Introduction

Circumcision is the most commonly performed operation in males and is among the oldest, with evidence of its practice in Egyptian mummies – long before Abraham's pact with God introduced ritual circumcision to the Jewish nation in 1713 BC. Ritual circumcision is also practiced among Moslems, Aboriginals, and certain African tribes. Hot, dry climates and poor hygiene predispose to balanitis, so circumcision has conferred some medical benefit to these cultures, a fact that did not escape desert troops in the Second World War and led to an increase in circumcision in Western cultures. On the other hand, its identification with Jewish culture has resulted in an avoidance of circumcision in many central European countries since the War. Currently, it is estimated that one-sixth of the world's population is circumcised.

Religious considerations apart, the variable incidence of circumcision betrays marked differences in cultural and medical attitudes towards the foreskin. Currently, in England the majority of circumcisions are performed for medical reasons (about 21000 annually in children), and it is estimated that 1 in 15 boys are circumcised before their fifteenth birthday. This is significantly less than the 24% rate reported in the 1950s, although more stringent criteria for medical circumcision could undoubtedly effect a further reduction. In Scandinavian countries the rate is the lowest amongst Western cultures in contrast to the United States where routine neonatal circumcision has become the norm and 90% of males are circumcised shortly after birth in some areas.