Brown M S, Brown C A
Pediatrics. 1987 Aug;80(2):215-9.
Despite policy statements against routine circumcision of newborns by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology more than 10 years ago, there has been virtually no change in circumcision practices in the United States. In addition, controlled trials of programs to educate parents about the lack of medical indications for routine newborn circumcision have shown that parental education has little impact on the circumcision decision. We hypothesized that parents based their circumcision decision predominantly on social concerns rather than on medical ones. We prospectively surveyed parents of 124 newborns soon after they made the circumcision decision to learn their reasons for the decision. The strongest factor associated with the circumcision decision was whether or not the father was circumcised (P less than .0001). The survey also showed that concerns about the attitudes of peers and their sons' self concept in the future were prominent among parents deciding to circumcise. The circumcision decision in the United States is emerging as a cultural ritual rather than the result of medical misunderstanding among parents. In counseling parents making the circumcision decision, the health care provider should provide a knowledgeable and honest discussion of the medical aspects of circumcision. Until information is available that addresses parents' social concerns about circumcision, it is unreasonable to expect a significant change in circumcision customs in the United States.
尽管十多年前美国儿科学会和美国妇产科学会就发表了反对对新生儿进行常规包皮环切术的政策声明，但美国的包皮环切术实施情况几乎没有变化。此外，关于向父母宣传常规新生儿包皮环切术缺乏医学指征的项目的对照试验表明，对父母的教育对包皮环切术决策影响甚微。我们推测，父母做出包皮环切术决策主要基于社会因素而非医学因素。我们在124名新生儿的父母做出包皮环切术决策后不久对他们进行了前瞻性调查，以了解他们做出该决策的原因。与包皮环切术决策关联最强的因素是父亲是否接受过包皮环切术（P小于0.0001）。调查还显示，在决定进行包皮环切术的父母中，对同龄人的态度以及儿子未来自我认知的担忧较为突出。在美国，包皮环切术决策正逐渐成为一种文化习俗，而非父母医学认知误解的结果。在为做出包皮环切术决策的父母提供咨询时，医疗服务提供者应就包皮环切术的医学方面进行有见地且诚实的讨论。在有信息能够解决父母对包皮环切术的社会担忧之前，期望美国的包皮环切术习俗发生重大改变是不合理的。
