In humans, foreskin length varies widely and coverage of the glans in a flaccid and erect state can also vary.[7] The foreskin is fused to the glans at birth and is generally notretractable in infancy and early childhood.[8] Inability to retract the foreskin in childhood should not be considered a problem unless there are other symptoms.[9] Retraction of the foreskin is not recommended until it loosens from the glans before or during puberty.[9] In adults, it is typically retractable over the glans, given normal development.[9] The male prepuce is anatomicallyhomologous to theclitoral hood in females.[10][11] In some cases, the foreskin may become subject to a pathological condition.[a][12]
Structure
Different studies estimating timing of preputial separation in children and teens
External
The outside of the foreskin is a continuation of theshaft skin of the penis and is covered by akeratinizedstratified squamous epithelium. Theinner foreskin is a continuation of the epithelium that covers theglans and is made up ofglabrous squamousmucous membrane, like the inside of the eyelid or themouth.[13] The mucosal aspect of the prepuce has a great capacity for self-repair.[14] The area of the outer foreskin measures 7–100 cm2,[15] and the inner foreskin measures 18–68 cm.2[7] Themucocutaneous zone occurs where the outer and inner foreskin meet. The foreskin is free to move after it separates from the glans, which usually occurs before or duringpuberty. The inner foreskin is attached to the glans by thefrenulum, a highlyvascularized tissue of the penis.[16] TheWorld Health Organization states that "the frenulum forms the interface between the outer and inner foreskin layers, and when the penis is not erect, it tightens to narrow the foreskin opening.[16]
Subcutaneous
The human foreskin is alaminar structure made up ofouter skin,mucosal epithelium,lamina propia,dartos fascia anddermis.[14][17] The superficial dartos fascia, formerly called theperipenic muscle, is one of the two sheaths ofsmooth muscle tissue found below the penile skin, along with the underlyingBuck's fascia ordeepfascia of the penis.[18] The dartos fascia extents within the skin of the prepuce and contains an abuncance ofelastic fibers.[19] These fibers form a whorl at the tip of the foreskin, known as the preputial orifice, which is narrow during infancy and childhood.[20][17] The dartos fascia is sensitive to temperature and reacts to temperature changes by expanding and contracting.[21] The fascia is only loosely connected with the underlying tissue, so that it provides the mobility and elasticity of the penile skin.[19]Langerhans cells are immature dendritic cells that are found in all areas of the penile epithelium, but are most superficial in the inner surface of the foreskin.[22]
The penis develops from aprimordial phallic structure that forms in theembryo during the early weeks of pregnancy, known as thegenital tubercle.[30] Initially undifferentiated, the tubercle develops into a penis depending on the exposure tomale hormones secreted by thetesticles.[31] Thedifferentiation of the external sexual organs will be evident between twelve and sixteen weeks ofgestation.[32][33] Preputial development is initiated at around eleven weeks or earlier and continues up to eighteen weeks.[34][35][36]
Historically, the theories regarding the stages of preputial development during gestation fall into two main ideas.[37] The earliest report by Schweigger-Seidel (1866)[38] and later Hunter (1935)[39] suggested the formation of the prepuce out of dorsal skin and its progressive distal extension to completely cover and eventually fuse with theepithelium of the glans.[37] Glenister (1956)[40] expanded the theory suggesting that the preputial fold results as an ingrowth of thecellular lamina, which rolls outwards over the glans, but with the resultant preputial lamina also expanding backwards to form an ingrowing fold at the coronal sulcus.[37]
By eleven and twelve weeks of gestation, the process of preputial formation is evident as a thickening of theepidermis that separates from the penis creating a raised fold, known as the preputial fold.[41] On the underside of this structure forms the preputial lamina, which expands dorsolaterally over the base of the developing glans.[42][43] At thirteen weeks, the prepuce has not yet extended to the distal tip of the glans covering only a part of its surface.[44] By sixteen weeks, the bilateral preputial folds cover most of the glans and the ventral sides of the prepuce fuse in the midline.[45] Thepenile raphe, the continuation of theperineal raphe in human males, occurs on the ventral side of the penis as a manifestation of the fusion of the urethral and preputial folds.[46] The dorsal nerve of the penis, which is present as early as nine weeks of gestation, completely expands through branches to the distal end of the glans and prepuce by sixteen weeks.[47] At nineteen weeks, foreskin development is complete.[35] Towards the end of the secondtrimester,[48] the glans and the prepuce have completely fused together by the preputial, sometimes referred to asbalanopreputial lamina.[49] At birth, this shared membrane is physiologically adherent to the glans preventing retraction in infancy and early childhood.[50][51] The phenomenon of non-retractile foreskin in children naturally starts to resolve in varying ages; in childhood, preadolescence or puberty.[52]
Retraction
Once the foreskin has naturally separated from theglans, the foreskin's two layers of outer skin and inner mucosa can be retracted to reveal the glans and inner foreskin.
