Penile Circumcision (Removal of foreskin)

Threshold

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

• Phimosis (inability to retract the foreskin due to a narrow prepucial ring)
• Recurrent paraphimosis (inability to pull forward a retracted foreskin)
• Recurrent balanitis (inflammation of the glans) or balanoposthitis (inflammation of the glans and prepuce)
• Balanitis Xerotica Obliterans (chronic inflammation leading to a rigid fibrous foreskin)
• Dermatological disease (such as lichen planus or eczema) which is unresponsive to other treatment, where biopsy is required
• Recurrent febrile urinary tract infections due to an anatomical abnormality
• In children, the procedure will also be considered for ballooning of the foreskin or spraying of urine
• Traumatic foreskin injury where it cannot be salvaged
• Tight foreskin causing pain on arousal/interfering with sexual function

Nearly all boys are born with an unretractable foreskin, which as part of normal development gradually becomes retractile without the need for any intervention. By the age of 16, only 1% of boys have an unretractable foreskin. There are a number of non- invasive alternatives to treating retraction difficulties before circumcision is considered, such as treatment with topical steroids or manual stretching of the prepuce under local anaesthetic.

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.

*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.