Non-therapeutic circumcision of male children is carried out for religious reasons and is generally not available on the NHS1. 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.
Members need to be aware that the procedure can carry considerable risks. Common problems associated with circumcision can include:
- Post operative bleeding
- Residual foreskin
- Complications relating to sedation and anaesthesia
More rarely, complications can include:
- Amputation of the glans penis
- Extensive loss of penile skin
- Damage to the urethra
On occasion 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. Members should ensure that patients/parents are aware of all the potential risks, and make sure that informed consent has been obtained before proceeding.
MPS 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 with adequate availability of surgical facilities.
MPS 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), and in particular paragraphs 18-23 (“Procedures provided for mainly religious or cultural reasons”). Appropriate consent should be obtained from both parents.
MPS also expects members to follow the guidance of the British Association of Paediatric Surgeons (BAPS), published in January 2001 and revised in October 2014.
MPS requires all members undertaking circumcision to hold appropriate registration with the CQC, where required under the relevant legislation.
MPS is able to offer indemnity to GPs and certain other non-specialist doctors with sufficient experience and training in circumcision. For GPs, subscriptions will generally be based on an appropriate sessional rate. Members performing circumcisions must contact the membership department of MPS to ensure that the benefits of membership are extended to include this work.
- 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.