During the first years of life, the inner foreskin is fused to the glans making them hard to manually separate.[8][53] At that time, forced retraction can cause pain or microtearing and is thus not recommended.[54][55][56] The two surfaces may begin to separate from early childhood, but complete separation and retraction is a process that normally occurs over time.[57][58] The phenomenon of non retractile or tight foreskin in childhood, sometimes referred to as physiologic phimosis,[51] may completely resolve before, during or even after puberty.[9][59][55] When the foreskin starts to become retractile, a pediatrician can recommend careful retraction at home and rinsing with water during bath.[54] Mild soap may be used, but can be avoided, if it causes irritation.[56] If full retraction is hard to achieve, the child may only wash the exposed area of the glans.[60] Since there is no specific age when non-retractile foreskin begins to resolve, the time of foreskin retraction can vary considerably among children.[52]
Duringpuberty, as the male begins tosexually mature, foreskin retractability gradually increases allowing more comfortable exposure of the glans when needed. Gentle washing under the foreskin during shower and maintaining good genital hygiene is sufficient to prevent smegma buildup.[61][57] Smegma is an oily secretion in the genitals of bothsexes that maintains the moist texture of the mucosal surfaces and prevents friction.[62][63] In boys, it helps resolve the natural adhension of the glans and inner prepuce.[64][53] By the end of puberty, most boys have a fully retractable foreskin.[59]
Variability
In children, the foreskin usually covers the glans completely but in adults it may not. Duringerection, the degree of automatic foreskin retraction varies considerably; in some adults, when the foreskin is longer than the erect penis, it will not spontaneously retract upon erection. In this case, the foreskin remains covering all or some of the glans until retracted manually or bysexual activity. The foreskin can be classified as long, when the preputial orifice extents beyond the glans, medium, when the preputial orifice is located around the meatus, and short, when most of the glans is exposed.[65] The variation of long foreskin was regarded by Chengzu (2011) as 'prepuce redundant'. Frequent retraction and washing under the foreskin is suggested for all adults, particularly for those with a long or 'redundant' foreskin.[66] Some males, according to Xianze (2012), may be reluctant for their glans to be exposed because of discomfort when it chafes against clothing, although the discomfort on the glans was reported to diminish within one week of continuous exposure.[67] Guochang (2010) states that for those whose foreskins are too tight to retract or have some adhesions, forcible retraction should be avoided since it may cause injury.[68]
Evolution and function
The foreskin typically covers the glans when the penis is not erect (top image), but generally retracts upon erection (bottom image). Coverage of the glans in a flaccid and erect state varies depending on foreskin length.
