Trends in pediatric circumcision in Belgium and the Brussels University Hospital from

Trends in Australia and New Zeeland

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Trends in Australia and New Zeeland

Trends in circumcision rate

From the latter half of the 19th century, the habit of routine male circumcision was accepted in Australia and New Zeeland.7 In Australia, circumcision peaked at 85% prevalence in the 1950s and has declined ever since. In 1971 the official policy of the Australian College of Pediatrics has been to discourage circumcision of newborns.38 Currently, an estimate of 10-20% of male newborns is circumcised in Australia and New Zeeland. After reviewing the available evidence in 2010, the Royal Australasian College of Physicians (RACP) states that there is no evidence to warrant routine infant circumcision. However, parental choice should be respected.54

Trends in indication

A 2003 Australasian study investigated the incidence rate of postneonatal circumcision for medical indications in Western Australian boys from the 1st of January 1981 to the 31st of December 1999. This was a population-based incidence study using hospital discharge data of circumcisions performed in all Western Australian hospitals. Circumcisions performed for routine (non-medical) reasons were excluded from analysis. Overall 56% of the circumcisions were performed for medically indicated reasons. The most common medical indication for circumcision at all ages was phimosis, followed by balanoposthitis and balanitis xerotica obliterans. There was a steady increase in the rate of medically indicated circumcisions in boys aged less than 15 years. This was due to an increase in the rate of circumcisions performed for phimosis. If the 1999 rate remains stable, it is estimated that 4% of all boys will be circumcised for phimosis by their 15th birthday, a number that is 7 times higher than the estimated rate of pathologic phimosis at that age. Over half of these boys will undergo circumcision for phimosis before their 5th birthday, despite that this condition is uncommon in this age group. There are two possible explanations for the high incidence rate of circumcisions performed for phimosis. One is that physicians may be mistaking a physiologic phimosis for a pathologic phimosis. This hypothesis is supported by 2 studies concluding that physicians had difficulty discriminating these two conditions. The second theory is that hospital physicians may feel some pressure to encode a medical indication for routine (non-medical) circumcisions. The Australasian Association of Paediatric Surgeons does not support this practice and the rate of routine circumcisions in boys aged less than 6 months has dropped from 20.5% in 1982-1983 to 7.9% in 1999. However, there was no evidence to confirm this theory.55

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