Thomas Miller underwent circumcision – the surgical removal of the foreskin – as a baby and says it has left him scarred for life.
It first became problematic when he started secondary school.
‘Getting changed for sport I realised I was the only one in a class of 20 that looked like that,’ says Thomas, 29. ‘Straight away, I felt different – I didn’t fit in.’
Being circumcised has also affected his love life – Thomas admits he’s avoided intimacy for fear a partner might find his appearance unsightly.
‘I’ve never had a long-term relationship – and I think my own concerns over circumcision are part of the reason why,’ says Thomas, speaking on condition of a pseudonym.
It is not just the emotional cost. To this day, Thomas experiences discomfort and soreness from clothing irritating the end of his penis and he now wears a soft, protective cup made of polyester to reduce friction.
Circumcision is the most common form of male surgery in the world, with more than 15million procedures performed globally every year.
In England, circumcision became popular in the Victorian era, but declined in the 20th century, from about 35 per cent of men in the 1930s to around a fifth in the 1940s. There was also a sharp division in social class; the practice was rumoured to have been popular among the Royal Family and the upper classes were more frequently circumcised.
Circumcision is the most common form of male surgery in the world, with more than 15million procedures performed globally every year
Today, figures suggest up to 15 per cent of UK males have had the procedure. More than half are for religious or cultural reasons (Thomas, who has a part-Jewish background, was circumcised at eight days old), but many are performed for medical purposes, such as for phimosis. This is a condition that affects around one in 100 men, where the foreskin does not retract properly, leading to painful erections that can make sex difficult.
By contrast, in the US more than 70 per cent of males are circumcised – most of whom when they are a few days old.
This is not only for religious reasons: The American Academy of Pediatrics and the American Urological Association both recommend that routine circumcision is offered for newborn males on the grounds that long-term benefits outweigh the risks.
In the UK, medical guidelines have cautioned against the surgery in newborns for health purposes, arguing that the risks are too great (more on this later). Instead, the NHS strictly reserves it for men whose lives are adversely affected by complications such as severe phimosis.
Now some experts are warning that the UK’s cautious attitude to medical circumcision – combined with men’s embarrassment about foreskin-related health problems – means too many are missing out on a procedure that could benefit them.
Meanwhile, campaigners point to a different concern: that surgical procedures are being carried out on those too young to give consent.
Separately, there are men who feel their lives have been irrevocably affected by their circumcisions, both physically – including a loss of sensitivity in the head of the penis, profoundly affecting their sex lives – and psychologically, with some contemplating suicide.
Circumcision is a controversial procedure – but perhaps the most immediate issue is that in the UK it can be performed by anyone. They do not need medical qualifications, and there is no requirement to undergo any training or gain accreditation.
Some communities have set up voluntary training for non-medical practitioners – for example, in Judaism, the practice in the UK is overseen by The Initiation Society, founded in 1745, which provides training for non-medics undertaking the role of ‘mohel’, or circumciser.
However, these practitioners are not independently regulated.
In December last year, the assistant coroner for West London issued a Prevention of Future Deaths report, warning that unless new regulations were brought in to govern non-therapeutic male circumcision (done primarily for religious or cultural reasons), babies could die.
This stark warning followed the tragic death of six-month-old Mohamed Abdisamad on February 19, 2023, from an infection caught during his circumcision, which was carried out by a non-medically qualified individual who’d been recommended to his parents.
Within days of the procedure, Mohamed began showing signs of illness and was rushed to nearby Hillingdon Hospital by ambulance. He suffered a cardiac arrest and died.
An inquest revealed he’d contracted a Streptococcus infection following the procedure.
‘There is no system of external accreditation and no requirement for record keeping or infection control measures,’ the coroner’s report concluded.
In another case last year, 54-year-old Mohammed Alazawi, from Ilford in east London, was jailed after pretending to be a doctor and carrying out up to 40 circumcisions on male infants in what the Crown Prosecution Service (CPS) later described as ‘unsafe, unsanitary and harmful ways’.
Mohammed Alazawi, from Ilford in Essex, was jailed after pretending to be a doctor and carrying out up to 40 circumcisions on male infants
The CPS added: ‘He was able to carry out these procedures because non-therapeutic male circumcision is unregulated and is not required to be carried out by a medical practitioner.’