The foreskin is part of the humanphylogenetic heritage and is present in the vast majority of mammals. Non-humanprimates, such as thechimpanzees, have prepuces that partially or completely cover the glans penis.[16] In primates, the foreskin is present in the genitalia of both sexes and likely has been present for millions of years of evolution.[69]
TheWorld Health Organization (WHO) stated in 2007 that there was "debate about the role of the foreskin, with possible functions including keeping the glans moist, protecting the developing penis in utero, or enhancing sexual pleasure due to the presence of nerve receptors".[16] In 2009, the World Health Organization called it a "myth" thatcircumcision has an effect on sexual pleasure. The view is echoed by othermajor medical organizations.[70] The foreskin containsMeissner's corpuscles, which are one of a group of nerve endings involved in fine-touch sensitivity. Compared to other hairless skin areas on the body, the Meissner's index was highest in the finger tip (0.96) and lowest in the foreskin (0.28) which suggested that the foreskin has the least sensitive hairless tissue of the body.[71] The foreskin helps to provide sufficient skin during an erection.[72] In infants, it protects the glans from ammonia and feces in diapers, which reduces the incidence ofmeatal stenosis. And the foreskin helps prevent the glans from getting abrasions and trauma throughout life.[72]
In modern times, there is controversy regarding whether the foreskin is a vital orvestigial structure.[73] In 1949, British physicianDouglas Gairdner noted that the foreskin plays an important protective role in newborns. He wrote, "It is often stated that the prepuce is a vestigial structure devoid of function... However, it seems to be no accident that during the years when the child is incontinent the glans is completely clothed by the prepuce, for, deprived of this protection, the glans becomes susceptible to injury from contact with sodden clothes or napkin".[73] During the physical act of sex, the foreskin reduces friction, which can reduce the need for additional sources of lubrication.[73] TheCollege of Physicians and Surgeons of British Columbia has written that the foreskin is "composed of an outer skin and aninner mucosa that is rich in specialized sensory nerve endings and erogenous tissue".[74] In the March 2017 publication of theGlobal Health Journal: Science and Practice, Morris and Krieger wrote, "The variability in foreskin size is consistent with the foreskin being a vestigial structure".[75]
Clinical significance
The foreskin can be involved inbalanitis,phimosis,sexually transmitted infection andpenile cancer.[76] The American Academy of Pediatricians' now expired 2012 technical report on circumcision found that the foreskin can harbor micro-organisms that may increase the risk of urinary tract infections in some infants and contribute to the transmission of some sexually transmitted infections in adults.[77] In some cases of recurrent pathologies, excessive soap washing may irritate the mucosa, therefore washing of the area should be done gently.[78]
Phimosis is a condition where the foreskin of an adult cannot be retracted properly. Phimosis can be treated by using topicalsteroid ointments and using lubricants during sex; for severe cases circumcision may be necessary.[79]Posthitis is an inflammation of the foreskin.
A condition calledparaphimosis may occur if a tight foreskin becomes trapped behind the glans and swells as a restrictive ring. This can cut off the blood supply, resulting inischemia of the glans penis.[79]
Lichen sclerosus is a chronic, inflammatory skin condition that most commonly occurs in adult women, although it may also be seen in men and children. Topicalclobetasol propionate andmometasone furoate were proven effective in treating genital lichen sclerosus.[80]
Some birth defects of the foreskin can occur; all of them are rare. Inaposthia there is no foreskin at birth,[81]: 37–39 in micropathia the foreskin does not cover the glans,[81]: 41–45 and in macroposthia, also called and congenital megaprepuce, the foreskin extends well past the end of the glans.[81]: 47–50
It has been found that larger foreskins place men who are not circumcised at an increased risk of HIV infection[82] most likely due to the larger surface area of inner foreskin and the high concentration ofLangerhans cells.[83]
Preputioplasty: Fig 1. Penis with tightphimotic ring making it difficult to retract the foreskin. Fig 2. Foreskin retracted under anaesthetic with the phimotic ring orstenosis constricting the shaft of the penis and creating a "waist". Fig 3. Incision closed laterally. Fig 4. Penis with the loosened foreskin replaced over the glans.
Circumcision is the removal of the foreskin, either partially or completely. It is most commonly performed as an elective procedure forprophylactic,cultural, orreligious reasons.[84][85]: 257 Circumcision may also be performed on children or adults to treat phimosis, balanitis, and other pathologies.[86] Theethics of circumcision in children is a source ofcontroversy.[87][88] Some menuse weights or other devices to stretch the skin of the penis to regrow a foreskin; the resulting tissue does cover the glans but does not fully replicate the features of a foreskin.[89] Other cultural or aesethetic practices includegenital piercings involving the foreskin andslitting the foreskin.[90]Preputioplasty is the most common foreskin reconstruction technique, most often done when a boy is born with a foreskin that is too small;[91]: 177 a similar procedure is performed to relieve a tight foreskin without resorting to circumcision.[91]: 181
Foreskins obtained from circumcision procedures are frequently used by biochemical and micro-anatomical researchers to study the structure and proteins of human skin. In particular, foreskins obtained from newborns have been found to be useful in the manufacturing of more human skin.[92]
^Raynor, Stephen C. (2010-01-01), Holcomb, George Whitfield; Murphy, J. Patrick; Ostlie, Daniel J. (eds.),"chapter 61 - CIRCUMCISION",Ashcraft's Pediatric Surgery (Fifth Edition), Philadelphia: W.B. Saunders, pp. 791–795,ISBN978-1-4160-6127-4, retrieved2022-10-24,The prepuce is a specialized junctional mucocutaneous tissue that provides adequate skin and mucosa
^Fahmy, Mohamed A. Baky (2015), Fahmy, Mohamed A. Baky (ed.),"Prepuce",Rare Congenital Genitourinary Anomalies: An Illustrated Reference Guide, Berlin, Heidelberg: Springer, pp. 33–41,doi:10.1007/978-3-662-43680-6_3,ISBN978-3-662-43680-6, retrieved2022-12-01
^abWerker PM, Terng AS, Kon M (September 1998). "The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap".Plastic and Reconstructive Surgery.102 (4):1075–1082.doi:10.1097/00006534-199809040-00024.PMID9734426.S2CID37976399.
