Contraindications of circumcision

In case of existence of an important disease, the baby must not be circumcised.

Congenital anomalies:

• Hypospadias: Hypospadias is a congenital malformation in which the male urethral opening is located on the underside of the penis instead of its tip. Circumcision should be delayed because the foreskin tissue may be needed to surgical correction of this condition.
• Epispadias: Epispadias is a malformation in which the male urethral opening is located at the upperside of the penis instead of its tip.
• Chordee: is a condition that shaft of penis curves downward or upward during erection because of stiff scar tissue on one side of shaft. Foreskin may be required for surcigal correction. Chordee is usually seen in combination with hypospadias.
• Buried penis: Buried penis is a congenital or acquired condition, in which the penis is partially or completely hidden below the surface of the skin. It can lead to obstruction of urinary stream, poor hygiene, soft tissue infection and phimosis, Congenital causes include maldevelopment of penile shaft skin. Circumcision must be postponed to ages when the growth is stopped as the loss of prepucium may prevent the growth of penis
• Micropenis: Micropenis is defined as a penis that is anatomically normal but below the normal size range for an infant. A penis length of less than 1.9 centimeters (0.75 inches) is considered micropenis. Circumcision should be delayed as the penis may undergo rapid growth with the local application of testosterone. Removal of the foreskin may results in a smaller penis or restrict growth, so that painful erections may occur during childhood or adulthood.
• Intersex appearance of the sex organ: – Iintersex is a variation in sex characteristics including chromosomes, gonads, or genitals so that an individual can not be distinctly identified as male or female. Circumcision should be delayed until psychological sexual identity develops and the child can express his own sexual identity. Early circumcision and circumcision scarring can make future sexual assignment and reconstructive surgeries more difficult.
• Penile torsion: Penile torsion is a congenital rotational defect of the penile shaft. This condition may be associated with other congenital abnormalities such as hypospadias. Circumcision should be delayed as it can increase the possibility of malapposition of the shaft skin of the penis, impeding adult function of the penis.

Because foreskin is usually used for surgical reconstruction, circumcision must be delayed in all conditions mentioned above.

• Balanitis is the infection of prepucium and glans penis. In case of recurrent infections, circumcision must be performed after treatment and tissue healing.
• Bleeding disorders:
  The children who have bleeding diathesis must not be circumcised unless treatment is done. After a vessel injury a platelet plug occurs and it must be strenghten by a substance called “fibrin”. The clotting factors are necessary for synthesis of fibrin. In capillary vessels local vasoconstruction and platelet aggregation is usually enough for hemostasis. Fibrin is not needed.4
  As the bleeding is only at capillary level in Nerve Sparing Esthetic Technique of Circumcision (NES), the baby or child can be circumcised without the need for clotting tests.
• Premature Birth : Normally, a pregnancy usually lasts about 40 weeks. A premature birth is a birth that takes place more than three weeks before the start of the 37th week of pregnancy. Because premature babies are at a greater risk of infection, have a more difficult time breathing, and may have several undiagnosed conditions that the stress of circumcision can complicate, circumcision is contraindicated. Unnecessary stress to a premature baby should be avoided wherever possible.
  Circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery.