Too many medically unwarranted circumcisions being done in England

September 28, 2000

Towards evidence based circumcision of English boys: survey of trends in practice

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Too many English boys, especially those under the age of 5, are being needlessly circumcised reveals a study in this week's BMJ.

Rickwood and colleagues analysed only medically indicated circumcision rates for the Mersey region and its health districts for 1975 to 1997, and for England between 1984 and 1986, and between 1990 and 1998. Circumcisions are usually done for phimosis - a condition in which the foreskin cannot be pulled back over the glans of the penis, leading to scarring and potential blockage of the urethra. At birth, the foreskin is almost always non-retractable, but in most boys it becomes movable as they get older.

The results of the analysis showed that similar rates of circumcision were being carried out in the Mersey region and England as a whole. Since the mid 1980s the trend has been for fewer circumcisions among boys up to the age of 4, smaller decreases among 5 to 9 year olds, and static rates among 10 to 14 year olds.

Around 12,200 circumcisions are carried out for medical reasons every year, and if these rates remain the same, almost 4 per cent of English boys would be circumcised by the time they are 15, say the authors; the equivalent proportion in Liverpool would be 1.5 per cent. But, say the authors, true phimosis affects only just over half a per cent of all boys, is rarely found before the age of 5, and peaks at around the age of 11. While the decreases in the rates are encouraging, they say, too many unnecessary procedures are still being done.

The cost of needless surgery also takes its toll on the NHS, point out the authors. Halving the circumcision rate, which is perfectly feasible given the evidence, would save £3 million, they say.

Mr Anthony Rickwood, Department of Urology, Alder Hey Children's Hospital, Liverpool
Tel: 44-0-151-228-4811


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