Complication

This article refers to complications in connection with genital mutilation. The text is adapted from the (German) DocCheck Flexikon.

“	Although haemorrhage and sepsis are the main causes of morbidity, the variety of complications is enormous. The literature abounds with reports of morbidity and even death as a result of circumcision. – Neville Williams & Leela Kapila

Definition

In medicine, a complication is the undesired development or the unexpectedly difficult course of a disease, trauma or therapy. Complications are therefore secondary events.

In relation to drug therapy, the term "side effect" is used rather than "complication".

Background

Complications of a disease can arise from many different mechanisms, for example through

• spread of inflammatory processes (e.g. septicemia in an abscess);
• bleeding complications (e.g. with anticoagulation);
• dysregulation (e.g. shock);
• chronic tissue damage (e.g. neuropathy in diabetes mellitus).

In the case of invasive interventions in the human body, complications are frequent and must be communicated to the patient as part of the patient education. A "circumcision" is an invasive intervention in the human body by definition.

Classification

• Early complication: Short time between the triggering event and the occurrence of the complication
• Late complication: Long time lag between the triggering event and the occurrence of the complication

47 classes of complications

In a recently published meta-study, Iacob et al. (2021) defined 47 classes of complications arising from male circumcision. These are:

1. Extensive penile skin defects / avulsion
2. Infection (minor and major)
3. Penile herpes simplex virus type 1 infection (after Jewish ritual circumcision)
4. Necrosis
5. Partial penile/glans amputation
6. Complete penile amputation
7. Penile haematoma
8. Bleeding in the context of a genetic condition: haemophilia, sickle cell trait and factor VII deficiency
9. Oedema
10. Keloids
11. Phimosis (referring to pathological phimosis)
12. Sudden infant death syndrome
13. Haemorrhage (bleeding) (outside of a genetic deficiency)
14. Nonhealing wound
15. Scrotal injuries
16. Preputial stenosis
17. Meatal stenosis
18. Cicatrix
19. Meatitis
20. Trapped/buried/concealed/inconspicuous penis
21. Urethrocutaneous fistula
22. Iatrogenic hypospadias
23. Intraperitoneal bladder perforation (leading to life-threatening renal failure)
24. Circulatory shock
25. Death (from bleeding or infection)
26. Unsatisfactory cosmetic results including uncircumcised appearance
27. Device displacement
28. Early sloughing of foreskin tissue
29. Long foreskin obstructing urine flow
30. Insufficient foreskin removal/redundant foreskin
31. (Acute) Ischaemia (which can lead to necrosis)
32. Pain
33. Skin bridges (penile skin adhesion)
34. Fournier’s gangrene
35. Penile mycosis leading to penile gangrene
36. Glandular adhesion (of remnant foreskin)
37. Implantation dermoid/epidermal inclusion cysts/penile implantation cyst
38. Myiasis (fly infestation)
39. Denuded penis
40. Chordee
41. Suture sinus tracts
42. Lower clinical neurophysiological elicitability of the penilo-cavernosus reflex
43. Sexual dysfunction
44. Traumatic neuroma
45. Decreased urine output
46. Excessive skin removal
47. Injury to urethra

See also

• Risks and complications
• Documented severe complications of circumcision

External links

• (22 February 2013). Complications of circumcision, CIRP.org. Retrieved 25 November 2020.
• Complications of Circumcision , Doctors Opposing Circumcision. (July 2016). Retrieved 13 January 2022.
• Fahmy M (2009): Complications in Male Circumcision. Pp. 193. ISBN 978-0-323-68127-8. Retrieved 16 March 2022.