October 23, 2014
GPs being pressurised on infant circumcisionby Catherine Reilly
Some families are pleading with GPs to indicate pathological phimosis in an attempt to access circumcision for cultural reasons, according to a Specialist Registrar in Urology.
Dr Fardod O’Kelly told the Medical Independent (MI) that public hospitals generally only have provision for circumcision for pathological phimosis, for which there are “huge” backlogs for adults and children.
[Pathological phimosis is not a disease of children, since the foreskin may not be mobile until puberty. It seems doctors are already gaming the system.]
The HSE intercultural strategy acknowledged that early circumcision of infant males is an expected cultural or religious duty in some ethnic minority groups. However, due to lack of provision, some families are pressuring their GPs to indicate medical need.
“Some families would try to go privately to get [cultural circumcision] done because there are some surgeons that might have more space on their lists in the private sector,” Dr O’Kelly told MI. “Other families are trying to get primary care physicians to actually suggest there is a problem with the foreskin — that it is pathological — to get seen in the first place.”
Some had been successful in having their GP make a referral to an OPD to put forward their case. Dr O’Kelly said he did not envy the predicament of GPs on this issue, particularly given “they are under so much pressure themselves”.
He said there was also a danger that some families may turn to unlicensed individuals, as occurred in 2003, when a young baby of African background died following a ‘home cultural circumcision’ in Waterford.
[There is an equivalent danger of girls being genitally cut by unlicenced practitioners, but nobody thinks about providing that "service".]
More widely, provision of paediatric circumcision in Ireland is challenged by a trend towards its non-performance by younger consultant general surgeons, with it increasingly viewed as a urological responsibility, according to a paper Dr O’Kelly co-wrote in the Irish Journal of Medical Sciences (IJMS).
Dr O’Kelly said surgical sub-specialisation and gradual lack of exposure to paediatric surgery had meant that many newer general surgeons were no longer in a position to undertake the procedure, with the burden of cases left to urologists and paediatric surgeons, especially outside Dublin.
Significant manpower issues would be exacerbated by retirements of older, more classically-trained general surgeons, noted the IJMS paper.
Dr O’Kelly told MI that, ideally, paediatric circumcision could be performed on specific lists, under sterile conditions, by appropriately-trained surgeons and this did not necessarily have to occur in an acute hospital.
[Ideally, non-therapeutic paediatric circumcision would not be performed at all. Where are their ethics?]