In 2006, the British Association of Paediatric Urologists (BAPU) published a statement paper on the management of foreskin conditions (www.baps.org.uk/resources/management-foreskin-conditions). Non-therapeutic circumcisions (those to comply with religious or cultural practices) are not uniformly available on the NHS. Circumcisions for medical reasons are normally limited to cases of balanitis xerotica obliterans (BXO), severe recurrent episodes of balanoposthitis or recurrent urinary tract infections (UTI) in those boys with an abnormal urinary tract. It is therefore always interesting to read an article from ‘across the pond’ to discover their perspective. The American Academy of Pediatrics’ (AAP) last statement on neonatal circumcision (2012) concludes that access to this procedure is medically justified (prevention of UTIs, penile cancer and transmission of some sexually transmitted infections, including HIV) and warrants third-party reimbursement. Here, Jacobsen et al. have undertaken a retrospective review of circumcisions undertaken in the neonatal period. Among approximately eight million boys sampled over a 13-year period (2003-2016), just over half (55%) underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race and socioeconomic status. Overall, there was a decline over time in rates of operation. Boys with public insurance had lower circumcision rates in all years studied. Black (68%) or white (66%) boys were most likely to undergo circumcision and Hispanic boys (18.8%) were the least likely. Circumcision rates increased with home income (50% in the lowest quartile underwent surgery vs. 61% in the highest income quartile). Boys in the Midwest were most likely to undergo circumcision (75%) and boys in the West were the least likely (26%).
