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Am Fam Physician. 1999;59(11):3194

Routine circumcision remains a commonly performed but controversial surgical procedure. Possible benefits include a decreased risk of urinary tract infections, fewer sexually transmitted diseases and a lower incidence of penile cancer. In 1989, the American Academy of Pediatrics modified its position on routine circumcision, changing from opposition to stating that parents should be told about the risks and benefits of the procedure and that informed consent should be obtained. Few parents are aware of the medical debate over circumcision, and most make their decision based on concerns of appearance and hygiene. Tiemstra surveyed parents to determine how they made their decision about circumcision and if their physician influenced this decision. The time at which parents discussed the procedure was also noted.

Questionnaires were distributed to parents of all male infants six months of age or younger who presented to one of two family practice clinics for a well-child visit over a period of six months. The 13-item questionnaire included eight questions about their decision-making process and the timing of the decision; three questions about the location of prenatal care and their religious tradition; and two questions in check-list form that cited reasons for or against circumcision.

Fifty-five surveys were distributed, but only 52 were completed. The health plans of the parents varied, as did the principal provider of prenatal care. Forty-four (80 percent) of the infants had been circumcised. Forty-three parents made their decision either before or during the pregnancy—before discussing it with their physician or midwife. Of these, only four parents discussed their decision with a physician before delivery. When asked about the information given by their physician, more than 80 percent of the parents indicated that the physician was neutral about the procedure, 13 percent said circumcision was recommended and 4 percent were advised against the procedure. When asked if their discussion changed their minds, 83 percent said no. However, among those who did change their minds, more than one half selected circumcision. Seven of eight parents in the latter group reported having a neutral discussion about the procedure, and in only one instance was circumcision chosen after it was recommended.

Circumcision was most commonly done at birth for reasons of hygiene, convenience, other “medical” reasons and a history of the father being circumcised. Religion was not a significant factor. The most common reasons for not doing the procedure were related to the belief that it is not necessary, that it is painful and that the father was not circumcised.

The author concludes that most parents decide about circumcision before they discuss it with their physician and that the physician's opinions do not significantly affect their decision. Social reasons, such as hygiene and convenience, remain more important for parents than the medical indications for circumcision. Physicians who wish to influence this decision might consider discussing circumcision at the preconception visit.

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