In Britain a class distinction is associated with circumcision. Circumcision traditionally indicated that a doctor had attended the birth (a marker of family wealth) rather than a midwife (more likely to be used instead by poorer people). The Royal Family and the upper classes are circumcised and the lower classes and those who left school before 17 much less so [402]. Queen Victoria believed her family descended from King David (of the Biblical Old Testament) and sanctioned circumcision. Prince Charles was circumcised by a mohel (a rabbi who specializes in circumcision). Princess Diana decided that Princes William and Harry would go uncircumcised. However, it is suspected that William was later circumcised in his teen years when it was announced that he went into hospital for a ‘hernia’ operation (regarded as ‘code’ for ‘circumcision’).

Socio-economic stratification is seen in the USA as well. The US National Health and Lifestyle Survey saw higher circumcision rates among whites and the better-educated [327]. There was little difference between different religious groups. In the National Health and Nutrition Examination Survey (NHANES) 1999-2004, for those born in the 1970s, circumcision rate was 96% in men with an annual household income of greater than $55,000, 92% for income $35,000-54,999, and 84% in those below the poverty level [650]. For those born in the 1980s the corresponding rates were 85%, 85% and 75%, respectively.

Similarly, in Australia, the higher socio-economic-educated groups in society had higher rates of circumcision [465].

In the US NHNES survey sexual initiation occurred at the same age (16.7 and 16.9 years) in uncircumcised and circumcised men [650]. The proportion who had ever had a male partner was also similar (3.4% and 4.9%, respectively). Median number of lifetime sex partners was 5.8 and 7.0 in uncircumcised vs. circumcised, respectively, but after stratification by race/ethnicity there was no difference [650].

Thus, in English-speaking countries of Anglo-Celtic heritage, the upper echelon tend to be circumcised.