MPS policy on circumcision
Correct as of January 2011
Non-therapeutic circumcision of male children is carried out for religious reasons and is a central feature for both Islam and Judaism. Non-therapeutic circumcision is generally not available on the NHS, and there is a significant issue related to the appropriateness of the facilities in which the operation is carried out. There is also a lack of formal qualifications in circumcision.
Potential difficulties
Doctors need to be aware that the procedure can carry considerable risks to the patient. Common problems associated with circumcision can include:
- Post operative bleeding
- Infection
- Residual foreskin.
More rarely, complications can include:
- Amputation of the glans penis
- Extensive loss of penile skin
- Damage to the urethra.
Rarely, the operation can be carried out inappropriately with a pre-existing congenital condition. There have been a few reports of deaths, usually related to drugs administered at the time of the circumcision. You should ensure that patients/parents are aware of all the potential risks, and make sure that you have their informed consent, before proceeding.
MPS policy
MPS urges anyone carrying out the operation to ensure they have the necessary skills and experience to do so
MPS urges anyone carrying out the operation to ensure they have the necessary skills and experience to do so, and to carry out the procedure with the appropriate facilities and equipment. If you are unsure whether or not to proceed, contact a medicolegal adviser at MPS for advice.
If the procedure is not being carried out in hospital premises, then it should be undertaken in an appropriate setting and with surgical facilities. Members should also ensure that appropriate consent, ideally from both parents, is obtained.
BAPS guidelines
Anyone considering carrying out the procedure should also be aware of the guidelines published by the British Association of Paediatric Surgeons in 2001, and act in accordance with them whenever appropriate. For medicolegal advice please call us on: 0845 605 4000 or email us at: querydoc@mps.org.uk.
Professional indemnity
General practitioners who carry out the procedure will be charged the GP subscription rate. Junior hospital doctors carrying out a circumcision should have a surgical or urological background and have gained experience of the operation. Doctors who are acting as private specialists, but are not on the specialist register, will be charged the rate for speciality group 3 as paediatric surgery and thus the subscription rate will be dependent on their income band.
GMC guidance
MPS also advises members carrying out non-therapeutic circumcisions to follow the guidance issued by the GMC 0 – 18 years: guidance for all doctors; particularly at paragraph 12 (‘Assessing best interests’).
The situation in Scotland
While non-therapeutic circumcision is generally not available on the NHS, 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.