There have been other deaths. In 2012, Grace Ebun Adeleye, a nurse from Oldham, Greater Manchester, was given a 24-month suspended jail sentence for manslaughter by gross negligence after performing a circumcision using scissors and olive oil – without anaesthetic – on a four-week-old boy who subsequently bled to death.
Shockingly, there were 14 deaths in England alone between 2001 and 2024 where circumcision was mentioned on the death certificate, according to the latest data from the Office for National Statistics (ONS) – half were in boys under 18. It noted the figures may not account for all circumcision-related deaths as the procedure ‘may not be recorded’ on the certificate.
Between 2012 and 2022, meanwhile, the General Medical Council dealt with 39 complaints relating to ‘botched’ infant circumcisions carried out by doctors in the UK. Some babies needed blood transfusions, others were left with penises that required surgical repair.
In response to the coroner’s report on the death of Mohamed Abdisamad, the British Islamic Medical Association called for the NHS in England to adopt the same approach as Scotland – where religious circumcision is provided free on the health service by paediatric surgeons, after a referral from a GP, when the child is six to nine months old.
The Department of Health and Social Care said: ‘There is no requirement in law for a practitioner performing non-therapeutic male circumcision to be medically trained. All medical procedures carry some level of risk – considering the number of circumcisions that occur in the UK, it is rare that a death occurs.’
A separate issue is the question of consent.
The charity 15Square – so named because the average surface area of a foreskin is approximately 15in2 – says putting infants through circumcision can have long-term physical and psychological effects.
The charity insists it is not opposed to circumcision on religious or cultural grounds – just that it should be done after males reach 16, the age of medical consent.
Psychotherapist Leanne Morris, who works with the charity, published a report last year in the journal Culture, Health and Sexuality, based on her interviews with dozens of young men who felt troubled by being circumcised at birth.
‘Many had all the signs of trauma – including intrusive dreams and flashbacks,’ she told Good Health. ‘Some likened it to a violation – knowing someone has done that to an intimate part of their body. The worst case I’ve heard of ended in suicide.’
The foreskin is thought to serve as a protective layer of tissue for the head of the penis, with the inside surface made up of mucosal tissue, which is packed with sensitive nerve endings that are stimulated during sex – some men, like Thomas, believe circumcision has severely impacted their relationships.
Yet, on the other side of the debate, there are concerns that men are missing out on the potential benefits of the procedure.
For more than 100 years, doctors in the US have promoted circumcision as a means of improving genital hygiene, reducing the risk of urinary tract infections (UTIs) and protecting against penile cancer – which affects around 800 men a year in the UK – as the foreskin is one of the main sites where tumours originate.
It has also been shown to reduce transmission of viruses – such as HIV and human papillomavirus (HPV), a major cause of cervical cancer in women and genital warts or cancer of the anus or throat in men – which may lie hidden underneath the foreskin.
A 2017 analysis by researchers at Soonchunhyang University in South Korea, which pooled data from eight different studies involving more than 500 infant boys with phimosis, found HPV in the foreskins of up to 17 per cent of them.
Circumcision can also be used to treat men with phimosis, as discussed previously.
‘Lots more men would benefit from circumcision but just don’t realise it,’ says Hussain Alnajjar, a consultant urological surgeon at the Cleveland Clinic in London and spokesperson for the British Association of Urological Surgeons.
‘I see lots of patients who need the procedure, most commonly for phimosis, but simply had no idea it could help them.’
He adds that while it’s normal for young boys not to be able to fully retract the foreskin, ‘if you reach your late teens or adulthood and your foreskin is still too tight to fully retract then you should seek medical attention’.
Treatment initially involves applying steroid creams or gels to soften the foreskin while carrying out twice-daily ‘stretching’ exercises.
Studies show this works in about 70 per cent of cases, usually within four to six weeks – if it fails, circumcision is usually the next step.
‘Lots more men would benefit from circumcision but just don’t realise it,’ says Hussain Alnajjar, a consultant urological surgeon at the Cleveland Clinic in London
Mr Alnajjar says the majority of phimosis cases in adults are due to an underlying problem, lichen sclerosus, an inflammatory skin condition affecting the head of the penis, causing itching, white patches and tightening of the foreskin. The most common trigger is urine.
