Circumcision is the removal of a simple fold of skin (the `foreskin' or `prepuce') that covers the head (glans) of the un-erect penis. The amount of this skin varies from virtually none to a considerable amount that droops down from the end of the flaccid penis.

In male babies the foreskin is lightly attached to the penis underneath it, much like the skin on an orange, and comes free over the course of the first few years of life. By this analogy the foreskin can be readily separated from the main body of the penis at the start of a circumcision.

A variety of methods are available to remove the foreskin, and the amount eliminated can also vary, depending on technique.

Medical indications (Non-ritual / non-religious) are :

Phimosis (pathological):

Phimosis is defined as a medical condition when the prepuce skin of the uncircumcised male penis cannot be retracted fully.

This is generally regarded as narrowing of the foreskin orifice so as to prevent retraction of the foreskin over the glans. Phimosis is normal in very young boys (physiological), but is gone by age 3 in 90%. If still present after age 6 (pathological) it is regarded as a problem.

The narrow foreskin opening causes urinary obstruction that can be partial or complete. Backward pressure to the kidney may impede its function and lead to high blood pressure, which is associated with increased risk of heart attack and stroke.

BXO Balanitis Xerotica Obliteran commonly occurs on the foreskin and glans penis. Atrophic white patches appear on the affected area, and commonly, a whitish ring of indurated (hardened) tissue usually forms near the tip that may prevent retraction. This give rise to secondary phimosis.

Phimosis also increases risk of penile cancer and treatment by complete circumcision to prevent this outcome is advocated.

Mild to moderate phimosis can be treated with topical steroids with regular retraction of the foreskin. It has been shown to be quite successful. However, regular applications are needed for at least 1 month. Sometimes can be longer up to 18 months.

Paraphimosis:

This is when the retracted foreskin cannot be brought back again over the glans and is a very painful problem. When the tight retracted foreskin cannot be relieved under anaesthesia by force or dorsal slit , then circumcision is indicated.

Zipper injury (moderate to severe):

In uncircumcised boys the foreskin can become accidentally entrapped in zippers, resulting in pain, trauma, swelling and scarring of this appendage. Foreskin accidents in men can also occur.

Balanitis and posthitis:

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.

In babies, 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.

Penile skin diseases also include psoriasis, those arising from penile infections, lichen sclerosis, lichen planus, schorrheic dermatitis, and Zoon balanitis.
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