INTRODUCTION

In most parts of the world, male circumcision, the elective surgical removal of the skin covering the end of the penis (ie, prepuce or foreskin), is uncommon. Although circumcision rates have been high in Canada and the United States, it is being performed less frequently in both of these countries because it is unclear whether potential benefits outweigh the risks of the procedure [1-3].

The care and complications of the uncircumcised penis will be reviewed here. The procedures, risks, benefits, and complications of circumcision are discussed separately. (See "Procedures for neonatal circumcision" and "Neonatal circumcision: Risks and benefits" and "Complications of circumcision".)

NORMAL DEVELOPMENT OF THE FORESKIN

The foreskin is the redundant skin that typically extends about 1 cm beyond the glans (picture 1 and figure 1). It provides protection to the urethral meatus and glans penis.

The normal foreskin begins to develop as an epithelial fold that grows inward from the base of the glans penis at eight to nine weeks gestation with normal completion by 4 to 4.5 months gestation. The squamous epithelial lining of the inner prepuce is contiguous with the glans penis resulting in the normal circumferentially initial adhesions between the inner layer of the prepuce and the glabrous epithelium of the glans penis.

FORESKIN RETRACTION

Separation from the foreskin from the glans penis occurs by desquamation and begins late in gestation, but remains incomplete in most male infants at birth. Only about 4 percent of males have a completely retractable foreskin at birth, and in more than half of newborn males, the foreskin cannot be retracted far enough to visualize the urethral meatus [4].