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British men who were circumcised for childhood phimosis


December 29, 2021


A paper published in April 2021 reported a survey of British men who were circumcised during childhood for phimosis. [1] The researchers sought to determine the level of circumcision satisfaction among men who were circumcised during childhood. According to the survey results 9% of the men had a positive association with their circumcision and 22% had a negative association. When asked which treatment options they would have selected, 43% chose circumcision, 39% chose preputioplasty (a surgical procedure to widen a non-retractile foreskin,) 35% chose topical creams, 4% chose the latter two options, and 9% chose all three options. Unfortunately there are a few reasons why it would be inadvisable to draw firm conclusions from the results of this survey, and why it would be irresponsible to relate the results to men circumcised during infancy.


NON-RESONSE RATE

The survey was mailed to 177 men in the United Kingdom who were identified from hospital databases as having been circumcised for pathological phimosis during childhood. Just 27 surveys were returned, of which 4 were blank. The resulting 23 indicates a very high non-reponse rate of 87%. A study of adolescents and young adults in The Netherlands found that certain groups were over-represented in a voluntary survey compared to a mandatory survey - based on demographic characteristics and health behaviors. [2] It’s also reasonable to assume that men who hold strong feelings - positive or negative - about their circumcision status would be more likely to complete and return the survey about circumcision. The researchers admitted that the low response rate might be due to the fact that many men "do not think about [their circumcision] and the survey may have seemed pointless - such men probably have neutral or positive perceptions of their circumcision."


THERAPEUTIC CHILDHOOD PROCEDURE

The study involved men who were circumcised during childhood to correct a medical problem. The range of ages during the procedure was 3 to 15 years, and the average age was 9.7 years. Nineteen of the 23 recalled at least one symptom that led to their circumcision, and 7 - all older than 9 at the time - remembered the circumcision decision. Men circumcised at an age when they would retain a memory may have different views than men circumcised in infancy with no recollection of their foreskin or the medical treatment.


Among the respondents 19 had Lichen Sclerosus, and 4 had chronic balanitis. Four had further surgery as an adult - 3 for voiding symptoms and 1 for a "redo." One may suspect that a patient's medical history may affect his view of his circumcision status. Men might view circumcision to correct a medical procedure differently from circumcision performed for religious, cultural, personal, or preventative medical reasons.

CULTURAL BIAS

The survey involved men who live in the United Kingdom, a nation where the circumcision rate is low. A 2015 study found that 17.4% of sexually-active men ages 16-44 were circumcised, [3] while a 2012 BBC article reported that about 9% of men were circumcised. [4] Clearly circumcised men in the U.K. are in a distinct minority. As the American Academy of Pediatrics has noted, Europe has a "cultural norm [that] clearly favors the uncircumcised penis ... and there is a clear bias against circumcision." [5] Surely a low circumcision rate combined with an anti-circumcision cultural bias would affect the views of many British men regarding their own circumcisions. By contrast men living in a culture where circumcision is normal and which has a neutral or pro-circumcision bias presumably would be less likely to hold negative views toward the procedure.


CONCLUSION

The researchers advised: "The long-term perceptions expressed by the respondents to this survey show that surgeons should be mindful about how to best counsel boys and their parents... One might consider that circumcision at a younger age, when boys do not remember the decision and the reasons for it, seems to be associated with less regret than decisions for circumcision in older boys when they were more aware of the discussion surrounding surgery."


This is certainly useful advice for medical practitioners and parents. The various issues discussed above make the survey results impractical with respect to a circumcision decision during infancy.



[1] Harriett Jane Corbett et al; "A survey of adult men who underwent circumcision in childhood for pathological phimosis"; Journal of Men's Health; pp 43-48; April 8, 2021

[2] Kei Long Cheung et al; "The impact of non-response bias due to sampling in publich health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health"; BMC Public Health; March 23, 2017

[3] Virginia Homfray et al; "Male Circumcision and STI Acquisition in Britain: Evidence from a National Probability Sample Survey"; PLoS One; June 17, 2015

[4] Cordelia Hebblethwaite; "Circumcision: the ultimate parenting dilemma": BBC News; August 21, 2012

[5] Susan Blank M.D. et al: "Cultural Bias and Circumcision: the AAP Task Force on Circumcision Responds"; Pediatrics; April 1, 2013



#Circumcision #Phimosis #Balanitis #LichenSclerosus #MensHealth #MensSexualHealth #MaleSexualHealth #MensAttitudes #MaleAttitudes

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