Circumcision Informed Consent - FOI Response Register

As part of my ongoing research into circumcision within the Scottish NHS, I require details into the following:

1. There are four main styles of circumcision:

• High & tight circumcision

• High & loose circumcision

• Low & tight circumcision

• Low & loose circumcision

Please indicate if patients, or in the case of pediatric patients the parents, are informed about the different styles of circumcision and the benefits/negatives of each.

No

2. There is evidence to suggest that surgeons working in the NHS are defaulting to a High & Tight circumcision style which removes not only the entire foreskin but also some penile shaft tissue. This can commonly lead to uncomfortable erections and pubic skin and hair being drawn up the shaft of the penis. Please state the rationale for this given that Low & Loose circumcisions preserve more erogenous tissue and are commonly performed in continental Europe without the negatives associated with more radical circumcisions.

High and tight circumcisions are not performed in NHS Shetland

3. Are all surgeons properly trained in the aforementioned styles of circumcision to the extent that they are able to perform them competently?

Not formally

4. Are patients also informed that partial circumcision may also be an option? An important consideration given that some ethnic communities, specifically Hindus, object to radical circumcision given its association with Islam and may decline treatment if only radical circumcision is offered.

No unless patient/relatives ask

5. Are patients/parents properly informed as to the nature of the foreskin, it’s role in sexual function, and that circumcision may result in significant loss of sensitivity to the extent that it may result in difficulty climaxing or anorgasmia?

No

6. Are patients informed that circumcision could result in severe psychological destress and has been associated with at least one highly reported suicide in recent years?

No

7. Are patients sent a follow up survey to ascertain levels of satisfaction, effect on sexual function, or presence of regret? If not, how is patient satisfaction monitored?

No, Not monitored

8. Where male patients are diagnosed with a condition such as Lichen Sclerosis but wish to avoid circumcision are they given the option of a referral to dermatology or must they specifically request it?

Alternatives would be discussed if the patient indicated concern

9. Given that Lichen Sclerosis is now understood to be an autoimmune condition triggered by an adverse reaction to urine, what immunosuppressive medications (both topical and systemic) are potential options when potent topical steroid creams have failed to control symptoms adequately?

Refer to dermatology if appropriate