Letters

Circumcision of children

Although it was shown 28 years ago that preputial development continues to the age of 17 and that only three of 1968 boys needed surgery,² many British doctors still seem to be ignorant of this research.³ The European charter for children in hospital states that every child must be protected from unnecessary medical treatment. The United Nations Convention on the Rights of the Child states that children have rights to self determination, dignity, respect, integrity, and non-interference and the right to make informed personal decisions. Unnecessary circumcision of boys violates these rights.

A non-retractile foreskin in a boy can be managed conservatively.^{4 5} Circumcision should therefore rarely be necessary. It would be helpful if paediatric urologists could produce guidelines to advise doctors how foreskin problems in boys can be managed. Preferably, circumcision should not be done until the patient is adult or at least old enough to understand what is intended; then he has a right to a full, illustrated explanation of the nature of the operation and the reasons for it in advance, with the opportunity to ask questions, and help in coming to terms with the alteration of his anatomy afterwards. If the patient is not satisfied with the explanations his views should be taken into consideration.

It cannot be ethical for a doctor to amputate normal tissue from a normal child. In the case of disease, circumcision should be used only when there is evidence that conservative treatment is unlikely to be effective or when it has failed. Avoiding surgery may even be cheaper for purchasers of health care. Doctors should approach the child's foreskin with a combination of good ethics, a recognition of the rights of children, and advice based on evidence.

Norm UK, PO Box 71, Stone, Staffordshire ST15 0SF

John P Warren, P David Smith, John D Dalton, Grahm R Edwards, Marc Foden, Robert Preston, Philip Stewart, Adam Roberts, Philip C Cookson, Joseph Elliott, J S Phillips, James Williams, Matthew Mallinson-Read, Ian Morris, John Bowring, Rob Warburton, James Blazeby, Tony Peters, John Moore, John Stevens 

1. BMA. Medical ethics today: its practice and philosophy. London: BMJ Publishing Group, 1993.
2. Oster J. Further fate of the foreskin. Arch Dis Child 1968;43:200-3.
3. Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med 1992;85:324-5. [Abstract]
4. Wright JE. The treatment of childhood phimosis with topical steroid. Aust NZ J Surg 1994;64:327-8. [Medline]
5. Cuckow PM, Rix G, Mouriquand PDE. Preputial plasty: a good alternative to circumcision. J Pediatr Surg 1994;29:561-3. [Medline]