Circumcision may be the oldest known surgical procedure. For the past 100 years, it has consistently been the most frequently performed surgery in the world.1 The procedure is performed on almost all males in the Jewish and Muslim communities. The World Health Organization estimates that 30% of males worldwide are circumcised; the majority are Muslims.2 In the United States, the prevalence of newborn circumcision peaked at 80% in the 1960s but had declined to 65% (or 1.2 million procedures annually) by 1999.1 Circumcision is less common in other developed countries, where it is often viewed as unnecessary. Many types of physicians perform circumcisions, including obstetricians, pediatricians, family physicians, and surgeons.
Several techniques for performing circumcisions are in general use. In this article, I focus on Gomco circumcision, since this is the method most commonly used in the United States. ("Gomco" stands for Goldstein Medical Company, the original manufacturer of the clamp used in this method.) The Mogen technique is quicker and is the method of choice of some physicians and of mohels (Jewish persons specially trained to perform ritual circumcision). The Plastibell method has largely fallen out of favor because of an increased risk of infection associated with foreign-body retention.3
Although circumcision is commonly thought to have originated with Abraham (the patriarch of the Israelites) some 4000 years ago, Egyptian wall carvings that date back at least 6000 years depict the procedure.1 Interestingly, when Europeans first made contact with the New World, they discovered that many American Indians were circumcised.
In addition to the religious reasons for circumcision, foreskins have been removed as trophies of battle, for hygienic reasons, as a milder form of castration, for cultural identity, and as a rite of passage.1 In the late 1800s, circumcision was touted as a means of freeing up the glans from a constricting foreskin that led to irritation of "other organs." Masturbation, headaches, gout, and a laundry list of other problems were thought to be preventable through circumcision. These theories were debunked in the 1900s, when cultural or cosmetic rationales for circumcision again became the norm. In recent years, new evidence has been emerging on the medical benefits of the procedure. Circumcision has been associated with a decreased risk of urinary tract infections; balanitis; phimosis; penile cancer; and sexually transmitted infections, including HIV infection.1,3-5
1. Alanis MC, Lucidi RS. Neonatal circumcision: a review of the world's oldest and most controversial operation. Obstet Gynecol Surv. 2004;59:379-395.
2. World Health Organization. Male circumcision: global trends and determinants of prevalence, safety and acceptability. 2007. http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf. Accessed June 3, 2010.
3. Reynolds RD, Fowler GC. Newborn circumcision. In: Pfenninger JL, Fowler GC, eds. Pfenninger and Fowler's Procedures for Primary Care. 2nd ed. St Louis: Mosby, Inc; 2003:1367-1376.
4. Mayeaux EJ Jr. Circumcision using Gomco clamp and dorsal penile block. In: Mayeaux EJ Jr, ed. The Essential Guide to Primary Care Procedures. Philadelphia: Lippincott Williams & Wilkins; 2009:911-919.
5. Fergusson DM, Boden JM, Horwood LJ. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics. 2006;118:1971-1977.
6. Peleg D, Steiner A. The Gomco circumcision: common problems and solutions. Am Fam Physician. 1998;58:891-898.
7. Erickson SS. A model for teaching newborn circumcision. Obstet Gynecol. 1999;93(5, pt 1):783-784.
8. Brill JR, Wallace B. Neonatal circumcision model and competency evaluation for family medicine residents. Fam Med. 2007;39:241-243.
Disclaimer: Any procedures described in Consultant For Pediatricians should not be performed by clinicians without appropriate and complete training, evaluation of their patien's condition and any possible contraindications or risk factors, review of any applicable manufacturer's product information, and comparison with the recommendations of other authorities.
Acknowledgment: Dr Hitzeman wishes to thank Ninad Athale, MD, who performed the procedure pictured in this feature. Dr Athale is a resident in the Sutter Health Family Medicine Residency Program in Sacramento, Calif.