No. It’s true that the NHS is well-regarded when it comes to affordability and access for all. One US think tank, the Commonwealth Fund, which publishes a survey comparing 11 rich-country health systems every three years, rates the NHS top on those criteria – as well as strong on safety and reasonably efficient. The trouble…
Male circumcision is the surgical removal of the foreskin. The foreskin is the hood of skin covering the end of the penis, which can be gently pulled back.
- Circumcision may be performed for:
Religious reasons – circumcision is a common practice in the Islamic and Jewish faiths and is also practiced by many African communities as a tribal or ethnic tradition.
Medical reasons, although alternative treatments are usually preferred to circumcision. Circumcision is most commonly carried out when the foreskin is tight and won’t pull back (retract), which is known as phimosis; however, alternative treatments, such as topical steroids, are sometimes preferred.
During the 19th century, many medical practitioners believed that being circumcised was more hygienic than not being circumcised.
As a result, the routine medical circumcision of all boys, regardless of religious faith, became a widespread practice in England. However, routine male circumcision gradually became less common as many members of the medical community began to argue that it had no real medical benefit in the vast majority of cases.
Routine circumcision may offer a number of potential benefits, such as reducing the risk of some types of bacterial or viral infections. However, most healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, outweigh any potential benefits.
Advantages and disadvantages of circumcision
There are several potential advantages and disadvantages associated with circumcising boys shortly after they are born.
- Circumcision may reduce the risk of developing a urinary tract infection (UTI), such as a bladder infection.
- Circumcision may reduce the risk of getting some types of sexually transmitted infections, such as HIV and genital herpes.
- Circumcision may reduce the risk of female partners developing some types of sexually transmitted infections, such as bacterial vaginosis and trichomoniasis.
- Circumcision may reduce the risk of developing cancer of the penis.
However, there are much more effective and less invasive ways of preventing these conditions. For example, practising good hygiene to prevent UTIs, or using a condom to prevent STIs.
Most healthcare professionals maintain that the potential benefits of circumcision are not strong enough to justify routine childhood circumcision.
Critics of circumcision argue that it has disadvantages, such as:
- Reduced sensitivity – an uncircumcised penis is more sensitive than a circumcised penis, meaning that circumcised men may experience less pleasure during sex.
- Potential complications of circumcision – these include excessive bleeding, post-operative infection and, in rare cases, injury to the urethra. These complications are thought to outweigh any potential benefits.
- Critics have also argued that routinely circumcising baby boys on medical grounds violates the principle of consent to treatment. They say that circumcision should only be performed when a boy is old enough to make an informed decision about whether he wishes to be circumcised.
The majority of clinical commissioning groups (CCGs) do not fund routine circumcision or circumcision that is carried out for religious reasons.
The NHS mainly funds circumcision that is used to treat a small number of medical conditions (see below). In such cases, circumcision is usually regarded as a “treatment of last resort”, when all other treatment options have failed.
It is important to note that some CCGs in England do currently fund religious or ritual circumcision on the NHS. The decision is based on priorities that relate to its own local population.
In rare cases, circumcision may be considered for the following health conditions:
- Paraphimosis – a condition where the foreskin gets trapped under the tip of the penis
- Balanitis xerotica obliterans – an uncommon condition causing hardening and inflammation of the tip of the penis
However, these conditions are extremely rare in children and other treatments are often preferred.
Circumcision may also be considered in some cases with the following health conditions:
- Severe cases of phimosis – a tight foreskin that can’t be retracted
- Recurrent balanitis – inflammation of the tip of the penis and foreskin
How circumcision is performed
Circumcision for medical reasons is usually carried out on a day-patient basis. This means that you will not have to stay overnight in hospital.
Older children and adults who are circumcised are usually given a general anaesthetic, where they are put to sleep.
In Mediwell Clinic Circumcision Centre, we perform circumcision for only religious and cultural reasons and use local anaesthetic injection which will numb the penis and the surrounding area.
The circumcision procedure is relatively simple. The foreskin is removed with a scalpel, scissors or a surgical clamp. Any bleeding is either cauterised (closed using heat) or the remaining edges of skin are stitched together using dissolvable stitches.
After circumcision, there may be some pain and swelling, and the penis will be easily irritated until it heals. The healing process can take up to four to six weeks.
Recovering from circumcision
In babies who are circumcised, the foreskin usually takes about 7 to 10 days to heal. In older boys and men, the healing process can take up to four to six weeks.
As circumcision is a painful procedure, painkillers such as paracetamol or ibuprofen will need to be taken for at least the first three days after the operation. Children aged 16 or younger should not take aspirin.
Circumcision exposes the sensitive skin of the tip of the penis (glans). In babies, nappies can rub against the glans, making it sore. Therefore, make sure that you tuck down your baby’s penis before putting the nappy in place. You may be advised to apply an antibacterial cream for up to a week.
After circumcision, the penis will be red and swollen for a few days. You or your child may find it more comfortable to wear loose clothing for a while. Putting petroleum ointment directly on to the area can also reduce irritation.
After a boy has been circumcised, make sure that he does not ride a bike or use other sit-on toys until the swelling has completely gone down. If he is of school age, he should be able to return to school about a week after being circumcised. However, let his teacher know that he has had the operation.
It is important to practise good hygiene and ensure that your child’s nappies are frequently changed after a circumcision.
Do not use scented products in the shower or bath and leave the penis to dry naturally.
For adults, the surgeon will also give advice about sexual activity. Usually, sex should be avoided until the wound has healed, to avoid it reopening.
When to seek medical advice
After a child has been circumcised, speak to your GP if:
- There is any infection or bleeding from your child’s penis
- Your child’s penis remains swollen after two weeks
- Your child still finds passing urine painful a few days after the operation
- Older boys and men should also see their GP if they have any problems after circumcision.
Complications are rare when circumcision is performed for medical reasons, but there are some risks of circumcision that should be considered.
Risks of circumcision
As with all types of surgery, circumcision has some risks. However, complications from circumcisions carried out for medical reasons are rare in England.
Bleeding and infection are the most common problems associated with circumcision.
Other complications can include:
- A decrease in sensation in the penis, particularly during sex
- Damage to the tube that carries urine inside the penis (urethra), causing it to narrow and making it hard to pass urine
- Removal of too much of the foreskin
- Accidental amputation of the head of the penis, which is very rare
- A blood infection or blood poisoning (septicaemia)
Problems with circumcisions carried out for religious or cultural reasons may go unreported.
Circumcision is not carried out on boys born with a specific birth defect of the penis that affects where the opening of the urethra (urinary tube) is found. This is because the foreskin is used to reconstruct the urethra.