[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.]

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 only.
Female circumcision is prohibited by law: The Prohibition of Female Circumcision Act 1995

Circumcision for religious reasons is outside the remit of this statement.

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 surgery.
• 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 operation.
• 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.

References:

• ¹Paediatric Forum, Children's Surgery – 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 – Guidance for Doctors, BMA, Sept 1996
• 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:

• Miss Leela Kapila representing The Royal College of Surgeons of England (chair)
• Miss Sue Burr representing The Royal College of Nursing
• Dr Keith Dodd representing The Royal College of Paediatrics and Child Health
• Dr Adrian Lloyd Thomas representing The Royal College of Anaesthetists
• Mr Anthony Rickwood Consultant Paediatric Urological Surgeon, Alder Hey
• Professor Lewis Spitz representing The British Association of Paediatric Surgeons

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© Copyright The Royal College of Surgeons 2001