Foreskin Morbidity in Uncircumcised Males

Abstract

OBJECTIVE: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated the incidence and morbidity of foreskin surgery due to medical indications in boys from the Capital Region of Denmark in 2014. METHODS:Medical records from all boys operated on the foreskin due to medical reasons in the Capital Region in 2014 were reviewed. Patients with hypospadias, ritual circumcision, and redo-surgery because of complications to nontherapeutic circumcision were excluded. RESULTS:A total of 181 patients were included. The cumulative risk of undergoing foreskin operation before 18 years of age was 1.7%. Forty patients had histologic verified balanitis xerotica obliterans (BXO) corresponding to a total risk of 0.37% of developing BXO. Mean age at surgery was 10.1 years (range 1-17). Phimosis was the most frequently reported indication (95.0%). The remaining 5.0% underwent surgery because of frenulum breve causing problems during erection. Before surgery, 27.1% had foreskin-related voiding problems and 17.1% had at least 1 episode of balanitis. Circumcision was initially performed in 44 cases. The remaining 137 patients had a foreskin-preserving operation performed. Nine boys had secondary circumcision after initially having foreskin-preserving operation. Fifty patients initially had preputial histology performed. BXO was verified in 37 patients. Of the 9 patients with redo-surgery due to recurrent phimosis, a further 3 had histologically verified BXO. CONCLUSIONS:Childhood foreskin-related problems in a region with no tradition of newborn male circumcision should not be neglected.

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

“…But they fail to acknowledge that the healthy foreskin of an uncircumcised male remains vulnerable to adverse medical conditions, infections, and genital cancers. We draw attention to a Danish study by Sneppen and Thorup that found “significant morbidity related to foreskin problems in a predominantly uncircumcised population.” 41 It pointed out that the reason most Danish boys might go through infancy, childhood, and adolescence without being circumcised reflects “the strict foreskin-preserving culture of Denmark.” 41 “More than 5% … were admitted to the pediatric surgical department with foreskin-related problems [mainly phimosis] and at least 1.66% of the boys needed surgical procedures in [ sic ] general anesthesia.” 41 Of these, 24% initially received a circumcision and another 5% received circumcision after alternative treatment failed. Moreover, foreskin-preserving preputioplasty had to be repeated in 5.5% of cases (repeat surgery for MC was lower, at 2%), further exposing the boy to surgical risks.…”

Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury

“…In response to recent Danish research showing that the overwhelming majority (roughly 98.3 percent) of genitally intact (not circumcised) boys will not require a circumcision for medical reasons before an age of legal majority [61], a former member of the AAP Task Force on Circumcision, Andrew L. Freedman, conceded that circumcision is fundamentally a religious or cultural practice in search of a "medical" justification [62].…”

Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

“…The Danish study by Sneppen and Thorup that Van Howe then referred to stated there was, "significant morbidity related to foreskin problems in a predominantly uncircumcised population" [132]. That study pointed out that the reason most Danish boys might go through infancy, childhood and adolescence without being circumcised reflects, "the strict foreskin-preserving culture of Denmark" [132].…”

“…That study pointed out that the reason most Danish boys might go through infancy, childhood and adolescence without being circumcised reflects, "the strict foreskin-preserving culture of Denmark" [132]. In contrast to Van Howe's misleading statement that this study showed, "only 0.5% of boys needed circumcision for medical reasons", Sneppen and Thorup noted that, "More than 5% … were admitted to the pediatric surgical department with foreskin-related problems [mainly phimosis] and at least 1.66%…”

“…of the boys needed surgical procedures in [sic] general anesthesia" [132]. Of these, 24% initially and another 5% after alternative treatment failed, received a circumcision.…”