Legal Aspects of Men's Genitourinary Health

J. Henning; S. Waxman

Disclosures

Int J Impot Res. 2009;21(3):165–170 

In This Article

Circumcision

Litigation and indemnity related to adult circumcisions are relatively rare in the United States. A study of urologic malpractice suits over a 4-year period nationwide revealed only 5.2% of negligence cases were classified as related to circumcision (adult or pediatric).[26] The World Health Organization recommendations regarding the decreased transmission of Human Immunodeficiency Virus in circumcised males may lead to an increase in the performance of circumcision.[27]

Adult circumcision is usually performed as an outpatient procedure with local or regional anesthesia. Indications vary widely, but include phimosis, paraphimosis, balanitis, as well as religious and cosmetic reasons.[28]

Of the various complications that can occur after circumcision, patients should be counseled about cosmetic, as well as functional problems that may require future corrective surgery. Certainly, bleeding and hematoma formation can have undesired sequelae and should be discussed. Furthermore, the possibility for chronic pain, sexual dysfunction, tethering, infection and the potential for ejaculatory latency are recognized complications.[29,30] Injury to the urethra, glans penis and meatus can all occur during a circumcision. There is conflicting opinion in the literature regarding worsened erectile function, penile sensitivity and satisfaction. Despite the disagreement in urologic literature, informing patients regarding these potential effects may be warranted.[31,32,33,34]

Although penile carcinoma is rare, its effects are devastating. Therefore, it is imperative to send adult foreskin for pathologic examination. This is particularly true for adult patients undergoing circumcision for phimosis as epithelial atypia is found in approximately one third of specimens.[35] Circumcision has only been found to be protective against penile cancer when performed in very young children.[30]

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