NHS 24 Health Library

When should it be done?

In the UK, circumcision is only carried out on the NHS in cases where it is medically necessary. It is usually performed as a last resort when other types of treatment have been unsuccessful.

Circumcision is a painful operation. If a baby boy needs to be circumcised, he will usually be given a local anaesthetic because it is safer than using a general anaesthetic. Local anaesthetic is a numbing medicine that can be injected into the base, or shaft, of the penis, or applied as a cream. Older children and adults who are circumcised are normally given a full, general anaesthetic.

Non-therapeutic circumcision

Non-therapeutic or ritual circumcision is conducted as a result of religious or cultural beliefs, rather than for medical reasons.

NHS Boards will only perform circumcisions for medical reasons, as recommended by The British Medical Association (BMA). For example, circumcisions will only be carried out to relieve severe pain, discomfort or disability. NHS Boards consider each patient individually, however, they are unlikely to agree to a free circumcision based on religious reasons. For further advice speak to your GP who can refer you to a private health clinic. Health clinics will only carry out the procedure with the consent of both parents, and following careful consideration of the childs best interests. These health clinics charge a fee for performing the procedure.

Parents who are considering having their son circumcised should be fully aware of the issues and risks involved. The operation involves pain, bleeding, and the possibility of surgical error. Most doctors also urge parents to think about what is best for the child. In cases where the boy is old enough to understand what circumcision means, doctors and parents should consider his feelings and ensure that he is informed about what the procedure involves, the implications of not being circumcised, and any other possible alternative options that are available.

As well as the childs medical welfare, his social and cultural circumstances should also be taken into account when deciding whether or not he should be circumcised. In certain religions and cultures, circumcision may be required for all males. The decision not to circumcise may cause problems, such as social exclusion, or it may make it harder for the child to find his sense of identity. However, this must also be weighed up against the standard of medical care available.

Medical opinion is mixed as to whether or not circumcision has any health benefits. However, in cases involving serious medical illnesses or conditions, such as cancer of the penis, or sexually transmitted infection (STI), circumcision may be the best or only option.

Cancer of the penis

The exact cause of cancer of the penis is unknown, but it may be related to general hygiene. Penile cancer is less common in men who have been circumcised. This may be because, some men, who have not been circumcised, may find it difficult to pull back their foreskin enough to clean underneath it. However, other factors, such as smoking, and the STI known as the human papilloma virus (HPV), are thought to be more significant in the development of penile cancer.

Sexually transmitted infection (STIs)

Some types of sexually transmitted infections (STIs) are more common in uncircumcised men than in men who have been circumcised. Men who are not circumcised, may be less likely to notice the symptoms of STIs that cause warts or ulcers on the genitals, such as herpes or syphilis. Also, the symptoms of chlamydia can be less obvious, making it more likely for men to pass on the infection without realising.

However, infections such as penile warts and urethritis, are more common in circumcised men, and yeast infections, such as thrush, affect circumcised and uncircumcised men equally. Therefore, the most reliable way to prevent the spread of sexually transmitted infections is to ensure that you practice safe sex. Always use a condom and, if you have a new partner, you should both get checked for any STIs before having sexual intercourse.

HIV/AIDS

In 2006, two clinical trials, conducted in Africa, showed that adult male circumcision helped protect men against HIV (the virus that leads to AIDS). The first trial involved 2,784 HIV-negative men, and resulted in a 53% reduction in circumcised men getting HIV compared to those who were uncircumcised. In the second trial, involving 4,996 HIV-negative men, there was a 48% reduction. However, in the UK, previous research has shown that circumcision does not outweigh the protection offered by using condoms and ensuring safe sexual practices.