To Circ or Not to Circ: Indications, Risks, and Alternatives to Circumcision in the Pediatric Population with Phimosis

Barbara Steadman; Pamela Ellsworth

Disclosures

Urol Nurs. 2006;26(3):181-194. 

In This Article

Abstract and Introduction

Circumcision, the removal of the foreskin, is perhaps the oldest identified and currently the most frequently performed elective surgical procedure for males throughout the world. Neonatal circumcision may be performed for medical, cultural, or religious reasons. A review of risks and benefits of circumcision, individual indications for circumcision, as well as both medical and surgical alternatives to circumcision in the pediatric population with phimosis are presented. The intent is to offer providers and parents current information that will assist them in making a responsible decision about pediatric circumcision.

Egyptian mummies and wall carvings offer some of the earliest recorded history of circumcision dating over 15,000 years ago. Ritualistic circumcision has been carried out in West Africa for over 5,000 years and in the Middle East for at least 3,000 years (Warner & Strashin, 1981). Muslims incorporated ritualistic circumcisions as a pubertal rite of passage into manhood among older boys.

The transformation of this ancient ritual into a routine medical operation began late in the 19th century. This was primarily the result of several published works by prominent physicians of the time. They believed that constriction of the glans by the prepuce led to nervous irritation in other organ systems. Several published works cited "reflex neuroses," puzzling syndromes with no somatic explanation, as being caused by constriction of the glans (Alanis & Lucidi, 2004). Soon the list of medical indications grew, and physicians in England and America began to offer circumcision for masturbation, headache, strabismus, rectal prolapse, asthma, enuresis, and gout (Gollaher, 1994). By the early 20th century, there was near universal agreement among physicians that circumcision should be done on a routine basis.

Rates of circumcision began to drop in Britain in 1948, when a nationalized health care system analyzed cost versus benefit. Circumcision is currently available through National Health Insurance for medical indications only. In the early 1970s, both the Australian and the Canadian Pediatric Societies followed, stating that routine neonatal circumcision was not medically indicated. Despite these changes, rates of circumcision remained high in the United States.

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