Circumcision UK

Est: August 2012

Circumcision - About

I first became interested in this subject in 1994 when I saw a video taken by my brother of his 6 year old nephew being circumcised in Morocco. It would help for me to explain that my brother is married to a Moroccan lady and spends an equal period of time in the UK as he does in Morocco and that as a professional photographer and cameraman is known to be fixated, much to the annoyance of his family, with recording everything that moves!

In this video I saw a young boy enter a room flanked by his family, smiling and clearly proud of himself, knowing that this was an important day for him. His trousers were removed and as he sat on his father's lap, his legs were gently held apart. The lay circumcision practitioner sat in front took hold of his penis, pulled the foreskin forward using his left hand, clamping it with his fore and index finger, carefully checking to make sure the glans was securely behind and manoeuvred his right hand with a new razor blade across the front of his clamped fingers, slicing off the foreskin and immediately wrapping a gauze bandage firmly around the tip of the penis.

This whole procedure, which was carried out without anaesthesia, took less than a minute and was over before the child was able to get more than a little distressed. Naturally at the point of 'cut' the child began to cry but before he knew it he was all bandaged up and in the arms if his parents being congratulated by his kinfolk and by the time he had finished putting his trousers on he was seen proudly smiling again as he John Wayne'd his way out of the room.

Since then I have seen several procedures carried out by medically qualified surgeons where local or general anaesthesia has been used. In most cases I have seen children experience more distress and procedures have taken significantly longer and in a less comfortable atmosphere. I have asked my brother to give me a copy of that video and if and when he does I hope to share it with you.

I am not quite sure why the viewing of this video sparked an interest in me. It could be that having been circumcised as a child I hadn't thought much about the subject, accepting it as a natural part of my childhood. It could be that I was impressed with the skill, simplicity and eloquence with which the lay circumcision practitioner performed the procedure within the context of the ceremonial setting, allowing the child to go through this experience with minimal trauma, feeling a proud participant. It could be that I was alarmed that a child underwent such a procedure without any form of anaesthesia, or it could simply be my analytical mind which wondered if there may be an easier, better and or less painful or painless way to perform circumcisions. In retrospect having learnt a little more over these past few years, I can't imagine how I could have wondered that I could come up with anything simpler than what I saw, but I have come across anaesthesia techniques not all of which are universally practiced.

Back then when I first saw the video I recall discussing it with my other brother who is a UK trained medical doctor. I was surprised to learn that in general the medical community in the UK are opposed to elective (non medical) circumcision and even so consider it only as a last resort. Circumcision is one of a handful of elective procedures not allowed / offered on the NHS.

Furthermore circumcisions carried out by most medical practitioners, certainly those within the NHS for medical reasons are rarely carried out on babies and young children. When carried out in older children and adults they tend, in most cases, to be complex procedures, usually involving general anaesthesia, taking over an hour and in some cases inpatient care which in itself brings along a whole host of additional complications.

Over the past several years I have explored the subject on and off and thought through several ways in which to improve the procedure, reduce complications and make it more cost effective whether carried out for medical, religious, ritual, social or cosmetic reasons.

Suffice it to say that since circumcision is as old as time (arguably one of the oldest surgical procedures known to man) my research has found that most if not all possible techniques have in one way or another been tried and tested. Some techniques are simple as described above and are commonly practiced by lay practitioners from the Jewish and Muslim communities and some are incredibly complex. However like all surgical procedures they carry risks of one form of complication or another. In general the more complex the procedure the higher the risk and number of complications. Interestingly the type of risks also vary between lay and medical practitioners and between elective and non elective procedures with the most serious complication ie death, only ever being reported in procedures carried out within a medical setting ironically a result of general anaesthesia rather than the procedure itself.

Whilst some procedures have become standard in one group or another no common or shared set of standards exist or are promoted across the different groups or nationally.

I have also learnt, and this was a real surprise to me, that circumcision is a hotly debated subject with some people and groups vehemently against even just the idea of circumcision using emotive words such as 'male genital mutilation'. These anti circumcision groups have managed, at least in the UK, to lobby and control discussion of the subject potentially censoring what I see as important sexual health education and screening. These groups are also trying to affect parents' ability to exercise their obligations and rights to bring up their child within the context of their cultural and social values and individuals from exercising their right for self determination. On the other hand there are those who are pro circumcision and appear to behave defensively against the anti circumcision group and have not (as far as I can see) set up a framework which will allow these two groups to come to the table to promote dialogue and corporation. One group argues their point against, whilst another argues their point for, completely independently, and the central and political organisations stay clear of what has become a taboo subject.

