Development of circumcision rates in Germany since the approval of ritual circumcision. A population-based analysis from 2013 to 2018

Introduction: The religious and cultural circumcision of male infants in Germany is controversially discussed. After the passing of the religious circumcision bill in 2012, an increase of infant circumcisions without medical indication was feared. The aim of this study was to analyze the development of the circumcision case numbers. Materials and methods: We used the research database of the German Institute for Applied Health Research with a representative anonymous sample of 4.9 million insured persons to estimate the annual circumcision numbers in Germany from 2013-2018. We stratified the data according to age (< 18 vs. >= 18 years). The number of male adolescents in the study period was taken from the database of the German Federal Statistical Office. Results: In the study period, 673,819 circumcisions were performed. From 2014, there was a significant decrease in the number of cases across all age groups (p= 0.049). Thereby, circumcisions in minors significantly increased (p= 0.002) and procedures in adults significantly decreased (p= 0.01) during the entire study period. The number of male minors increased by 4% from 6,709,137 (2013) to 6,992,943 (2018). The corresponding population-based number increased from 7.5 circumcisions per 1000 minors in 2013 to 8 in 2018 (p= 0.037). Conclusions: After the passage of the circumcision bill in 2012, there was a significant increase of circumcisions in the age group of < 18 years in Germany. A major limitation of our study is that presumablymany ritual circumcisionsmight not be provided within the health care system.