A GP’s Guide: When Does Your Son Need a Circumcision? Understanding the Medical Indications

Written By Carly Hupfeld

As a GP specializing in circumcision procedures, I frequently encounter questions about the medical reasons for circumcision or people asking if they should have their son circumcised. This guide outlines the key indications, helping patients and families make informed decisions.

What Is Circumcision?

Circumcision is the surgical removal of the foreskin covering the head of the penis. While often performed for cultural or religious reasons, there are also well-established medical indications.

Medical Indications for Circumcision

Absolute Medical Reasons

  • Pathological Phimosis

    • Phimosis is the inability to retract the foreskin. When caused by scarring or chronic inflammation (such as lichen sclerosis or balanitis xerotica obliterans), circumcision may be necessary if topical treatments aren’t adequate.

    • Signs of pathological phimosis include:

      • Inability to retract the foreskin (note this can be normal in younger boys)

      • Ballooning or bulging of the foreskin during urination

      • Pain or discomfort during urination, erection, or sexual activity

      • Redness, swelling or soreness of the foreskin

      • Difficulty urinating where the tight foreskin may block the flow leading to a weak stream or inability to empty the bladder fully

      • Discharge or odour due

      • White ring or scar tissue may indicate lichen sclerosis or repeated infections.

    • If your son is experiencing any of these symptoms, then he may have phimosis and benefit from a circumcision.

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Figure 1.1 Symptoms of Phimosis

Recurrent Balanitis or Balanoposthitis

  • Repeated infections or inflammation of the glans (balanitis) or foreskin (balanoposthitis) can be indications for circumcision if other treatments fail or if they are recurrent and impacting life.

Relative Medical Reasons

  • Recurrent Urinary Tract Infections (UTIs)

    • In boys with recurrent UTIs, especially those with underlying urological abnormalities, circumcision may be considered, and the latter case is often recommended.

  • Paraphimosis

    • This is an emergency where the retracted foreskin cannot be returned to its normal position. Circumcision may be needed if episodes recur or if reduction is unsuccessful.

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Figure 1.2 Phimosis vs Paraphimosis

Penile or Preputial Neoplasms

  • Suspicious or cancerous lesions may require circumcision for diagnosis or treatment.

  • Prevention of Sexually Transmitted Infections (STIs)

    • There is evidence that circumcision reduces the risk of HIV transmission in high-prevalence areas, as well as HPV rates though the benefit is less clear in low-prevalence regions.

Non-Medical Reasons

Many circumcisions are also performed for cultural, religious, or personal reasons.

As a medical practitioner, it is important to ensure that parents or patients are fully informed about the risks and benefits, especially when the procedure is not medically indicated.

Why Choose a GP Specializing in Circumcision?

As a General Practitioner with specialized training and experience in circumcision procedures, I am dedicated to providing safe, evidence-based care. I ensure that all patients and families receive thorough information, appropriate pain management, and high-quality follow-up. Circumcision is a decision that should be made carefully, with a full discussion of the risks, benefits, and available alternatives.

Where circumcision is considered the best option, I offer the plastibell technique for boys up to 12 or 13 years of age (depending on their size). The procedure is performed in my consulting rooms, eliminating the need for anaesthesia, costly hospital fees, or lengthy waitlists.

If you are considering circumcision for your son, if you think your son requires a circumcision, or if your older son is requesting the procedure, I am happy to consult with you and your family to discuss the process, risks, benefits, and necessity. To arrange an appointment, please call Medical on Robina.

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Table 1.1 Reasons for Circumcision Summary

Reference List

·       USANZ Guidelines: How to Perform Circumcision on Infant Males. Available at: USANZ - Guidelines on how to Perform Circumcision on Infant Males

·        NHS: Circumcision in Men – Medical Reasons. Available at: Circumcision in men - NHS

·       USANZ: Quality and Safety Considerations. Available at: USANZ - Guidelines on how to Perform Circumcision on Infant Males

·       Patient.info: Indications for Circumcision. Available at:   Circumcision: Assessment and Complications | Doctor

·       The Urology Place: Adult Circumcision Before and After Photos. Available at: San Antonio Urology | Board Certified | Experienced Doctors

·       Wikimedia Commons: Circumcision Images. Available at: Category:Circumcision - Wikimedia Commons

·       Medical aspects of male circumcision. BMJ. 2007 Dec 8;335 (7631): 1206 – 1209. Morris BJ, Wiswell TE. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2128632/1

·       Circumcision StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.Stang HJ, Snellman LW. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535436/2

·       Male circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability. World Health Organization. 2007. Available at: https://apps.who.int?iris/bitstream/handle/10665/43749/9789241596169_eng.pdf

·       Adult Circumcision. American Family Physician.1999 Mar 15;59(6):1514-1518. Weiss HA, Larke N, Halperin D, Schenker I. Available at: https://www.aafp.org/pubs/afp/issues/1999/0315/p1514.html

·       Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust. 2003 Feb 17;178(4):155-8. Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD. Available at: https://www.mja.com.au/system/files/issues/178_04_170203/spi10278_fm.pdf

·       Circumcision. Raising Children Network. October 2024. Available at: https://raisingchildren.net.au/guides/a-z-health-reference/circumcsion

·       Circumcision Clinical Presentation: Physical Examination. Medscape. Updated: Jan 31, 2020. Available at: https://emedicine.medscape.com/article/1015820-clinical

·       Circumcision of Infant Males. Royal Australasian College of Physicians (RACP). Position Statement. 2010. Available at: racp-circumcision-of-infant-males-position-statement.pdf

Carly Hupfeld
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Circumcision in Infants and Children: Weighing the Benefits and Risks