The Foreskin

N.R.C. Roberton, "Care of the Normal Term Newborn Baby," in Textbook of Neonatology, eds. Janet M. Rennie, N.R.C. Roberton, 3rd ed. (Edinburgh: Churchill Livingston, 1999), pp. 378-379. [ISBN 0443 055416]

Note:

The following is an extract from the above text.

Circumcision of either sex in the neonatal period should be seen for what it is, a tribal ritual. Many studies in the last 15 years have shown that uncircumcised males have an increased number of urinary tract infections, particularly under 1 year of age.¹⁸,⁷⁸,⁹⁵ But as Winberg et al.⁹⁴ pointed out, it is fundamentally illogical that mutilating someone might be beneficial. Furthermore, if the UTI is due to underlying reflux, with the potential for scarring and chronic pyelonephritis, the sooner this is unmasked the better. I do not believe, therefore, that the case has been made for routine neonatal male circumcision.

For those who elect to have their child treated in this way, they should be reminded that the parts in question are not bereft of nerve endings and contain blood vessels. Adequate analgesia and vitamin K should therefore be provided.

All newborn males have 'phimosis'; the foreskin is not meant to be retractile at this age, and the parents must be told to leave it alone and not to try and retract it. Forcible retraction in infancy tears the tissues of the tip of the foreskin causing scarring, and is the commonest cause of genuine phimosis later in life.

References

Craig JC, Knight JF, Sureshkumar P, Mantz E, Roy LP. Effect of circumcision on incidence of urinary tract infection in preschool boys. J-Pediatr. 1996 Jan; 128(1): 23-7.

Schoen EJ. Circumcision updated--indicated? Pediatrics. 1993 Dec; 92(6): 860-1.

Winberg J, Bollgren I, Gothefors L, Herthelius M, Tullus K. The prepuce: a mistake of nature? Lancet. 1989 Mar 18; 1(8638): 598-9.
Wiswell TE, Enzenauer RW, Holton ME, Cornish JD, Hankins CT. Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy.Pediatrics. 1987 Mar; 79(3): 338-42.

Citation:

Roberton NRC, Care of the Normal Term Newborn Baby, in: eds. Rennie JM, Roberton NRC. Textbook of Neonatology, 3rd ed. Edinburgh: Churchill Livingston, 1999:378-9. [ISBN 0443 055416]

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