Medical circumcisions rate rising `needlessly'

By Julie Robotham, Medical Writer
February 17 2003

Boys are being circumcised unnecessarily because doctors do not understand that being unable to retract the foreskin is part of normal child development, an Australian survey has found.

The study found a large majority of circumcisions for medical reasons were performed because of phimosis - a condition in which scar tissue grows between the foreskin and the tip of the penis. But it concluded most cases were unlikely to be true phimosis, because the condition occurs rarely in children and almost never in boys under five.

Katrina Spilsbury, a research associate from the University of Western Australia's School of Population Health, found circumcision rates had crept up steadily since the early 1980s, their all-time low.

For boys aged 10 to 14, rates had doubled in the past two decades, while they rose by two-thirds among five- to nine-year-olds and by one-third among the under-fives. During that time, phimosis was also increasingly likely to be cited as the reason.

"If the 1999 rate remains stable, it is estimated that 4 per cent of all boys will be circumcised for phimosis by the time they reach 15 years," Dr Spilsbury wrote in the Medical Journal of Australia.

"This is seven times higher than the estimated rate of pathological phimosis. Over half of these boys will be circumcised for phimosis before they reach five years of age, despite the condition being rare in early childhood."

It was most likely doctors were mistaking the normal development of the penis for phimosis, Dr Spilsbury said. But it was also possible doctors were recording a medical reason when it was really required by parents for religious or cosmetic reasons.

Paddy Dewan, a pediatric urologist not involved in the research, said parents might also be inventing symptoms to persuade doctors to circumcise.

"Such manipulation is not surprising when dealing with such an emotive topic. Nor is it necessarily improper given the differing cultural and medical views on the value of circumcision," said Professor Dewan, from Melbourne's Royal Children's Hospital.