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April 2001

Appropriate Controls Are Essential in Assessing the Relationship Between Circumcision and Penile Dermatoses

Arch Dermatol. 2001;137(4):503. doi:

Unfortunately, the control group in the report titled "Circumcision and Genital Dermatoses"1 is not comparable with the patient group. Moreover, social factors have not been taken into account. Both these facts lessen the power of the conclusions that circumcision protects against common inflammatory and infective dermatoses.

The patients in the study1 were evaluated in a penile dermatoses clinic in London between 1994 and 1997, while the controls were seen in a general dermatology clinic in the same institution over a 4-month period in 1997. A mean age difference of 4.2 years implies that more than half of the control population came of age (sexually) before the "sexual revolution" (the late 1960s), while the target subjects overwhelmingly came of age after the sexual revolution. Actually, mean data for looking at social and behavioral variables are not ideal when looking at characteristics related to sexual behavior. Findings from 1992 and 1991 comparative data from the United States and Britain show that behavior was more variable in the United States, and opinions less tolerant, but that there was a higher prevalence of sexually transmitted disease in the United States than in Britain. In both countries, sexually transmitted disease risk increased with the number of sex partners.2