The prepuce of the penis covers the glans and originates proximally to the coronal sulcus and is made up of an outer skin layer, dartos fascia, and an inner mucocutaneous layer (Figure 44.1).

The development of the prepuce coincides with the development of the penis. Therefore, any anatomic variations or abnormalities of the penis will result in abnormal foreskin.

Circumcision ultimately removes the inner and outer layers of the prepuce as well as dartos fascia.

The United States is the only country in the developed world where the majority of male newborns are circumcised for nonreligious reasons.

It is estimated that approximately 80% of males aged 14 to 59 years are circumcised. Most of these patients underwent circumcision as newborns.¹

Circumcision rates in the United Sates vary depending on geographic area, race, religion, and socioeconomic status.

The formal indications for circumcision have been debated for decades.

Circumcision is an elective procedure, and therefore there are no current absolute medical indications.

In the United States, 40% to 67% of parents decided to have their son circumcised for hygienic, social, and perceived medical benefits.

Potential benefits of circumcision include lower rates of urinary tract infection (UTI), sexually transmitted infections/diseases, and penile cancer.

In the pediatric population, decreased rates of UTI are the major benefit of circumcision.

Contraindications to neonatal circumcision include an unstable infant, prematurity, congenital penile abnormalities, blood dyscrasias, or a family history of abnormal bleeding.

If the infant has other penile conditions that require surgical attention, circumcision should not be performed. These include hypospadias, penile curvature, dorsal hood deformity, buried penis, and webbed penis.³

All circumcision procedures are delayed until at least 24 hours after birth to rule out any congenital disorders that may elevate the risk of the procedure.