Circumcision: indications

The indications for circumcision within the NHS framework remain relatively elusive to pinpoint for general practice. According to the "Interim Clinical Commissioning Policy, the following can be used as guidance for indications of circumcision.

Type of Indication	Specific Condition/Reason	Description/Notes
Absolute Indications	Penile malignancy	Cancerous growth on the penis.
	Traumatic foreskin injury	Injury is so severe that the foreskin cannot be preserved.
Medical Indications	Balanitis Xerotica Obliterans (BXO)	Chronic inflammation causes a rigid fibrous foreskin.
	Severe recurrent attacks of Balanoposthitis	Recurrent bacterial infection of the glans and foreskin.
	Recurrent febrile UTIs with an abnormal urinary tract	Frequent urinary tract infections are accompanied by urinary tract abnormalities.
	Phimosis in adults	Condition causing difficulties in retraction of the foreskin, which can lead to paraphimosis or erection difficulties.

Let us also review the NICE guidance on penile cancer

Criteria for Referral	Description
Penile mass or ulcerated lesion	Referral is considered when a sexually transmitted infection has been excluded as the cause.
Persistent penile lesion after treatment	Referral is considered after treatment for a sexually transmitted infection has been completed.
Unexplained or persistent symptoms affecting the foreskin or glans	Referral is considered for men with these symptoms to assess for potential penile cancer.

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