American Journal of Diseases of Children, Volume 132: Page 1168, December 1978.
Opponents of routine circumcision of the male infant will greet with pleasure the appearance of the article by Annunziato and Goldblum (p 1187) and the one by Sussman et al (p 1189) on unusual complications of the operation. Those who favor routine circumcision will be quick to point out that Fournier's syndrome and the scalded skin syndrome are very rare complications that should not deter parents from requesting circumcision for the newborn boy.
Circumcision of the newborn continues for the following reasons: it may be routine because of religious beliefs, and parents and physicians have for years accepted the procedure on the basis that arguments that the circumcised male is at less risk of having cancer develop, and that a malignant neoplasm in the genital tract of women married to circumcised men is less frequent than in women married to uncircumcised men. It is an uncontestable fact at this point that there are more deaths from complications of circumcision than from cancer of the penis.
It is unlikely that a listing of the hazards of circumcision will deter parents who insist on circumcision of their infant for religious reasons. However, for all other parents, physicians should become more vociferous than they have been in discouraging circumcision of the newborn. They have been slow to do so because they have not been convinced that circumcision is of little benefit. Yet, today, especially, the circumcised infant is at greater risk than ever before. He is clustered in large newborn nurseries (because small units are too costly) and is therefore exposed to even greater numbers of organisms that have been altered by their own exposure to multiple antibiotics. He has enough portals of entry as it is—his nose, mouth, conjunctivas, and the end of his umbilicus. It seems totally unnecessary to aid and abet lurking bacteria by adding a raw wound to his genitalia.
Finally, I should like to cast my vote against the use of the term Fournier's syndrome and beg that the condition be referred to as gangrene of penis, scrotum, or perineum. There are already far too many syndromes. The reader in two weeks or even less will be hard put to recall the meaning of the name, but he is unlikely to be confused by the term gangrene. Down, I say, with both circumcision and Fournier's syndrome.
SYDNEY S. GELLIS, MD, Department of Pediatrics, New England Medical Center Hospital, 20 Ash St, Boston, MA 02111
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