I guess the big question in this emotionally charged arena is 'are there any areas where both the anti and pro groups agree?' I believe there is and I list them below;

1. Dialogue and open discussion of this subject which has in most circles become 'taboo'. This will benefit and improve cross platform collaboration, sharing of information and ultimately provide better resources for the consumer.

2. Health education of adults and children from both genders, parents, schools and indeed medical professionals. This must include providing access to detailed, objective information of all the indications for and against circumcision, all known current procedures and the pros (benefits) and cons (complications) of undergoing circumcision. This will improve knowledge and help care givers guide consumers towards making informed choices.

3. When and if a decision to proceed has been made the parent, guardian or patient should be able to exercise their right to choose whether to have the procedure through the NHS or private sector.

4. National standards should be published which allow consumers to measure and gauge providers skills and services.

5. Such providers should be appropriately trained and experienced so that parents, guardians or patients have access to quality healthcare, counselling and support.

The question of regulation is a tricky one because there are benefits and problems with both central regulation and self regulation.

The way the law works in the UK makes it virtually impossible to completely regulate a procedure, discipline or professional activity. Doing so will simply create groups that fall within regulation and feel ever strangulated by it and other groups that continue to provide an 'underground' service outside the scope of regulation.

This situation does not benefit the consumer in either situation as those that fall within the scope of regulation are likely to be more costly and those that fall outside the scope of regulation are likely to have less accountability.

Central regulation would also face a further challenge in that a large proportion of circumcisions are carried out for religious reasons (not to mention cosmetic and social) and these social groups do not lend themselves to regulation nor should they.

Personally I am in favour of continuing with self regulation and setting up structures that support it ,the most important element of which, is raising consumer awareness and consumer support rather than regulating a discipline, profession or group.

The next tricky question is whether to choose a lay or medical practitioner. At the time of writing this article I was unable to find any evidence to show that one is better off choosing a medical practitioner versus a lay practitioner. Infact if the video I referred to above has anything to go by, then often the medical route could arguably be an overkill and may well be more complicated than is necessary. Right now my knowledge about this whole subject is in its early stages and I don't feel qualified to make a judgement either way. However what I am prepared to say on this point, is that excepting the rules if cleanliness, sterility and medical issues the procedure is little more than a technique and there are no additional benefits gained from a medical practitioner versus a lay practitioner. In fact one may argue that a lay practitioner is more skilled as he will be more experienced than a medical practitioner who on the whole is unlikely to be spending all his time performing circumcisions. When I say this I don't advocate one group of practitioners over another. Rather what I am trying to say is that seeing a practitioner who has a medical qualification may not necessarily mean that you are likely to receive the best or most appropriate procedure so long as such a practitioner has considered the cleanliness, sterility and medical issues of your case.

A friend of mine once told me that the best way to regulate is to 'hit them in the pocket where it hurts'. For better or worse he is right because money talks.

Inform and educate the public and caregivers and allow the consumers to make an informed decision. If a particular caregiver is not providing an appropriate service or procedure a well informed and educated consumer will make an elective decision to go to someone who is better or consider alternatives to circumcision! Providing the service on the NHS will also help by ensuring that most procedures are carried out within the 'fold of healthcare services' where they may be indirectly regulated by ensuring best practice.

Finally I have read several websites for and against circumcision and each of them make several citations to clinical and anecdotal studies. At the time of writing this article no references were given and no copies were published due to 'copyright issues'. My feeling is that if you wish to have your opinion taken seriously then publish your evidence openly so that it can be independently scrutinised by the reader. Notwithstanding that I believe further independent work should be carried to enhance our medical and social knowledge on this important medical and social subject.

I remain hopeful that even the best technique or set of procedures available today may be improved upon and feel even more convinced that this subject needs to be discussed openly in all walks of life, in all cultural and social groups and all political and professional arenas. I would like to play my part in bringing this about whether it be as an inventor of a new procedure or a facilitator of dialogue and collaboration between these groups to objectively debate their views for and against circumcision.

Finally although I initially set out to provide objective information to promote circumcision I have now decided to establish an independent organisation which allows the objective promotion of both views and support providers and consumers - those who are seeking information about circumcision, those who wish to undergo, those who decide not to and those who have undergone and are seeking support for positive or negative outcomes. So I extend an invitation to all who wish to become part of this exciting project of bringing circumcision onto the mainstream agenda

Firoz

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