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Ancient wall paintings and mummies record the practice of male circumcision 6000 years ago.1 Its origins remain obscure but are variously derived from religion, ritual and culture.
Today, surgical indications for circumcision are either therapeutic, to treat established conditions such as balanitis xerotica obliterans, or preventive.2 In 2012, the American Academy of Pediatrics (AAP) radically changed their original 1999 circumcision policy.3 The AAP now asserts that the preventive health benefits of newborn circumcision outweigh the risks of the procedure, which is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. The potential derived health benefits highlighted include prevention of urinary tract infection and penile cancer and reduced transmission of some sexually transmitted infections, including HIV. They concluded that the evidence was sufficient to warrant third-party payment for circumcision and it was for parents to decide whether or not circumcision was in the best interests of their newborn male child. This policy statement provoked sharp responses from a number of sources, the Royal Dutch Medical Association and the British Association of Paediatric Urologists (BAPU).4 They did not accept the recommendation that the reduction in HIV transmission justified the use of routine newborn circumcision in countries where it was not endemic. BAPU also questioned whether the evidence in relation to the prevention of urinary tract infection justified the routine use of circumcision for that indication.5 ,6 It is clear that there remains considerable controversy about the medical indications for circumcision, particularly when it is used as a preventive measure. Within the National Health Service (NHS) in the UK, it is becoming increasingly common for providers to seek prior approval for therapeutic circumcision. In some European countries, parental desire to avoid circumcision has resulted in the innovation of foreskin reconstruction during hypospadias repair, …