^abcdPotts, Jeannette (2004). "Penis Problems".Essential Urology: A Guide to Clinical Practice. Humana Press. p. 29.ISBN9781592597376.Virtually all foreskins become retractable in puberty. Thus, phimosis is not a pathological condition in young children unless it is associated with balanitis, or, rarely, urinary retention.
^abRaynor, Stephen C. (2010-01-01), Holcomb, George Whitfield; Murphy, J. Patrick; Ostlie, Daniel J. (eds.),"chapter 61 - CIRCUMCISION",Ashcraft's Pediatric Surgery (Fifth Edition), Philadelphia: W.B. Saunders, pp. 791–795,ISBN978-1-4160-6127-4, retrieved2022-10-24
^Quartey, J. K.M. (2006), Schreiter, F.; Jordan, G.H. (eds.),"Anatomy and Blood Supply of the Urethra and Penis",Urethral Reconstructive Surgery, Berlin, Heidelberg: Springer, pp. 13–14,doi:10.1007/3-540-29385-x_3,ISBN978-3-540-29385-9, retrieved2022-10-26,Behind the corona, the axial arteries send perforating branches through Buck's fascia to anastomose with the terminal branches of the dorsal arteries before they end in the glans. The attenuated continuation of the arteries pass into the prepuce.
^George, Fredrick W.; Wilson, Jean D. (1984-01-01), Beard, RICHARD W.; Nathanielsz, PETER W. (eds.),"2 - Sexual Differentiation",Fetal Physiology and Medicine (Second Edition), Butterworth-Heinemann, pp. 57–79,ISBN978-0-407-00366-8, retrieved2022-11-04
^Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adrian; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018)."Human Glans and Preputial Development".Differentiation; Research in Biological Diversity.103:86–99.doi:10.1016/j.diff.2018.08.002.ISSN0301-4681.PMC6234068.PMID30245194.Human preputial development begins at ~11 weeks of gestation [...] when the epithelium thickens on the dorsal aspect of the glans penis and forms the preputial placode [...] from which bilateral preputial laminar processes extend ventrally into the glanular mesenchyme
^Fahmy, Mohamed A. Baky (2020), Fahmy, Mohamed A. Baky (ed.),"Embryology of Prepuce",Normal and Abnormal Prepuce, Cham: Springer International Publishing, pp. 29–33,doi:10.1007/978-3-030-37621-5_4,ISBN978-3-030-37621-5,S2CID216479793, retrieved2022-11-15,The first indication of the onset of the developmental processes of the prepuce involved the appearance of a raised fold (the preputial fold), just at the coronary sulcus.
^Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adrian; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018)."Human Glans and Preputial Development".Differentiation; Research in Biological Diversity.103:86–99.doi:10.1016/j.diff.2018.08.002.ISSN0301-4681.PMC6234068.PMID30245194.Development of the prepuce is initiated by ~12 weeks with the appearance of a novel structure, the preputial placode, which is a dorsal thickening of the epidermis on the dorsal aspect of the developing glans penis.
^Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adrian; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018)."Human Glans and Preputial Development".Differentiation; Research in Biological Diversity.103:86–99.doi:10.1016/j.diff.2018.08.002.ISSN0301-4681.PMC6234068.PMID30245194.From the lateral aspect of the preputial placode the bilateral preputial laminae expand ventrally until the preputial folds (foreskin) cover all of the glans, fusing in the ventral midline at ~16 weeks gestation.
^Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adrian; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018)."Human Glans and Preputial Development".Differentiation; Research in Biological Diversity.103:86–99.doi:10.1016/j.diff.2018.08.002.ISSN0301-4681.PMC6234068.PMID30245194.Formation of the prepuce occurs after formation of the urethra in the penile shaft. The penile raphe within the penile shaft is a manifestation of fusion of the urethral folds within the shaft
^Cunha, Gerald R.; Sinclair, Adrian; Cao, Mei; Baskin, Laurence S. (2020)."Development of the human prepuce and its innervation".Differentiation; Research in Biological Diversity.111:22–40.doi:10.1016/j.diff.2019.10.002.ISSN0301-4681.PMC6936222.PMID31654825.Examination of the ontogeny of innervation of the glans penis and prepuce reveals the presence of the dorsal nerve of the penis as early as 9 weeks of gestation. Nerve fibers enter the glans penis proximally and extend distally...to eventually reach the distal aspect of the glans and prepuce by 14 to 16 weeks of gestation.
^Fahmy, Mohamed A. Baky (2020), Fahmy, Mohamed A. Baky (ed.),"Embryology of Prepuce",Normal and Abnormal Prepuce, Cham: Springer International Publishing, pp. 29–33,doi:10.1007/978-3-030-37621-5_4,ISBN978-3-030-37621-5,S2CID216479793, retrieved2022-11-15,Prepuce completely covering and fusing with the glans structure at around twenty-fourth week of gestation.
^Carmack, Adrienne; Milos, Marilyn Fayre (2017)."Catheterization without foreskin retraction".Canadian Family Physician.63 (3):218–220.ISSN0008-350X.PMC5349724.PMID28292801.The foreskin and glans are connected by the balanopreputial lamina, a membrane similar to the synechial membrane that connects the nail bed and the fingernail... This membrane and the small preputial opening prevent retraction in boys with normal physiologic phimosis.
^Liu, Xin; Liu, Ge; Shen, Joel; Yue, Aaron; Isaacson, Dylan; Sinclair, Adrian; Cao, Mei; Liaw, Aron; Cunha, Gerald R.; Baskin, Laurence (2018)."Human Glans and Preputial Development".Differentiation; Research in Biological Diversity.103:86–99.doi:10.1016/j.diff.2018.08.002.ISSN0301-4681.PMC6234068.PMID30245194.At birth the solid preputial lamina is intact and thus "physiologically adherent" to the glans. Thereafter, the preputial lamina will canalize creating the preputial space that "houses" the glans.
^ab"Newborn male circumcision | Canadian Paediatric Society".cps.ca. Retrieved2023-02-01.In the male newborn, the mucosal surfaces of the inner foreskin and glans penis adhere to one another; [...] Until this developmental process is complete, the best descriptor to use is 'nonretractile foreskin' rather than the confusing and perhaps erroneous term 'physiologic phimosis
^The Children's Hospital of Philadelphia (2014-08-23)."Care of the Uncircumcised Penis".www.chop.edu. Retrieved2022-12-21.As long as the foreskin doesn't easily retract, only the outside needs to be cleaned. If the foreskin retracts a little, just clean the exposed area of the glans with water.
^Chengzu L (2011). "Health Care for Foreskin Conditions".Epidemiology of Urogenital Diseases. Beijing: People's Medical Publishing House.
^Xianze L (2012).Tips on Puberty Health. Beijing: People's Education Press.
^Guochang H (2010).General Surgery. Beijing: People's Medical Publishing House.
^Martin RD (1990).Primate Origins and Evolution: A Phylogenetic Reconstruction. New Jersey: Princeton University Press.ISBN978-0-691-08565-4.{{cite book}}: CS1 maint: publisher location (link)
^The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejadet al. "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyleet al. "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Pereraet al. "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.
Shabanzadeh DM, Düring S, Frimodt-Møller C (July 2016). "Male circumcision does not result in inferior perceived male sexual function - a systematic review".Danish Medical Journal (Systematic review).63 (7).PMID27399981.
