In concluding that adequate penile hygiene is a viable alternative to neonatal circumcision (Pedatrics 56:610, October 1975), the Task Force seems unaware of our experience in England where circumcision is not general. Gairdner[1] as far back as 1949 advocated education in penile hygiene but Burrowes[2], a school medical officer, observed in 1963 " . . . among uncircumcised 17-year-old school-boys 70%-80% have never attempted to retract the prepuce though this was possible. Most suffered from balanitis."
A survey of uncircumcised 15-year-olds in a British school only last year showed that 60% of them were not practicing penile hygiene. Gairdner and others[3] have noted[4] that 20% to 80%[5] of 5-year-olds had a foreskin that was either nonretractile or only partially retractile due to persistent preputial adhesions. All these boys are put at risk by a policy of noninterference, which makes hygiene impossible. Fortunately penile cancer is rare.
The genital cancers are clearly of multiple causality and the components are likely to be synergistic in their effect. Remove a link in the chain of development and you have gone some way to avoid completion.
The value of circumcision in reducing the incidence of syphilis and gonorrhea is equivocal but we have ample evidence[6] that other venereal infections such as monilial balanitis and genital herpes occur mainly in uncircumcised males. Reeently cervical cancer has been shown to be associated with genital herpes and research is required to determine if soap and water are as effective as circumcision in preventing transmission of this virus.
The Task Force rightly draws attention to meatal stenosis as a consequence of neonatal circumcision but does not mention that this condition is also found in uncircumcised adults, probably due to low-grade balanitis.
When comparing the mortality statistics for circumcision in infants and children in England with the figures for the United States we were surprised to discover that the mortality for the neonatal operation in the United States was apparently less than for the selected patients circumcised for mainly surgical indications after the neonatal period here.
Routine neonatal circumcision was never encouraged here because Gairdner predicted a high mortality, but 26 years' experience in the United States has proved him wrong. We think the Task Force should exercise caution before advocating a reversal of U.S. policy using equivocal and admittedly inadequate information.
References
- Gairdner D. The fate of the foreskin: A study of circumcision. BMJ 1949; 2: 1433
- Burrowes HP. Cytology of the cervix. Lancet 1963; 2: 588
- Kalcev B. Circumcision and penile hygiene in schoolboys. Med Officer 1964; 112: 171
- Oster J. Further fate of the foreskin: Incidence of preputial adhesions, phimosis and smegma among Danish schoolboys. Arch Dis Child 1968; 43: 200
- Troshev K. Contribution to the anthropometric study of the penis in a group of Bulgarian boys from birth to the age of seven years. Acta Chir Plast 1969; 2: 140
- Taylor PK, Rodin P. Herpes genitalis and circumcision. Br J Vener Dis 1975; 51: 274
