Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Foreskin Problems - Paraphimosis & Phimosis & Circumcision

Foreskin Problems - Paraphimosis & Phimosis & Circumcision

Consider IMMEDIATE referral if:

  • Paraphimosis does not respond immediately to management (For further information see Foreskin Problems, Paraphimosis, Phimosis & Circumcision pathway)

Consider referral under 2WW if suspicious of penile cancer: 

  • Balanitis with skin changes >6 weeks
  • Well defined raised lesions /ulceration

Consider routine urology referral if:

  • Recurrent balanitis
  • Pathological phimosis
  • Phimosis persisting after 2 years of age
  • Phimosis in patient aged over 2 years with recurrent balanoposthititis or UTI’s

Circumcision should only be funded by the NHS for medical reasons, and not for religious or social reasons. Please note that circumcision will only be routinely funded if the following criteria are met:

  • Pathological phimosis, with permanent scarring of the preputial orifice
  • Severe recurrent balanitis/ balanoposthitis
  • Exceptionally, recurrent febrile urinary tract infections in children with abnormal urinary tracts

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