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Controversy
Benefits of newborn circumcision: is Europe ignoring medical evidence?
  1. Edgar J Schoen
  1. Department of Pediatrics and the Department of Genetics, Regional Perinatal Screening Program, Kaiser Permanente Medical Care Program, Oakland, California, USA
  1. and reprint requests to: Dr Edgar J Schoen, Department of Genetics, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693, USA.

https://doi.org/10.1136/adc.77.3.258

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    A major difference between the paediatric care provided in Europe and that provided in the US stems from the attitudes of care providers toward newborn circumcision as a preventive health measure. In the US, the great majority of newborn boys (about 1.4 million annually) are circumcised, whereas in Europe, neonatal circumcision is rarely done. European countries consider newborn circumcision an unnecessary surgical procedure which increases the costs of operating nationalised health systems, whereas in the US, circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout life.

    Local foreskin problems and hygiene

    Phimosis, balanoposthitis, and difficulty of ensuring adequate genital hygiene in uncircumcised boys have been best described in the European literature.1-4 US anticircumcision groups claim that genital hygiene can easily be maintained as the foreskin naturally separates, but, in reality, genital hygiene in uncircumcised boys has been shown to be poor, even in British and Scandinavian middle class schoolboys.1 2

    The prevalence of true phimosis (anatomic constriction of the preputial opening, which must be distinguished from adherent foreskin) in published studies varies from 0.3% to 0.9%,5 but true phimosis requires circumcision later in life, when the procedure is more difficult, risky, and expensive.6 7 Balanoposthitis has been estimated to occur in 4% of uncircumcised boys, and incidence peaks at age 2 to 5 years.3 Although treatment can be conservative, late circumcision is often necessary for recurrent cases, and medical management requires additional physician visits and treatment.

    Cancer of the penis

    The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised men is essentially zero (about one reported case every five years), but it is 2.2 per 100 000 in uncircumcised men (about 1000 cases are reported annually). On the basis of life table analysis, Kochen and McCurdy estimated that an uncircumcised …

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