Circumcision remains a common operation, with over 30,000 procedures performed annually in the UK, mostly on children. The British Medical Association has recommended that circumcision should be performed only for medical reasons. Despite this, controversy exists over whether too many circumcisions are being performed. Are patients being exposed to an unnecessary operation? It may be argued that in doubtful cases it is easier to proceed to circumcision on the assumption that the attendant risks are low, but the operation is associated with a definite morbidity and rare deaths have been reported. This review considers the spectrum of complications that may result from circumcision and discusses the possible aetiological mechanisms.

Complications of circumcision

Objective: To review the epidemiology of invasive cancer of the penis based on scientific publications identified by a Medline search from 1966-2000 for the keywords penis/penile, cancer/carcinoma and risk as well as the cited references in the identified papers. Results: Strong risk factors (OR >10) identified by case-control studies included phimosis, chronic inflammatory conditions such as balanopostitis and lichen sclerosus et atrophicus and treatment with psoralen and ultraviolet A photo\chemotheraphy (PUVA). A consistent association was found between penile cancer and smoking that was dose-dependent and not explained by investigated confounding factors such as sexual history. Sexual history and self-reported history of condyloma were associated with a 3-5-fold increased penile cancer risk. Cervical cancer in the wife was not consistently associated with cancer of the penis in the husband. Circumcision was associated with penile cancer risk in ecological studies. In a case-control study, circumcision...

Etiology of squamous cell carcinoma of the penis.

This paper reviews epidemiologic studies employing religion as an independent construct, and finds that most epidemiologists have an extremely limited appreciation of religion. After a historical overview of empirical religion and health research, some theoretical considerations are offered, followed by clarification of several operational and methodological issues. Next, well over 200 studies are reviewed from nine health-related areas: cardiovascular disease, hypertension and stroke, colitis and enteritis, general health status, general mortality, cancer of the uterine corpus and cervix, all other non-uterine cancers, morbidity and mortality in the clergy, and cancer in India. Finally, an agenda for further research is proposed.

Is there a religious factor in health

Objective. We determined the relation between newborn circumcision and both invasive penile cancer (IPC) and carcinoma in situ (CIS) among adult male members of a large health maintenance organization. Subjects and Methods. Circumcision status was ascertained by a combination of pathology reports, medical record review, and questionnaires for 213 adult male members of a large prepaid health plan who were diagnosed with IPC or CIS. Results. Of 89 men with IPC whose circumcision status was known, 2 (2.3%) had been circumcised as newborns, and 87 were not circumcised. Of 118 men with CIS whose circumcision status was known, 16 (15.7%) had been circumcised as newborns. Conclusions. Our results confirm the highly protective effect of newborn circumcision against IPC and the less protective effect against CIS.

https://pediatrics.aappublications.org/content/pediatrics/105/3/e36.full.pdf

The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer

Context It is well recognized that the presence of a foreskin predisposes to penile carcinoma and sexually transmitted infections. We have investigated the relationship between the presence or absence of the foreskin and penile dermatoses. Objective To determine whether there is an association between circumcision and penile dermatoses. Design A retrospective case control study of patients attending the department of dermatology with genital skin conditions. Subjects The study population consisted of 357 male patients referred for diagnosis and management of genital skin disease. The control population consisted of 305 male patients without genital skin disease attending the general dermatology clinics over a 4-month period. Main Outcome Measures The relationship between circumcision and the presence or absence of skin disease involving the penis was investigated. The rate of circumcision in the general male dermatology population was determined. Results The most common diagnoses were psoriasis (n=94), penile infections (n=58), lichen sclerosus (n=52), lichen planus (n=39), seborrheic dermatitis (n=29), and Zoon balanitis (n=27). Less common diagnoses included squamous cell carcinoma (n=4), bowenoid papulosis (n=3), and Bowen disease (n=3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichen planus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised. Conclusions Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses. The presence of the foreskin may promote inflammation by a koebnerization phenomenon, or the presence of infectious agents, as yet unidentified, may induce inflammation. The data suggest that circumcision prevents or protects against common infective penile dermatoses.

https://jamanetwork.com/journals/jamadermatology/articlepdf/190052/dst9048.pdf

AbrL. Wolbarst

Papers

Circumcision and Penile Cancer.