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Doctors Opposing Circumcision
Genital Integrity Policy Statement

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Chapter Four: The Immediate Complications of Circumcision

The immediate complications of circumcision may be classified as hemorrhage, infection, surgical mishap, other miscellaneous complications, and death.

Bleeding

The foreskin is highly vascularized,1 so hemorrhage is a particular problem and risk when the foreskin is cut. An artery that passes through the frenulum to provide blood to the glans penis is in danger of being severed.2 Williams & Kapila (1993) report bleeding to be the most common problem associated with circumcision.3

Special clamps are used to crush the skin to provide hemostasis. Old clamps may be worn, deformed, and fail to provide adequate crushing and hemostasis.4 When using the Plastibell® device, failure to tie the string tightly may result in bleeding.5

When a newborn is circumcised, there is great danger from bleeding because the prepuce is highly vascularized and because an infant’s body contains only 85ml/kg of blood.6 With so little total blood volume, a small loss of blood may cause exsanguination, hypovolemia, hypovolemic shock, and death.7-9 The coroner of Dade County, Florida reported the death of an infant from hemorrhage.7 Hiss et al. reported a hemorrhage followed by death.8 The coroner of British Columbia reported the death of a one-month-old infant from bleeding, exsanguination, hypovolemic shock, and multiple organ failure.9

Infection

Infection may range from the trivial to the life-threatening systemic infection.3

Life-threatening infections, includind septicemia and meningitis,10,11 tuberculosis,12,13 wound diphtheria,14 staphylococcus,15 and streptococcus,16 pyoderma17, impetigo,18,19 and scrotal abscess with salmonella infection,20 also have been reported. Scurlock & Pemberton (1977) reported a death from meningitis.11 The coroner of Ontario reported the death of a two-week-old infant from infection with Escherichia coli, intravascular coagulopathy, and hypoxic-ischemic encephalopathy.21

There are several reports of a significant increase in urinary tract infection (UTI) after ritual circumcision.22-24

Necrotizing fasciitis25-27 and Fournier’s gangrene (gangrene of the scrotum) have been reported.28 Such infections require extensive debridement (surgical excision) of infected tissue, if the patient is to survive.25-28

Circumcision infections may be spread by hospital workers.16,29,30,32,33 Hospitals are increasingly infected with antibiotic-resistant pathogens. St. Catherines’s Hospital on Long Island experienced an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among circumcised boys in the hospital nursery.31 Any invasive procedure increases the risk of MRSA infection in the newborn nursery.32 Boys who are circumcised have a twelve-times greater risk of CA-MRSA infection.33

Surgical Accident

Circumcision is an imprecise surgical procedure. It is difficult to judge the amount of skin to excise. One problem is the removal of excess skin,3 which may denude the entire shaft of the penis and require an immediate corrective operation by a urologic specialist.34-36 Circumcision may also result in injuries to the urethra, including urethral fistula,37-39 which requires corrective surgery by a urologic specialist. A case of bivalving the glans penis caused by inserting the scissors into the urethra has been reported.40

Due to the difficulty in judging the correct amount of skin to excise, sometimes so little skin is removed that the penis does not appear to be circumcised. This may generate parental complaints and requests for a re-circumcision, although there is no medical indication for the second circumcision. Leith (1970) reported that, in his study of 200 circumcisions, 19 were recircumcisions.41 There is danger of painful erections if too much skin is removed.

More serious surgical mishaps include excision of part of the penis42-45 or glans penis,46-48 necrosis of the glans penis,48 necrosis of the penis caused by electrocautery devices,49-51 and total ablation or amputation of the penis.52

Death

Death may be the result of either bleeding7-9 or infection.11,12,15,21 There is no central registry of circumcision deaths, so the incidence of death from circumcision is controversial. Williams & Kapila (1993) characterize death as “rare.”3 Gairdner (1949), however, reported 16 deaths annually in Britain in the 1940s.53 Circumcision deaths may be attributed to bleeding or infection rather than the underlying circumcision. Few doctors are willing to acknowledge death from an elective, unnecessary, non-therapeutic, allegedly “minor,” surgical procedure. Gellis (1978) estimated there are more deaths from circumcision than from cancer of the penis (which would mean more than 200 deaths per year).54 (Prevention of penile cancer is not a valid excuse for circumcising. See Chapter 3.) Baker (1979) argued that there are at least 229 deaths per year in the United States from circumcision.55 Bollinger (2010) estimates 114 deaths in the United States annually from circumcision-related causes.56

Miscellaneous

Miscellaneous immediate complications of circumcision include life-threatening pulmonary embolism,57 apnea and projectile vomiting,58,59 tachycardia and heart failure,60 pneumothorax,61 and gastric rupture.62

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