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→Decline in circumcision practice continues: Add text and citation.
==Reduction of practice==
A national election was held in the United Kingdom at the end of World War II. The Labour Party gained a majority of the seats in Parliament and its leader, Clement Atlee, became prime minister. The party leaned to the left and supported social welfare. Aneurin Bevan was Minister of Health. [https://www.nhs.uk/ The National Health Service] (NHS) was created in 1948 to provide free medical treatment for all. Services were provided based on clinical need, not ability to pay. The NHS did not provide non-therapeutic [[circumcision]], so the incidence of circumcision dropped to a very low level.<ref name="gollaher1994">{{GollaherDL 1994}}</ref>
Sir [[James Calvert Spence]], a prominent senior British paediatrician, urged his younger colleague, [[Douglas Gairdner]], to produce a paper on infant circumcision. The now famous classic paper, ''The fate of the foreskin: a study of circumcision'', was published in the ''British Medical Journal'' on Christmas Eve, 1949. The paper reported 16 deaths per year from non-therapeutic infant circumcision and concluded in part: "'''The prepuce of the young infant should therefore be left in its natural state.'''"<ref name="gairdner1949">{{GairdnerDM 1949}}</ref>
The NHS provides male circumcision only when there was a clinical need.<ref>{{REFweb
|url=https://www.nhs.uk/conditions/circumcision-in-men/
|archived=
|format=
|quote=
}}</ref> The NHS performs circumcisions on boys only for therapeutic need.<refname="nhschild">{{REFweb
|url=https://www.nhs.uk/conditions/circumcision-in-boys/
|archived=
}}</ref>
The ''British Medical Journal'', the house organ of the [https://www.bma.org.uk British Medical Association], in an unsigned editorial in 1979, slammed the practice of child circumcision, calling it unnecessary, and citing the danger of contracting staphylococcal [[infection ]] in the newborn nursery.<ref>{{REFjournal
|last=Van Howe
|first=Robert S.
}}</ref>
===Phimosis diagnosis issues===
Fewer boys were being [[circumcised ]] so there were more [[intact]] boys. The general practitioners (GPs) in the UK seemed to be unable to distinguish between true [[phimosis]] and developmentally non-retractile healthy [[foreskin ]] and were referring numerous boys for unnecessary [[circumcision]].
Rickwood et al. (1980) had provided guidance on diagnosis of [[phimosis]]. According to Rickwood et al. true [[phimosis ]] occurs when the [[foreskin]] has been attacked by [[balanitis xerotica obliterans ]] (BXO) (also known as lichen sclerosis). If BXO is not present then true phimosis does not exist.<ref name="rickwood1980">{{REFjournal
|last=Rickwood
|first=
}}</ref>
Several papers critical of phimosis diagnosis practice in the UK were published in the late 1980s and early 1990s. Rickwood & Walker (1989) reported that in the Mersey region (northwest England) "many boys are [[circumcised ]] for development non-retractability of the prepuce rather than for true [[phimosis ]] and that in consequence some two-thirds of the operations are unnecessary."<ref name="rickwood1989">{{REFjournal
|last=Rickwood
|first=
|DOI=
|accessdate=2021-09-05
}}</ref> Griffiths & Frank (1992) also expressed concern regarding the apparent inability of general practitioners to distinguish between a true phimosis and a developmentally non-retractile [[foreskin]]. They pointed out, "Not surprisingly, the diagnostic inaccuracy was greatest when the referring doctor did not examine the patient."<ref name="griffiths1992">{{REFjournal
|last=Griffiths
|first=
|DOI=10.1136/bmj.306.6869.1
|accessdate=2021-09-05
}}</ref> Williams et al. (1993) complained that most of the 30,000 circumcisions that were being done in the UK were on boys under 15. They reported that of 69 boys referred by GPs, 29 had a healthy retractile [[foreskin]], 30 had a healthy non-retractile foreskin, and only 9 had a phimosis requiring circumcision.<ref name="williams1993"> {{REFjournal
|last=Williams
|first=Nigel
}}</ref>
In defence of the much criticised British GPs, it should be stated that the data they were provided by [[Douglas Gairdner]] regarding development of foreskin retractility retractability was very inaccurate,<ref>{{REFjournal
|last=Denniston
|first=George C.
Rickwood & Walker (1989) reported that 21,000 circumcision were done annually on boys under 15 years of age,<ref name="rickwood1989" /> so Cathcart et al. (2006) are finding a reduction of 53 percent,<ref name="cathcart2006" /> although still much higher than it should be. It should be noted that manual [[stretching]] of the [[foreskin]] with the aid of topical steroid ointment to relieve [[phimosis]] had not yet entered general use.
