Although there are numerous medical indications for adult circumcision, none of them is very common. The most frequent indication is phimosis, a tightness of the prepuce that prevents its retraction over the glans. A patient may also complain of pain with erection or during intercourse. Paraphimosis, the unreplaceable retraction of a narrow foreskin that causes a painful swelling of the glans, is the second most common indication for adult circumcision. Acute paraphimosis is a urologic emergency requiring reduction of the foreskin through surgical or nonsurgical methods. Recurrent balanitis and posthitis (inflammation of the prepuce), preputial neoplasms, excessive prepuce redundancy and tears in the frenulum are also medical indications for adult circumcision.
Patients may have social, religious or personal reasons for requesting a circumcision. It is important to explore these reasons with the patient to ensure that he has a thorough understanding of the risks and benefits of circumcision and alternatives to the procedure.
There are no specific contraindications to adult circumcision in the literature; however, patients with active infection, possible squamous cell carcinoma of the penis or anatomic abnormalities of the external genitalia should be referred for a urologic consultation.