In Reply.—Dr Preston raises the question of whether there should be different levels of care for poor children and wealthy children, implying that there is a difference in penile hygiene between the two groups. This is a common belief, but it has never been substantiated. We refer him to the work of Metcalf et al,1 done in Salt Lake City in a presumably middle-class population. They found concerns about hygiene in 3% of mothers of circumcised children, and 9% of the children had problems with adhesions or meatitis. In our inner-city children, 9% had fair to poor hygiene as measured by observers (not an equivalent measure to maternal report). Our circumcised children had fewer problems with adhesions or meatitis. Thus, although our patients may have had more hygienic problems, they did not lead to more complications.
In regard to other complications, it is generally agreed that meatal stenosis
HERZOG LW, ALVAREZ SR. Circumcision and Genital Hygiene-Reply. Am J Dis Child. 1986;140(10):969-970. doi:10.1001/archpedi.1986.02140240015006