Circumcision often unnecessary

YOUNG boys might be undergoing unnecessary circumcisions for a condition that can be effectively treated with creams, according to a new study.

The percentage of Australian boys being circumcised has fallen from 95 per cent in the 1930s to only 6.5 per cent 20 years ago.

However, a West Australian  report published today in the Medical Journal of Australia reveals a high rate of circumcision for phimosis, a condition where the foreskin cannot be retracted, in boys under five.

This is despite the condition - which can easily be confused with normal development of the penis - being rare among this age group.

Dr Katrina Spilsbury, of the  University of Western Australia's  School of Population Health, reviewed the circumcision of boys in the state's hospitals between 1981-1999.

Boys aged five and under had the highest rate of surgery for phimosis, representing about 300 circumcisions each year.

More older boys were also being circumcised for phimosis, with a 70 per cent increase in the procedure among boys 10-14 during the period studied.

The past 19 years have seen a steady rise in the rate of medically indicated circumcision, Dr Spilsbury reports. Most of the increase is the result of an increase in the rates of phimosis.

Dr Spilsbury said if the current rate continued, about 4 per cent of boys would be circumcised for phimosis by the age of 15.

This rate was seven times higher than the estimated occurrence of the condition, she said.

These findings imply a high rate of unnecessary surgery, writes Dr Paddy Dewan of the  Royal Children's Hospital in Melbourne in an  accompanying editorial.

Dr Dewan suggests the high rates might be the result of manipulation, either by parents who want to circumcise their child for cosmetic reasons or GPs who expect resistance from surgeons unless they give a medical reason for circumcision.

She said phimosis could cause pain and urinary tract infections and was associated with sexual dysfunction and cancer in later life.

However, there was evidence the use of steroid creams could reverse the situation in about four to six weeks.

She said there might also be some confusion among doctors between phimosis and normal development of the penis in very young boys.

Our findings indicate that a review of current practice guidelines for the paediatric management of phimosis in Australia may be warranted, she concludes.

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