Threshold

This procedure is subject to Clinical Thresholds and will be funded if the following conditions apply:

• Penile malignancy (Note: if penile malignancy is suspected, referral should be via a two week wait pathway for suspected cancer)
• Traumatic foreskin injury where it cannot be salvaged
• Recurrent paraphimosis
• Pathological Phimosis (eg 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

Circumcision is NOT FUNDED for:

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

Policy Exclusions: For patients not meeting the above criteria or where a treatment is not routinely funded, an application should be made to the IFR panel if the referrer considers that there are clinically exceptional circumstances.