Some parents' religion or belief means they will want their male child to be circumcised as soon as possible after birth. NHS Scotland has developed a pathway to make sure that circumcision can take place once it is clinically safe to do so, i.e. no sooner than age 6 months and, ideally, no later than age 9 months.
What is male circumcision?
Circumcision is an operation to remove the loose foreskin covering the head of the penis. This may be done for medical or religious reasons.
Circumcision for religious reasons can be carried out by the NHS as long as doctors are satisfied that the operation is in the child's best interests.
Note: female genital mutilation (sometimes referred to as female circumcision) is a serious crime and a child protection issue whether undertaken in the UK or abroad.
Why circumcise for religious reasons?
Male circumcision is a central feature of both Judaism and Islam. It is also important in some African and other cultures.
The welfare of the child is paramount and healthcare workers must act in the child's best interests. The child's lifestyle and likely upbringing are relevant factors to take into account, as male circumcision can provide social or cultural benefits to the child by integrating him better into his community and enhancing his identity and sense of belonging to a family or society.
When should you discuss circumcision with parents?
The best time to raise the issue is at ante-natal booking, by the midwife, when the religion of the parents or carers can be established for relevant discussion. A lot of other information regarding the pregnancy is discussed at this stage and issues can be appropriately flagged in the notes.
The midwife should ask all parents at ante-natal booking if their religion would require a male child to be circumcised rather than presume someone's religion or belief.
It is important to discuss this with both parents, or those with parental responsibility (carers), to ensure that they are both in agreement about the procedure and are both clear about the potential risks of having the surgery done outwith the NHS if they are unhappy about the timescales.
Involvement of both parents or carers should also take place at the 6 week check up with the GP, when referral can be made, following a formal request by the parents/carers.
What to discuss
It is important to explain to parents or carers that this pathway has been established to ensure safe, high quality circumcision which is respectful of the parents' religion or belief and that will not compromise the health and wellbeing of their child.
The final referral can only occur after the child is born and if he is generally in good health, although the desire to have the child circumcised as early as it is safe to do so should have been signalled at the ante-natal booking and flagged in the mother's records by the midwife. However, the final referral can only occur after the child is born and if he is generally in good health.
In order, to give time to check the stability of health and wellbeing of the child, the referral by the GP to the Paediatric Surgeon should be undertaken at the 6 week check at the request of the parents or carers.
If the GP does not agree to the referral on non-clinical grounds, he or she should suggest an alternative doctor to the patient, in accordance with the GMC's advice that the patient has the right to seek a second opinion.
Consent for surgery
The male child and his parents or carers should be seen by the specialist team for a pre-operative check prior to the circumcision being carried out under general anaesthesia, usually as a day case.
The informed choice and valid consent of both parents/carers is preferred, where practicable; this is supported by the GMC
and the BMA
. However, any person considering performing religious circumcision is strongly advised to follow the GMC
outlining the issues of consent.
If there is a disagreement between parents/carers, such as parents of different religion (mixed religion marriage) or parents who are divorced/separated, which cannot be resolved informally, legal advice may be appropriate regarding application to the courts.
The timing of obtaining the formal informed consent should ideally be as close to the procedure as possible and the specialist team undertaking the circumcision would be responsible for obtaining informed consent. Parents should confirm their consent in writing by signing a consent form.
Undertaking male circumcision and follow up
Policy has been agreed that, given the very young age of the children undergoing circumcision (normally under 9 months) that the circumcisions should be undertaken in specialist centres at the 4 children's centres in Aberdeen, Tayside, Glasgow and Edinburgh.
Infant male circumcision will be carried out under general anaesthesia by trained Paediatric Surgeons. Unless there are complications this will normally be carried out as day surgery.
A discharge letter should then be sent to both the GP and the health visitor.
This leaflet has been produced by the Scottish Government, Directorate of Health and Wellbeing in consultation with relevant stakeholders.
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This information will also be made available in Urdu and Punjabi at: http://www.scotland.gov.uk/Publications/Recent
Further copies of this document are available, on request, in audio and large print formats and in community languages, please contact: 0131 244 2454