‘Urine is toxic to the skin – and when an uncircumcised man goes to the loo, some of it can get trapped under the skin, causing chronic inflammation.
‘In time, that inflammation causes a build-up of scar tissue in the foreskin which makes it tight.
Many men find this adversely affects their sex life because erections can be painful.’
Circumcisions in the NHS usually take place in hospital, under general anaesthetic – after the skin is removed to just below the head, the remaining skin is stitched to the shaft of the penis.
To prevent inflammation and lichen sclerosus, says Mr Alnajjar, uncircumcised men should fully retract their foreskin when they pee and clean and dry the head of the penis afterwards.
‘You’d be surprised at how many men I see in my clinic who don’t practise basic genital hygiene.
‘Make sure you dry even the last droplets and don’t allow any urine to remain under the foreskin.’
Routine cleaning might also reduce the risk of penile cancer.
‘Untreated lichen sclerosus is associated with a small but significant increase in the risk of penile cancer – between 2 and 5 per cent,’ says Mr Alnajjar.
‘I’ve a couple of young penile cancer patients, one of whom who is only 30. Both of them had lichen sclerosus but just thought they had tight foreskins – they thought it was normal and ignored it.’
He says changes in sensitivity are one of the main concerns voiced by men recommended for medical circumcision. However, while this can happen ‘it’s not common and most patients get used to it’.
Thomas says one of the casualties of being circumcised has been his relationship with his father, who pushed for him to have the procedure on religious grounds.
‘I sometimes get very angry with him about it – there’s been a big distance between us because of it. He’s tried to explain that there was a lot of family pressure on him. But non-medical male circumcision should be an individual choice, done at the age of consent and not before.’
I wish I could have made this choice myself
Robert White, 35, a kitchen manager, lives in Dorset, with his partner, Tessa*, 34. He says:
I don’t remember much about life before the operation – I was only five – though I remember feeling discomfort and my parents taking me to see various doctors. I now know I had a tight foreskin.
I remember being prepared for ‘specialist surgery’, my mother kissing me goodbye and not much after that. After I had healed, life carried on.
But during PE changing time or showers after swimming, other boys would make comments about my penis, such as ‘it looks weird’. I genuinely didn’t know what the operation was called or what it was for, so couldn’t defend myself. I wish my parents had explained it all sooner, as it might have saved me years of bullying.
But they did take me to a naturist beach, which helped me not to feel embarrassed about my penis as I saw a variety of all ages – circumcised and uncircumcised.
As a young man I found sex difficult. It would take me excessive time to orgasm, if at all, because I felt no sensitivity.
Girlfriends took this as me not finding them attractive – which had nothing to do with it – and we’d part.
Then two years ago, I met Tessa* and she seemed fine with me being circumcised. She understood it took me longer to get aroused and orgasm. We’ve found ways to make our sex life enjoyable.
I’ve read up on ‘stretching’ the skin back using special weights, and have looked into revision surgery (see box) – one day I might consider it but, for now, things with my current partner are going well.
Circumcision is not a tiny operation – it can have a lifetime of repercussions and I wish I could have made this choice myself .
But I don’t blame my parents: I feel they were forced to do this, as surgeons back then went for the quickest solution.
*A pseudonym
Interview: JULIE COOK
Could you ‘regrow’ skin after a circumcision?
Some private clinics in the UK offer circumcision ‘revision’ surgery, using a skin graft from elsewhere (often the inner thigh or abdomen) to fashion a replacement, partly restoring sensation. The procedure costs around £1,000.
A cheaper option involves using commercially available ‘stretching’ devices. Daily use of tape, weights or specially designed gadgets – costing £10 to £125 – aims to pull the remaining skin on the penis back to its original length.
But the process can take up to four years – and there is little data to show it’s effective.
A US firm, Foregen, has spent the last decade working on a ‘grow-your-own’ treatment, where donated human stem cells (master cells that can turn into any tissue) are used to regenerate the tissue.
After being grown in the lab, the stem cells, the patient’s own foreskin tissue and a biodegradable ‘scaffold’ are then grafted onto the penis.
In a study on rats, published in the journal Bioengineering last year, scientists at the University of Rome in Italy showed the technique can grow new tissue. But the procedure – likely to cost around £7,500 – has yet to be tried in humans.
