Circumcision for phimosis and other medical indications in Western Australian boys

Katrina Spilsbury, James B Semmens, C D'Arcy J Holman and Z Stan Wisniewski
Med J Aust 2003; 178 (4): 155-158.


Objective: To investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys from 1 January 1981 to 31 December 1999.

Design and setting: A population-based incidence study using hospital discharge data of all circumcisions performed in all WA hospitals during the study period.

Main outcome measures: Changes in the incidence rate of circumcision for medically indicated reasons.

Results: The rate of medically indicated circumcisions increased in boys aged less than 15 years during the study period. Phimosis was the most common medical indication for circumcision in all age groups. The rate of circumcision associated with phimosis was eight times that associated with balanoposthitis and 21 times that of balanitis xerotica obliterans. Boys aged less than five years had the highest rate of circumcision to treat phimosis, at 4.6 per 1000 person-years, representing about 300 circumcisions per year. Boys aged less than five years living in country areas were 1.5 times more likely to be circumcised for phimosis than boys living in metropolitan Perth.

Conclusion: The rate of circumcision to treat phimosis in boys aged less than 15 years is seven times the expected incidence rate for phimosis. Many boys are circumcised before reaching five years of age, despite phimosis being rare in this age group.

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  • Katrina Spilsbury1
  • James B Semmens2
  • C D'Arcy J Holman3
  • Z Stan Wisniewski4

  • 1 Centre for Health Services Research, School of Population Health, University of Western Australia, Crawley, WA.
  • 2 Western Australian Safety and Quality of Surgical Care Committee, Royal Australasian College of Surgeons, Western Australian Branch, Nedlands, WA.



We thank the Data Linkage Unit, Western Australian Department of Health, for the linked hospital morbidity data files. This project was funded through the Western Australian Safety and Quality of Surgical Care Project by a National Health and Medical Research Council research grant.

Competing interests:

None identified

  • 1. Maiche AG. Epidemiological aspects of cancer of the penis in Finland. Eur J Cancer Prev 1992; 1: 153-158.
  • 2. Rickwood AM. Medical indications for circumcision. BJU Int 1999; 83 Suppl 1: 45-51.
  • 3. Chu CC, Chen KC, Diau GY. Topical steroid treatment of phimosis in boys. J Urol 1999; 162: 861-863.
  • 4. Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int 2001; 87: 239-244.
  • 5. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int 1999; 84: 101-102.
  • 6. Oster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child 1968; 43: 200-203.
  • 7. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949; 2: 1433-1437.
  • 8. Rickwood AM, Walker J. Is phimosis over diagnosed in boys and are too many circumcisions performed in consequence? Ann R Coll Surg Engl 1989; 71: 275-277.
  • 9. Rickwood AM, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ 2000; 321: 792-793.
  • 10. Semmens JB, Lawrence-Brown MM, Fletcher DR, et al. The Quality of Surgical Care Project: a model to evaluate surgical outcomes in Western Australia using population-based record linkage. Aust N Z J Surg 1998; 68: 397-403.
  • 11. Holman CD, Bass AJ, Rouse IL, Hobbs MS. Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health 1999; 23: 453-459.
  • 12. World Health Organization. International classification of procedures in medicine. Geneva: WHO, 1978.
  • 13. Australian version of the international classification of diseases, 9th revision, clinical modification (ICD-9-CM). Sydney: National Coding Centre, 1995.
  • 14. International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). Sydney: National Centre for Classification, 2000.
  • 15. The SAS system for Windows [computer program]. Version 8.02. Cary, NC: SAS Institute, 2001.
  • 16. Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med 1992; 85: 324-325.
  • 17. Leditschke JF. Guidelines for circumcision. Brisbane: The Australasian association of paediatric surgeons, 1996.
  • 18. Wirth JL. Circumcision in Australia: an update. Aust Paediatr J 1986; 22: 225-226.
  • 19. Donnelly N, Semmens J, Fletcher D, Homan C. Appendicectomy in Western Australia: profile and trends 1981–1997. Med J Aust 2001; 175: 15-18.
  • 20. Dewan PA, Tieu HC, Chieng BS. Phimosis: is circumcision necessary? J Paediatr Child Health 1996; 32: 285-289.


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