Non-therapeutic circumcision - UK

Summary

Non-therapeutic circumcision of male children is carried out for religious or ritual reasons and is generally not available on the NHS.¹ There is also a significant issue related to the appropriateness of the facilities in which the operation is carried out and a lack of formal training and certification in circumcision.

Potential difficulties

Members need to be aware that the procedure can carry considerable risks and complications include:

• Pain
• Bleeding
• Infection
• Unsightly scarring
• Complications relating to sedation and anaesthesia
• Too much or not enough foreskin removed
• Difficulty passing urine
• Injury or ulcer to the tip of the penis
• Damage to the urethra and difficulty passing urine
• Cosmetic problems
• Adhesions
• Developing an epidermal inclusion cyst

Complications after circumcision are far more prevalent in older children than in newborns. Members should ensure that patients/parents are aware of all the potential risks, and make sure that informed consent has been obtained before proceeding.

Medical Protection policy

Medical Protection requires members undertaking circumcisions to ensure they have the necessary skills and experience to do so and that the procedure is performed only in an appropriate setting. If the procedure is not being carried out in clinical premises then it must be undertaken in a safe environment capable of fulfilling guidelines for surgical procedures in children. 

Professional guidelines

Medical Protection expects any member carrying out circumcisions on children to follow the general guidance issued by the GMC in its publication 0 – 18 years: guidance for all doctors, particularly paragraphs 12 and 13 “Assessing best interests”. Members should also follow the GMC guidance Personal beliefs and medical practice (2013, updated 2020), and in particular paragraphs 18-23, “Procedures provided for mainly religious or cultural reasons”. Gillick competent children who are able to express their views should be involved in the decision-making process. Where a child lacks competence, and where there are two parents, both must give consent.

Medical Protection also expects members to follow the guidance of the British Association of Paediatric Surgeons (BAPS) on circumcision.

CQC Registration

All members undertaking circumcision should hold appropriate registration with the CQC, where required under the relevant legislation. 

Professional indemnity

Medical Protection is able to offer indemnity to GPs and certain other non-specialist doctors with sufficient experience and training in circumcision. For GPs in Scotland and Northern Ireland, subscriptions will generally be based on an appropriate sessional rate. For GPs in England and Wales, Claims Protection cover must be purchased and subscriptions based on your non-NHS-indemnified income. Members performing circumcisions must contact us on 0800 561 9000 to ensure the benefits of membership are extended to include this work. 

Therapeutic circumcision

Medical reasons for circumcision include phimosis, paraphimosis, recurrent balanitis, balanitis xerotica obliterans and repeated urinary tract infections (UTIs). NICE CKS guidance recommends referral to a paediatric urologist or surgeon for consideration of circumcision in a child with suspected lichen sclerosus and/or persistent phimosis. 

GPs considering undertaking circumcision for therapeutic reasons must ensure that they have the appropriate competence and experience and recommend specialist referral accordingly as appropriate.

References

1. The Scottish government has agreed that religious circumcision for male children can be carried out under general anaesthesia by trained paediatric surgeons at one of four paediatric centres under the NHS.