Circumcision policy statement. Pediatrics. 2012; 130:(3)756-85

Cultural bias and circumcision: The AAP responds. Pediatrics. 2013; 131:(4)801-4

Arya M, Li R, Pegler K Long-term trends in incidence, survival and mortality of primary penile cancer in England. Cancer Causes Control. 2013; 24:(12)2169-76

Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005; 2:(11)

Bailey RC, Moses S, Parker CB Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 2007; 369:643-56

Centers for Disease Control and Prevention. Recommendations for providers counselling male patients and parents regarding male circumcision and the prevention of HIV infection, STIs, and other health outcomes. Federal Register. 2014. (accessed 6 March 2015)

Germany passes law to protect circumcision after outcry. 2012. (accessed 6 March 2015)

El Bcheraoui C, Zhang X, Christopher S Rates of adverse events associated with male circumcision in US medical settings, 2001 to 2010. JAMA Pediatr. 2014; 168:(7)625-34

Male circumcision: Let there be no more tragedies like baby Goodluck. 2012. (accessed 6 March 2015)

Frisch M, Aigrain Y, Barauskas V Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision. Pediatrics. 2013; 131:(4)796-800

Gattari TB, Bedway AR, Drongowski R Neonatal circumcision: Is feeding behavior altered?. Hospital Pediatrics. 2013; 3:(4)362-5

Gray RH, Kigozi G, Serwadda D Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet. 2007; 369:657-66

Greater Manchester Safeguarding Children Partnership. Non-therapeutic infant male circumcision services in Greater Manchester. 2013. (accessed 6 March 2015)

Hutson JM, O'Brien M, Spenser W, 7th edn. Oxford: Wiley Blackwell; 2015

Kim DS, Koo SA, Pang MG Decline in male circumcision in South Korea. BMC Public Health. 2012; 12

Liu CM, Hungate BA, Tobian AR Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria. mBio. 2013; 4:(2)e00076-13

Mielke RT Counseling parents who are considering newborn male circumcision. J Midwifery Women Health. 2013; 58:(6)671-82

Morris BJ, Krieger JN Does male circumcision affect sexual function, sensitivity, or satisfaction? A systematic review. Journal of Sexual Medicine. 2013; 10:2644-57

Naguib N, Faraz A, Davies B The value of betamethasone cream in reducing the need for circumcision for phimosis in children. The West London Medical Journal. 2012; 4:(1)19-24

Paranthaman K, Bagaria J, O'Moore E The need for commissioning circumcision services for non-therapeutic indications in the NHS: Lessons from an incident investigation in Oxford. J Public Health (Oxf). 2011; 33:(2)280-3

Pinty J, Baeten JM, Manhart LE Association between male circumcision and incidence of syphilis in men and women: A prospective study in HIV-1 serodiscordant heterosexual African couples. The Lancet Global Health. 2014; 2:(11)e664-71

Surely everyone carrying out circumcisions should be registered?. 2014. (accessed 6 March 2015)

The Scottish Government. Male religious circumcision. NHS staff leaflet. 2008. (accessed 6 March 2015)

Israel condemns Council of Europe resolution on ritual circumcision. 2013. (accessed 6 March 2015)

Norway Passes Circumcision Law. 2014. (accessed 6 March 2015)

Stringer MD, Brereton RJ Should religious circumcision be performed on the NHS?. BMJ. 1991; 302:(6771)

Spitzer JLondon: The Initiation Society; 1996

Thalassis NLondon: BME Health Forum; 2009

Weiss HA, Larke N, Halperin D, Schenker I Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urol. 2010; 10

Geneva: WHO; 2007

Male Circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability.Geneva: WHO; 2008

Williams N, Kapila L Complications of circumcision. Br J Surg. 1993; 80:(10)1231-6

Wright JL, Lin DW, Stanford JL Circumcision and the risk of prostate cancer. Cancer. 2012; 118:4437-43

Helping parents achieve safer male infant circumcision

02 April 2015
Volume 23 · Issue 4


Non-therapeutic neonatal circumcision, whether for religious or cultural reasons, is generally not available via the NHS. Tragedies can occur with unqualified practitioners, and some health-care Trusts have cooperated with local communities to provide approved services. Unfortunately, these are unevenly distributed throughout the UK and most involve cost. Midwives are well placed to help interested parents understand the procedure and contact an acceptable provider.

This article hopes to give midwives some knowledge of infant circumcision, its controversial nature, the pros and cons, the groups for whom it is important and the methods commonly used in the UK. Points are listed for patient discussion and suggestions made for examining websites. As with Scottish guidelines, were midwives to discuss neonatal circumcision with all parents in the antenatal period, it would give them time to consider the procedure and access a safe and reliable service.

Male circumcision or the removal of the foreskin holds a deep spiritual significance in Judaism and Islam. The Judaic origins are reflected in our language as no other part of the human body is afforded a negative prefix, as in ‘uncircumcised.’

A better understanding of foreskin problems and the use of steroid creams for phimosis have led to a decline in the operation for medical reasons (Naguib et al, 2012; Hutson et al, 2015). However, the development of a more ethnically diverse society has led to an increasing demand for non-therapeutic circumcision (Stringer and Brereton, 1991). Sadly, the complications caused by unregulated practitioners documented by these authors have continued, with increasing concerns regarding sterility and infection control (Paranthaman et al, 2011; Poole, 2014). In England, community-based circumcisions have resulted in two recent tragic deaths, which involved unqualified personnel, poor communication and the failure to appreciate the dangers of continued blood loss (Fogg, 2012). Scotland has attempted to resolve such problems by requiring midwives to ‘ask all parents’ about circumcision at antenatal booking, ‘rather than presume someone's religion or belief’ (The Scottish Government, 2008). Religious circumcision is then offered free of charge under a general anaesthetic between the ages of 6 and 9 months (The Scottish Government, 2008). However, most approved services in the rest of the UK usually consider local anaesthesia up to 6 months of age as perfectly safe (Hutson et al, 2015). Midwives can help significantly by ensuring that information relating to such recognised providers is widely available.

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