United Kingdom: Incidence of Male Circumcision

The incidence of male circumcision in the United Kingdom has varied sharply over the decades of the twentieth century. The National Health Service does not offer free non-therapeutic circumcision, so non-therapeutic circumcision of the newborn is almost unknown. When non-therapeutic circumcision of the newborn does occur, it is most likely to be in furtherance of the religious views of the parents.

There are sharp variations by age group in the percentage of males who are circumcised. Younger males are less likely to be circumcised.

Rickwood et al. report that the male circumcision rate was about 35 percent in the 1930s.7 The rate had declined to about 1/5 of boys being circumcised in the 1940s, or about 90,000 annually.1 Gairdner reported a sharp division by social class with the upper classes being circumcised much more frequently.1 The National Health Service (NHS) started operations in 1948 and did not provide non-therapeutic neonatal circumcisions. Following the publication of Gairdner's influential report on the lack of necessity of neonatal circumcision in 19491, the incidence of male non-therapeutic (routine) circumcision declined sharply. The BMJ reported that the incidence of non-therapeutic circumcision was 6 percent in 1975.2 Rickwood reported in 1989 that about 30,000 circumcisions a year were carried out in England and 70 percent were on boys under 15 years of age.3 Gordon and Collin suggested in 1993 that 5.6 percent of boys in England would be circumcised by age 17.4

Johnson et al. surveyed 7990 British men (1990) and found that 21.9 percent of all men in the survey were circumcised.5 There was a sharp division by age group. The oldest are the most likely to be circumcised while the youngest group is the least likely to be circumcised.

 Age group        %       Number      Birth Year
 16-24           12.5       1874      1966-1974
 25-34           15.9       2111      1956-1975
 35-44           26.4       1956      1946-1955
  45-59           32.3       2049      1931-19455
Religion            %    Number
None               18.4    4120
Church of England  24.7    2011
Roman Catholic     18.6     678
Other Christian    22.1     863
 Non-Christian      55.8     3125
Johnson et al. compared racial groups and found that whites were the least likely to be circumcised.5
Ethnic group    %       Number
White          20.9       7551
Black          34.1        150
Asian          35.3        165
 Other          51.5        1075

At the present time (2000) non-therapeutic (routine) neonatal circumcisions are rare in England. A few are performed for religious reasons. They are not covered by the NHS. Post-neonatal circumcisions are performed usually due to mis-diagnosis of phimosis.7 Rickwood reports that the incidence of post-neonatal circumcisions has declined sharply in the late 1990s. About 12,200 circumcisions were performed in Britain in a recent year (1998?).7 This would suggest that 3.8 percent of British boys born today would be circumcised by their 15th birthday, if current trends continue.7 However, in the Liverpool and Sefton districts only 1.5 percent of boys born today would be circumcised by their 15th birthday, if current trends continue.7

The British Medical Association (BMA) take the ethical position that doctors have a right to conscientiously object to the performance of non-therapeutic male circumcisions of children on moral, ethical, or legal grounds.6 The BMA consider male circumcision to be an invasive, radical procedure, and state that unless conservative treatments are tried first, a therapeutic circumcision would be unethical.6 The BMA and the British Association of Paediatric Surgeons (BAPS) insist that the written consent of both parents should be obtained for non-therapeutic circumcision.6,8,9 This ethical guidance may act to reduce the incidence of circumcision of male children.

The 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being circumcised. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent.10 Men of ethnic minorities (except black Caribbeans) were signficantly more likely to circumcised than those described as "white".10 Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddists were only 9.8 percent circumcised.10 The most recent survey, therefore, appears to show a continuing decline in the incidence of circumcised males in Britain when compared with previous data.

      NATSAL 2000

 Age      Percent Circumcised       Birth Year
16-44           15.8%               1956-1984
40-44           19.6%               1956-1960
16-19           11.7%               1981-1984

Cathcart and colleagues examined trends in paediatric circumcision from 1993 through 2003.11 They found that the incidence of post-neonatal therapeutic circumcision declined by about 20 percent through 2000 but leveled off and remained constant after the year 2000. 10,031 circumcisions were performed on boys younger than 15 years-of-age in 2003.11 Cathcart et al. report that, if present trends continue, 3.1 percent of British boys will be circumcised by age 15.11 Circumcision is the traditional (but outmoded) treatment for non-retractile foreskin. The authors report that the incidence of allegedly therapeutic circumcision is six times the expected rate of phimosis,11 so large numbers of boys are receiving circumcisions, which are medically unnecessary. This suggests that better training of physicians urgently is needed to enable them to distinguish in boys between normal developmentaly non-retractile foreskin, not requiring treatment and pathological phimosis, requiring treatment.

Library holdings
  1. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949; 2:1433-1437.
  2. Editorial. The case against circumcision. BMJ 1979; 6172: 1163-1164.
  3. Rickwood AMK, Walker J. Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? Ann R Coll Surg Engl 1989;71(5):275-7.
  4. Gordon A, Collin J. Saving the normal foreskin. BMJ 1993; 306: 1-2.
  5. Johnson AM, Wadsworth J, Wellings K, Field J, Bradshaw S. Sexual attitudes and lifestyles. Oxford: Blackwell Scientific, 1994.
  6. Committee on Medical Ethics. Circumcision of Male Infants: Guidance for Doctors. London: British Medical Association, 1996.
  7. Rickwood AMK, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ 2000;321:792-793.
  8. Youngson G. Religious Circumcision of Male Children: Standards of Care. London: British Association of Paediatric Surgeons, July 2001.
  9. Committee on Medical Ethics. The law & ethics of male circumcision - guidance for doctors. London: British Medical Association, 2003.
  10. Dave SS, Johnson AM, Fenton KA, et al. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect 2003;79:499-500.
  11. Cathcart P, Nuttall M, van der Meulen J, et al. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg 2006;93:885–90.

(File revised 8 August 2006)

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