What if circumcision is recommended for clinical reasons?
Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. Doctors should be aware of this and reassure parents accordingly.
What are the clinical indications for circumcision?
In 2016-17, just under 10,000 males under the age of 18 underwent circumcision on the NHS in England, although the indications for these circumcisions are not given in the published data. Clinical indications for circumcision might include phimosis (typically due to severe scarring of the opening of the foreskin or Balanitis Xerotica Obliterans (BXO)), recurrent paraphimosis (i.e. where the foreskin becomes painfully stuck behind the glans); recurrent balanitis (infection of the glans); and prophylaxis of urosepsis in those with underlying structural urological abnormalities. Traumatic (zipper) injury or penile malignancy in adults may also be indications for foreskin removal.
Are there any special considerations?
As with other therapeutic procedures, unnecessarily invasive procedures should not be used where alternative, less invasive techniques are equally effective and available. It is important that doctors keep up to date, and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise solely for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive (and there are no relevant social and cultural interests to take into account for that particular child) would be unethical and inappropriate.
If there is doubt about whether treatment is needed, or what is the most appropriate course of management, advice from a relevant specialist should be sought - for example, if the procedure could or should be delayed, or if there may be contraindications relating to disorders of the genitalia.
It is recommended that circumcision for medical purposes must only be performed by those who are experienced and competent to carry out the procedure, and in an environment capable of fulfilling guidelines for surgical procedures in children.
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