"The Circumcision Debate" presents a comprehensive review of circumcision; however it's only presented from the pediatric perspective. The discussion should be extended to include the complications experienced by uncircumcised elderly males. What happens when a man is unable to take care of his own hygiene needs? The geriatric community has had little say regarding circumcision, yet the consequences of these decisions are witnessed daily in nursing homes, longterm care facilities, and in the homes of the elderly.

Good perineal-genital care for an uncircumcised male involves retracting the foreskin to expose the glans. This procedure is difficult for older uncircumcised patients; because many of these patients suffer from dementia, their reactions range from embarrassment to disruptive behavior, such as kicking and scratching. Consequently, the patient's hygiene needs aren't met, and the stage is set for inflammation and phimosis.

Parents should question how this decision will affect the well-being of their child in 70 years.

Ruth Frank, RN, CS

Durham, NC