The National Health Service (NHS) took the decision not to offer circumcision for religious, cultural, social or personal reasons – also known as non-therapeutic – in 1949, very soon after its inception. This is because circumcision is not a medical necessity. Their decision led to a decline in the number of individuals undergoing circumcision in the United Kingdom.
A number of NHS hospitals did re-start offering offer a free circumcision service locally to parents, especially during the 1980s, however this is this is now rare or non-existent.
The situation may be changing in light of recent data showing that the impact of circumcision on HIV prevention is greater than what was previously thought. For this reason, the United States Public Health Department (the CDC) have recently change their stance on circumcision and state that the the benefits now outweigh the risks and recommend circumcision. In the last decade, many organisations fighting HIV, such as the Bill and Melinda Gates Foundation, have launched circumcision promotion campaigns in Africa to prevent HIV.
Non-therapeutic circumcision on the NHS
Circumcision is common among certain religious groups (such as Muslims and Jews) and cultural backgrounds. The NHS generally funds circumcision for specific medical reasons therefore most non-therapeutic circumcisions must be funded privately. Individual Clinical Commissioning Groups (CCG) (who locally decide how to spend NHS money) may choose to fund non-therapeutic circumcision for their local populations. We try keep an up to date list of CCGs and NHS providers that offer circumcision services:
- Tower Hamlets CCG: until recently, GPs in Tower Hamlets were able to refer to a CCG-run circumcision service however this was not a free service. The service ended in early 2016 and patients are now adviced to seek a private provider
- Sheffield Hospital: After ceasing free non-therapeutic circumcision in 2013, Sheffield Hospital now offer a paid service for children aged six months and above for £850
- All other NHS trusts have stopped offering free circumcision
Patients may be considered on an individual basis where their GP or consultant believes there is an exceptional circumstance that warrants deviation from the normal rules. Individual cases are considered by a treatment panel at the CCG. You can find out about ‘Individual Funding Requests’ by visiting your local CCG website (use the CCG finder tool on the NHS website) or speaking to your GP.
Therapeutic circumcision on the NHS
The NHS provides circumcision free of charge when a urologist decides there is a medical reason for the procedure. The most common reasons are:
- Recurrent balanitis
- Balanitis xerotica obliterans
To get this type of circumcision on the NHS, see your GP who will make a referral to a local hospital urology service. There is usually a delay to see the urologist for non-urgent referrals. The urologist will then examine you or your child to decide whether an alternative treatment might be useful. If circumcision is offered, a circumcision appointment in theatre will be booked. There is usually another delay with this as it’s unlikely to be considered urgent.
Waiting list times for NHS circumcision can vary from between 8 weekss to 32 weeks, varying greatly between different areas of the United Kingdom and the severity of the condition, however even minor to moderate pain is not usually considered an urgent situation. Situations where an operation can be arranged quickly include:
- Where there is a suspicion of cancer where a 2-week wait referral may be arranged by your GP. The urologist may examine you and decide to operate as soon as possible.
- Paraphimosis can be a medical emergency and an emergency circumcision may be performed. Paraphimosis is when the foreskin is retracted and cannot be replaced. This results in swelling and colour change of the tip, pain in the penis and may also result in the inability to pass urine. This condition requires immediate attention.
In the UK, health insurance only covers therapeutic (medical) circumcision. If you have health insurance, your GP will still need to make a referral and then an appointment can be made through your insurance provider. The operation can usually occur much sooner through this route than through the NHS.
Private circumcision clinics such as the IMC
Individuals looking for a private circumcision service for themselves or their son should choose a doctor-led circumcision clinic or a hospital. Ask the doctor who is operating about the level of experience he or she has. Some patients choose to fund their own therapeutic circumcision despite this being available on the NHS. If you choose a private clinic, the main disadvantage is cost. The main advantages are:
- individual choice whether you would like to undergo circumcision, no GP referral required
- no long waiting lists
- avoidance of hospital-acquired infections such as MRSA
- no hospital admission required
- usually, a method of circumcision is used that requires only local anaesthetic
- more flexibility to choose the doctor
- less embarrassment within a private environment the clinic can provide
- no need to attend hospital in the early morning and wait your turn on the theatre list