THE CIRCUMCISION REFERENCE LIBRARY
[CIRP Note: This
statement was produced pursuant to a 1997 request of the
General Medical Council (GMC). The statement is
limited to the medical aspects of non-therapeutic
circumcision of male children. The ethics and legality of the
procedure were not to be considered. Apparently, the GMC
plans to address the the issues of the ethics and lawfulness
of non-therapeutic circumcision of male children after
receiving this medical statement.]
The Royal College of Surgeons of England
Statement on Male Circumcision
06 March 2001
Statement from the British
Association of Paediatric Surgeons, The Royal College of
Nursing, The Royal College of Paediatrics and Child Health,
The Royal College of Surgeons of England and The Royal
College of Anaesthetists.
* This statement refers to circumcision in male children
Female circumcision is prohibited by law: The Prohibition of
Female Circumcision Act 1995
Circumcision for religious reasons is outside the remit of
Natural History of the Foreskin
- The foreskin is still in the process
of developing at birth and hence is often non-retractable
up to the age of 3 years
- The process of separation is
spontaneous and does not require manipulation
- By 3 years of age, 90% of boys will
have a retractable foreskin [CIRP Note:
This information is outmoded: By 16 years of age, 90% of
boys will have a retractable foreskin.]
In a small proportion of boys this natural process of
separation continues to occur well into childhood.
Indications for circumcision
- The one absolute indication for
circumcision is scarring of the opening of the foreskin
making it non-retractable (pathological phimosis). This is
unusual before 5 years of age.
- Recurrent, troublesome episodes of
infection beneath the foreskin (balanoposthitis) are an
occasional indication for circumcision.
- Occasionally specialist paediatric
surgeons or urologists may need to perform a circumcision
for some rare conditions.
Criteria to be fulfilled in performing circumcision
- The operation should be performed by
or under the supervision of doctors trained in children's
- The child must receive adequate pain
control during and after the operation.
- The parents and, when competent, the
child, must be made fully aware of the implications of this
operation as it is a non-reversible procedure.
- This operation must be undertaken in
an operating theatre or an environment capable of
fulfilling guidelines1 for any other surgical
- The person responsible for the
operation must be available and capable of dealing with any
complications which may arise.
- There should be close links with the
patient's GP and community services for continuing care
after the operation.
- Accurate records of all procedures
and audit of results are essential.
- 1Paediatric Forum, Children's Surgery
Â– A First Class Service, May 2000
- American Academy of Paediatrics, Circumcision Policy
Statement, Paediatrics Volume 103, 3, March 1999
- Guidance for Doctors Who Are Asked to
Circumcise Male Children, GMC, Sept 1997
- Circumcision of Male
Infants Â– Guidance for Doctors, BMA, Sept
- Australian College of Paediatrics, Position Statement on
Circumcision, Newsletter June 1996
- Williams N, Kapila L; Complications
of Circumcision. Review, British Journal of Surgery 80
(10): 1231-6, October 1993.
- Rickwood AMK, Walker J; Is Phimosis
Overdiagnosed in Boys and Are Too Many Circumcisions
Performed in Consequence? Annals of The Royal College
of Surgeons of England, Vol 71 No 5, 275-277, 1989.
- Gairdner D; The
Fate of the Foreskin, A Study of Circumcision. British
Medical Journal, December 24 1949, p1433.
Members of the Circumcision Working Party:
© Copyright The Royal College of Surgeons 2001
- British Association of Paediatric Surgeons, The Royal
College of Nursing, The Royal College of Paediatrics and
Child Health, The Royal College of Surgeons of England and
The Royal College of Anaesthetists. Statement on Male
Circumcision. London: Royal College of Surgeons of
England, 6 March 2001.
(File revised 10 October 2006)