foreskin-saving operation known as preputioplasty. In rare instances, after all other treatments have failed, circumcision may be indicated.

Where the foreskin is merely tight but not diseased, circumcision may not be necessary, and the condition may respond to gentle stretching, which can be combined with the application of topical corticosteroid cream (e.g. betamethasone valerate 0.05%) 2-4 times daily for 1-2 months.

Short frenulum

A short frenulum may be the cause of a foreskin not retracting behind the glans, or pulling the glans downwards as soon as retraction begins. If stretching the frenulum fails, as it usually does, it can be freed by a minor operation called a Frenuloplasty.

Ballooning of the Foreskin

Ballooning of the foreskin while urinating is normal in young boys. It is not an indication for circumcision. Ballooning is a temporary phenomenon that arises when the foreskin begins to separate from the glans. It speeds the process of separation and disappears when the process is complete.