^College of Physicians; Surgeons of British Columbia (2009)."Circumcision (Infant Male)"(PDF). Archived fromthe original(PDF) on February 15, 2012. RetrievedApril 22, 2012.
^Simmons MN, Jones JS (May 2007). "Male genital morphology and function: an evolutionary perspective".The Journal of Urology.177 (5):1625–1631.doi:10.1016/j.juro.2007.01.011.PMID17437774.
^Blank, Susan; Brady, Michael; Buerk, Ellen; Carlo, Waldemar; Diekema, Douglas; Freedman, Andrew; Maxwell, Lynne; Wegner, Steven (September 2012)."Male circumcision".Pediatrics.130 (3):e756 –e785.doi:10.1542/peds.2012-1990.PMID22926175. The technical report was published in conjunction with an updated statement of policy on circumcision:Blank, Susan; Brady, Michael; Buerk, Ellen; Carlo, Waldemar; Diekema, Douglas; Freedman, Andrew; Maxwell, Lynne; Wegner, Steven (September 2012)."Circumcision policy statement"(PDF).Pediatrics.130 (3):585–586.doi:10.1542/peds.2012-1989.PMID22926180.S2CID207166111.Archived(PDF) from the original on 2017-09-01. Retrieved2017-10-04.
^abcFahmy M (2017).Congenital Anomalies of the Penis – Springer. Springer.ISBN978-3-319-43310-3.
^Van Howe RS, Sorrells MS, Snyder JL, Reiss MD, Milos MF (December 2016). "Letter from Van Howe et al Re: Examining Penile Sensitivity in Neonatally Circumcised and Intact Men Using Quantitative Sensory Testing: J. A. Bossio, C. F. Pukall and S. S. Steele J Urol 2016;195:1848–1853".The Journal of Urology.196 (6): 1824.doi:10.1016/j.juro.2016.05.127.PMID28181790.
^Alan Glasper, Edward; Richardson, James; Randall, Duncan (2021). "Promote, Restore, and Stabilise Health Status in Children".A Textbook of Children's and Young People's Nursing.Elsevier Health Sciences. p. 382.ISBN9780702065033.
^Cox G, Morris BJ (2012). "Chapter 21: Why Circumcision:From Prehistory to the Twenty-First Century". In Bolnick DA, Koyle M, Yosha A (eds.).Surgical Guide to Circumcision. London: Springer-Verlag. pp. 243–259.ISBN978-1-4471-2858-8.
^McClung C, Voelzke B (2012). "Chapter 14: Adult Circumcision". In Bolnick DA, Koyle M, Yosha A (eds.).Surgical Guide to Circumcision. London: Springer-Verlag. pp. 165–175.ISBN978-1-4471-2858-8.
^"Policy Statement On Circumcision".Royal Australasian College of Physicians. September 2004. Archived fromthe original(PDF) on 2008-07-20. Retrieved2007-02-28.The Paediatrics and Child Health Division, TheRoyal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms thatthere is no medical indication for routine neonatal circumcision. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% and includes tenderness, bleeding and unhappy results to the appearance of the penis. Serious complications such as bleeding, septicaemia and may occasionally cause death (1 in 550,000). The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarizing the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.
^abSnodgrass WT (2012). "Chapter 15: Foreskin Reconstruction". In Bolnick DA, Koyle M, Yosha A (eds.).Surgical Guide to Circumcision. London: Springer-Verlag. pp. 177–181.ISBN978-1-4471-2858-8.
^McKie R (1999-04-04). "Foreskins for Skin Grafts".The Toronto Star.
^Grand DJ (August 15, 2011)."Skin Grafting".Medscape.Archived from the original on October 8, 2008. RetrievedAugust 18, 2012.
^Amst C, Carey J (July 27, 1998)."Biotech Bodies".www.businessweek.com. The McGraw-Hill Companies Inc. Archived fromthe original on December 24, 2013. Retrieved2017-09-17.
^Hodges FM (2001). "The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme".Bulletin of the History of Medicine.75 (3):375–405.doi:10.1353/bhm.2001.0119.JSTOR44445662.PMID11568485.S2CID29580193.
Management of foreskin conditionsArchived 2014-04-06 at theWayback Machine – Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists (2007).
