Penile Circumcision

Threshold

Norfolk and Waveney Integrated Care Board will only fund circumcision according to the following criteria:

• Traumatic foreskin injury where it cannot be salvaged.
• Recurrent Paraphimosis
• Pathological Phimosis (e.g. caused by Lichen Sclerosus or Balanitis Xerotica Obliterans)
• Balanoposthitis following failure of conservative management*
• Congenital abnormalities
• Recurrent Urinary Tract Infections in patients with an abnormal urinary tract
• Tight foreskin causing pain on arousal/interfering with sexual function.

For persistent phimosis in children approaching puberty, following an attempted a trial of non-operative interventions e.g. a six-week course of high-dose topical steroid. A prescription of this would not normally exceed three months and should have achieved maximal therapeutic benefit within this time. A topical steroid such as Betamethasone (0.025-0.1%) is commonly prescribed.

Penile malignancy (note: if penile malignancy is suspected, referral should be via a two week wait pathway for suspected cancer)

Circumcision is NOT FUNDED for:

• Healthy, non-retractile foreskin (physiological phimosis)
• Any non-medical circumstances such as religious or social reasons.

Note: Female genital mutilation is prohibited by UK Law.

*Conservative management includes simple bathing in the first instance with progression to topical steroids. A prescription for topical steroids would not normally exceed three months and should have achieved maximal therapeutic benefit within this time. Antibiotics would be of use in infective conditions (Siegfried et al 2003, Royal College of Surgeons 2013).

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case-to-case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.