CIRCUMCISION

SARA AHMED DAMMAG

 :Defination
: Male circumcision 

is the surgical removal of the foreskin (prepuce  

human penis from the ) .

:Benefits of circumcision
Circumcision and HIV.1
There is strong evidence that circumcision reduces the risk of
HIV infection in heterosexual men in high-risk
populations. Evidence among heterosexual men in sub-
Saharan Africa shows a decreased risk of between
38 percent and 66 percent over two years
 :Benefits of circumcision
: Circumcision and HIV .1 

When an uncircumcised penis is erect during . 

intercourse, any small tears on the inner

surface of the foreskin come into direct contact
with the vaginal walls, providing a pathway
for transmission. When an uncircumcised penis
is flaccid, the pocket between the inside of the
foreskin and the head of the penis provides an
environment conducive to pathogen survival;
circumcision eliminates this pocket
 :Benefits of circumcision
: Circumcision and Human papillomavirus.2 

Circumcision is associated with a reduced  

prevalence of oncogenic types of HPV
infection, meaning that a randomly selected
circumcised man is less likely to be found
infected with cancer-causing types of HPV than
.an uncircumcised man
 Benefits of circumcision
: Circumcision and Other infections.3 

Studies evaluating the effect of circumcision on the 

incidence of other sexually transmitted infections have

reached conflicting conclusions. A 2006 meta-analysis
found that circumcision was associated with lower rates of 
syphilis, chancroid and possibly genital herpes. A 2010
review of clinical trial data found that circumcision
reduced the incidence of HSV-2 (herpes simplex virus, type
2) infections by 28%. The researchers found mixed results
for protection against trichomonas vaginalis and chlamydia
trachomatisand no evidence of protection against 
gonorrhea or syphilis
 :Indications
:Routine or elective .1 

Neonatal circumcision is often elected for 

nonmedical reasons, such as for religious .beliefs

:Medical indications 

is the inability to retract the foreskin : phimosis_ 

over the glans penis

At birth, the foreskin cannot be retracted due . 

to adhesions between the foreskin and glans,

and this is considered normal (physiological
.phimosis)
 :Indications
An inflammation of the glans penis : balanoposthitis - 

and foreskin

Most cases of these conditions occur in 

uncircumcised males,affecting 4–11% of that group.

The moist, warm space underneath the foreskin is
thought to facilitate the growth of pathogens,
particularly when hygiene is poor. Yeasts, especially 
Candida albicans, are the most common penile
infection and are rarely identified in samples taken
from circumcised males
 :Indications
: urinary tract infections recurrent ,- 

A UTI affects parts of the urinary system including 

the urethra, bladder, and kidneys. There is about a

1% risk of UTIs in boys under two years of age, and
the majority of incidents occur in the first year of life
Contraindication: 

contraindicated in infants with

certain genital structure abnormalities,
such as a misplaced urethral opening (as
,in hypospadias and epispadias)
 Contraindication
Circumcision is contraindicated in  . .… 

premature infants and those who are not

clinically stable and in good health
If an individual, child or adult, is known to ..… 

have or has a family history of serious bleeding

disorders (hemophilia), it is recommended that
the blood be checked for normal coagulation
 properties before the procedure is attempted
 Technique
:Removal of the foreskin 

For infant circumcision, devices such as the Gomco clamp,  

Plastibell and Mogen clamp are commonly used in the USA.

 These follow the same basic procedure. First, the amount of
foreskin to be removed is estimated. The practitioner opens the
foreskin via the preputialorifice to reveal the glans underneath
and ensures it is normal before bluntly separating the inner
lining of the foreskin (preputial epithelium) from its attachment
to the glans. The practitioner then places the circumcision device
(this sometimes requires a dorsal slit), which remains until
blood flow has stopped. Finally, the foreskin is amputated. For
adults, circumcision is often performed without clamps [ and
non-surgical alternatives such as the elastic ring controlled
radial compression device are available
Technique
 ACUTE COMPLICATIONS
Bleeding …
… the removal of either too much or too little
foreskin,
…. infection
THANKS