In reply: I thank Darby for his correction of the historical facts, and for raising for further discussion the ethics of circumcision. While I concur that removal of the prepuce for cosmetic reasons may not be in the interests of the child, we do need to allow for the parents' perceptions, and for their willingness and ability to care for the prepuce appropriately, if we refuse to perform a circumcision. While the risks from a well-cared-for prepuce are very low, the foreskin being retained does come with potential problems.

I would always encourage the non-surgical option, but I think we, as the treating surgeons, need to accept that the parents are given a task that they may be either unwilling or unable to take on if we ask them to manage the perpuce of their boy non-operatively. Therefore, my editorial concluded that the view of the parents was part of the complex equation that allows us to treat the boy and his family well, recognising that even those without a problem still need to be managed.

I feel I have not given greater weight to the wishes of the parents, but have taken into account the wishes of the parents in the deliberation of what might be best for the child.