The circumcision controversy: an update

One constructive feature has come out of all of the circumcision controversy. It has made us aware that neonatal circumcision is not a simple procedure and that it should not be regarded as "routine." It is a surgical procedure and it should be taught as one. The authors of this article wrote a review article on circumcision in 1981 and Dr. Grossman has recently published a book designed to teach proper circumcision technique, and to familiarize the operator with the common congenital anomalies as well as the prevention and treatment of the complications of circumcision. The advocacy of neonatal circumcision cannot be considered as a cut and dried issue. For some, it has an absolute religious indication, which transcends current medical logic. For others the available facts still allow for a decision based on one's perception of those facts. If one has the perception that there is value in improving local hygiene, or that the loss of the prepuce will allow for an earlier discovery of a penile lesion, or that circumcision actually does cause a decrease in the incidence of penile or cervical cancer, or group conformity is important, then one might well advocate neonatal circumcision. If, however, one sees the potential values as insignificant in light of the lack of hard data relating circumcision to penile or cervical cancer, and that if one is concerned with the "rape of the phallus," then one is against routine neonatal circumcision. But, this individual must be aware that a small percentage of males will need a circumcision at a later time in life, when technical and psychological problems may lead to an increased morbidity. The decision of the physician, and the advice given to the new parents, at present, appears to be more subjective than the advice concerning RhoGAM, or DPT immunization, although it occasionally is given with as much certainty. We are dealing with the art of medicine rather than science. On this basis, rather than deride each other for positions taken, and religious considerations aside, we would do much better to develop better scientific studies to answer the scientific questions. Today's tendency to make decisions on evaluation of the risk:benefit ratio is clearly difficult if both are not adequately quantitated. Until these are available the decision of whether or not to circumcise must result from an objective discussion between the doctor and the parents of newborn males.(ABSTRACT TRUNCATED AT 400 WORDS)