A circumcision service for religious reasons

To review the results of a pioneering service introduced under National Health Service (NHS) cover, providing circumcision on religious grounds.

The service was offered to all male babies aged 6-14 weeks. Circumcision was carried out using the Plastibell technique under 1% lignocaine ring block/penile block anaesthesia. Between July 1996 and August 1998, 168 circumcisions were performed and assessed postoperatively by telephone enquiry, visiting at home by the nurse and review at the hospital if and when required.

Of the 168 babies, 31 required some follow-up care. In six babies the separated ring tracked back onto the shaft of the penis and had to be removed using a ring-cutter. Ten babies were referred for incomplete separation of the Plastibell ring; only two required removal, the rest of the rings detaching spontaneously within a few days. Two babies were reviewed for early separation of the ring and seven were reviewed for bleeding within 24 h of the operation. Two of these were immediately after circumcision, when the bleeding was seen to be from the torn frenulum. They were converted to a more formal circumcision without the Plastibell under the same anaesthesia. Surveillance with no intervention was required in the others, except one who needed a compression dressing. One baby had apyrexia, requiring antibiotics. Four babies had suspected wound infection but none was clinically significant. One parent remained dissatisfied and complained about the inadequate removal of the foreskin.

The aim of the service was to provide safe circumcision requested on religious grounds. The technique was simple and easily learned by nurses. Parents have generally been very satisfied and the complication rate was acceptable, with most problems occurring early in the series, suggesting an improvement with experience.