The 2000 British ''National Survey of Sexual Attitudes and Lifestyles'' (Natsal 2000) found that 15.8 percent of British males aged 16 to 44 reported being [[circumcised]]. The incidence of circumcision was highest in the men aged 40-44 at 19.6 percent [born 1956-60] and lowest in the group aged 16-19 [born 1981-84] at 11.7 percent. Men of ethnic minorities (except black Caribbeans) were significantly more likely to circumcised than those described as "white". Jews were 98.7 percent circumcised and Sikhs, Hindus, and Buddhists were only 9.8 percent circumcised.<ref>{{REFjournal
|last=Dave
|first=
}}</ref>
Quaba & MacKindlay (2004) reported a 33.7% decline in the incidence of [[circumcision ]] in Scotland from 1990 to 2000. This occurred because medical doctors were better trained in the recognition of [[Foreskin#Foreskin_in_infancy_and_childhood| healthy non-retractile foreskin in boys]].<ref name="quaba2004">{{REFjournal
|last=Quaba
|first=
|DOI=
|accessdate= 2021-11-16
}}</ref>
The percentage of males [[circumcised]] in the United Kingdom (prevalence) is reported to be 20.7%.<ref>{{REFweb
|url=https://circstatistics.github.io/
|title=Global Circumcision Statistics and Estimates
|last=
|first=
|init=
|publisher=https://circstatistics.github.io
|date=2024-04-01
|accessdate=2024-04-01
}}</ref>
|date=2013-10-01
|accessdate=2021-01-03
}}</ref>
The National Secular Society (2023) has called for the end of genital cutting of children.<ref name="nss2023">{{REFweb
|url=https://www.secularism.org.uk/religious-surgery/
|title=End forced genital cutting
|last=Anonymous
|first=
|init=
|publisher=National Secular Society
|date=2023
|accessdate=2023-09-23
}}</ref>
}}</ref> but has not prohibited non-therapeutic circumcision of non-consenting minors.
Although the UK has been a member of the [[Council of EuropeDebate Genital Cutting Of Boys| Council of Europe]], a [[human rights]] organisation since 1949, a state-party to the [[ICCPR]] since 1976, and the CRC since 1991, the General Medical Council has not revised its policies and procedures to recognise the [[human rights]] of child patients to the physical security of their person.
The GMC holds four disciplinary sessions a year. Over the last decade it has disciplined 39 doctors for ritual (non-therapeutic) [[circumcision]] issues. The Medical Protection Society warned circumcision carries "considerable risks and complications”. Religious and cultural [[circumcision]] on boys is permitted, including by non-doctors, and largely occurs among Jewish, Muslim and some African Christian communities, where they are often considered a religious obligation.<ref>{{REFnews
==The guidance of the British Medical Association==
The [[British Medical Association]] (BMA) is a [[medical trade association]]. It represents and protects the interests of its doctor-members. Unlike American medical trade associations, the BMA do not claim to be an authority on medical science. Its advice to members address ethical and legal issues to assist members in staying out of legal difficulties. The BMA have provided several statements regarding child circumcision to inform its members since 1996:
* 1996 [http://www.cirp.org/library/statements/bma/ Circumcision of Male Infants: Guidance for Doctors]
==Conclusion==
The BMA (2019) reports reported that the NHS therapeutically circumcises about 10,000 boys under 18-years-of-age per year.<ref name="bma2019">{{REFdocument
|title=Non-therapeutic male circumcision (NTMC) of children – practical guidance for doctors
|url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
|date=2019
|accessdate=2021-09-10
}}</ref> The Daily Mail (2022) alleged that 1/2 of the 10,000 NHS [[circumcision|circumcisions]] of boys are unnecessary.<ref>{{REFnews
|title=Is the NHS carrying out thousands of unnecessary circumcisions on teenage boys? New report shows irreversible surgery is carried out 10,000 times per year
|url=https://www.dailymail.co.uk/health/article-10554847/Is-NHS-carrying-thousands-unnecessary-circumcisions-teenage-boys.html
|last=Ennals
|first=Ethan
|init=
|author-link=
|publisher=The Daily Mail
|website=
|date=2022-03-01
|accessdate=2023-05-23
|format=
|quote=The analysis also found up to half of the boys who underwent medical circumcision at some trusts were under five, an age at which doctors agree the procedure is almost always unnecessary.
}}</ref>
The incidence of non-therapeutic [[circumcision ]] of boys in the United Kingdom has been substantially reduced from its former peaks in the 1930s and early 1940s. Non-therapeutic circumcision of boys remains lawful provided that both parents grant consent. The practice seems to be concentrated among ethnic minorities. Ethical and [[human rights]] concerns about the surgery persist.
Non-therapeutic [[circumcision]] usually is not covered by the NHS, so parents must find a private medical or non-medical operator such as a [[mohel]] to perform the [[foreskin]] [[amputation]] and must pay the fee out of pocket as [[third-party payment]] is not available. Given the recent legal cautions uttered by the BMA,<ref name="bma2019" /> it may not be easy to find a medical practitioner willing to accept the risk.
The NHS announced in November 2022 that it would no longer perform the 23,000 circumcisions that it had been performing every year.<ref name="warren2022">{{REFweb |url=https://www.dailymail.co.uk/news/article-11410577/Circumcisions-tummy-tucks-liposuction-operations-stop-funded-NHS.html |title=Circumcisions, tummy tucks and liposuction are among 13 operations which will stop being funded by the NHS in a 'crackdown' on wasteful spending in a bid to save £2bn a year |last=Warren |first=Jessica |publisher=Daily Mail |date=2022-11-09 |accessdate=2023-04-07}}</ref> == Videos ===== Maajid Nawaz: Male circumcision consent =Video==A discussion of consent for non-therapeutic male circumcision by Maaajid Maajid Nawaz from Sky News.===<br>
<youtube>v=1mrAZnijYcc</youtube>
=== Great Britain - History of Foreskin and Circumcision === <youtube>v=OuDiIHRqEVA</youtube> === Why my penis is in constant pain - BBC stories === <youtube>v=rXDoezKLZjc</bryoutube>
{{SEEALSO}}
* [[Genital Autonomy]]
* [[Men Do Complain]]
* [[Secular Medical Forum]]
{{REF}}