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Interviews - Key References - Images

In January 1999, NORM-UK , launched a national survey looking into circumcision rates and practices throughout the UK. Our findings suggest that up to 91% of these operations are unnecessary. The results also suggest that circumcision occurs throughout the country in greater numbers than medically necessary, with very little regulation, and without laboratory confirmation that diagnosis and surgery were appropriate.

"I find these results startling, here we have a significant operation that has life long effects, which could be almost totally avoided. Britain clearly over performs circumcision. More worryingly, there appears to be little or no monitoring of this procedure." said Dr John Warren.

Findings

Together, the responding Health Authorities (cumulative pop. 13,240,303) performed 7,115 circumcisions in 97/98. This represents a national number of approximately 32,000 per annum.

The figures below represent the percentile range by diagnosis, of the four main reasons for performing circumcision:

Phimosis 44% - 91% A recent article published in the British Journal of Urology International,(1999, 84,101-102) stated "The number of boys in England as a whole currently circumcised for 'phimosis', at 3.3/1000 per year consequently exceeds by more than eight times that expected from the present estimate of the incidence of pathological phimosis..."

BXO (Balanitis xerotica obliterans) 1% - 16% (many Health Authorities reported 0%). Circumcision has been reported as being ineffective in preventing or treating BXO. It responds to corticosteroids, topical testosterone or carbon dioxide laser treatment.

Balanoposthitis <1% - 12% Balanitis and posthitis are both infections. Recurring infections can be treated conservatively with antibiotics.

Religious/Ritual <1% - 12% The NHS Patients Charter (1995) states "You have a right to...receive health care on the basis of your clinical need, not on your ability to pay, your lifestyle, or any other factor."

Guidelines and Audits: Guidelines provide direction and procedures for the medical profession. Audits check practices within a Health Authority meet the current policies or guidelines.

• No respondent supplied a Policy for the Management of Foreskin Problems.
• No Health Authority could provide an audit of their circumcision practices.

Age at time of surgery: 30% of circumcisions performed are on patients between 0 - 6 years of age. 45% are performed before the age of 10.

Histological Findings: Histological findings are laboratory results. Testing either confirms or refutes the original diagnosis. No Health Authority returned any centrally held histological information.

Cost: On cost alone, Health Autohorities have a vested interest in reducing their circumcision rates. On conservative estimates, Health Authorities are currently spending between £50,000 and £150,000 per annum on circumcision. Some individual trusts are spending approx £40K