Further good news from the UK regarding the doctor who was recently sentenced to more than five years for operating an unsafe child circumcision service. Dr. Alejandro M. Sanchez, a retired National Health Service physician and Human Rights Lead at the National Secular Society, published in the British Medical Journal the day before yesterday [January 21, 2025] a Rapid Response to the earlier piece that we announced regarding Mohammad Siddiqui.

A few key points that Dr. Sanchez makes:
1) Why are doctors permitted to excise erogenous tissue from the genitals of boys without medical necessity in the first place?
2) Why was a doctor struck off the list of authorized physicians able to keep circumcising boys as a non-physician?
3) Since Siddiqui was convicted of child cruelty related to a circumcision performed without anesthetic, surely other unanesthetized “religious” circumcisions should be similarly punished?

21 January 2025
Alejandro M. Sanchez
Human Rights Lead at the National Secular Society, retired NHS doctor
High Holborn, London

Dear Editor

Last week, former doctor Mohammad Siddiqui received a five-year custodial sentence after pleading guilty to actual bodily harm and child cruelty relating to the non-therapeutic circumcision of boys between 2014 and 2019 [1]. He has also pled guilty to administering prescription-only medicines.

He was struck off in 2015 for performing “botched and unhygienic” ritual circumcisions [2]. The Medical Practitioners Tribunal Service described his practice as “callous and completely unacceptable” [3].

Nonetheless, he was able to continue circumcising boys: there is no legal requirement for a circumciser to be medically qualified or registered [4]. Non-medical circumcisers are unregulated, meaning a child can be circumcised in non-clinical settings, with no medical documentation or follow-up.

The grim episode raises troubling questions. Firstly, why are doctors permitted to excise erogenous tissue from the genitals of boys without medical necessity in the first place?

Ritual circumcision may enjoy a presumed exemption from the law against wounding, but it violates well-established norms of child safeguarding – not least that children should be protected from medically unnecessary surgery.

If parents expressed a strong desire to surgically remove any other healthy part of their child’s body, doctors would rightly treat that wish as a safeguarding concern. There is no coherent reason this should not be the case when that body part happens to be the foreskin.

The law does not accept cultural or religion reasons as a defence against other forms of wounding of children: ritual scarification [5], ritual flagellation [6] and female genital mutilation [7] to name a few.

Unfortunately, permissive guidance from the GMC [8] and the BMA [9] provides cover for doctors to perform this ethically and legally anomalous procedure [10].

At least the latter admits: “the evidence concerning health benefit from NTMC [non-therapeutic male circumcision] is insufficient for this alone to be a justification”.

Circumcision is not a mere ‘snip’ of a ‘flap of skin’. The foreskin is a highly vascularised muco-cutaneous junction – akin to the eyelid or the lip – richly innervated with Meissner’s corpuscles, the same nerve endings which give the palms and fingertips their high sensitivity to fine touch.

Indeed, the NHS website lists “permanent reduction in sensation in the head of the penis, particularly during sex” as a complication of circumcision [11]. British Association of Urological Surgeons guidance concludes that reduced or altered sensation will affect ‘almost all patients’ [12]

A second question: if a doctor like Siddiqui is deemed no longer able to safely carry out a circumcision, why is that same individual is legally permitted to continue carrying out circumcisions as a ‘non-doctor’? This runs counter to all other legal, regulatory or safeguarding principles and practice.

There is no comparably invasive procedure that we allow non-doctors to perform. Yes, Surgical Care Practitioners exist but they will have some healthcare training, and are supervised by doctors.

Yet ritual circumcision is often performed in non-clinical settings without anaesthesia. A circumcision FAQ from the website of the Jewish Medical Association, a registered charity, states: “No formal anaesthesia is given routinely” [13].

To be explicit, this is not a call for the medicalisation of ritual circumcision: Circumcision is a surgery; surgery is inherently dangerous; surgeries should only be performed by doctors (or those under medical supervision), and – in the case of non-consenting children – only with medical necessity.

But it does raise a third, and final, question: if Siddiqui has seemingly been convicted of child cruelty related to an unanaesthetised circumcision, what of those other unanaesthetised religious circumcisions? Surely legal coherence demands they too fall foul of the criminal law.

References

[1] BMJ, 2025 – https://www.bmj.com/content/388/bmj.r94[2] The Mirror, 2015 – https://www.mirror.co.uk/news/uk-news/mohammed-siddiqui-doctor-struck-af…[3] Medical Practitioners Tribunal Service, 2015 – https://www.gmc-uk.org/api/gmc/lrmpdocuments/download?dr=5206776&documen…[4] Crown Prosecution Service, 2024 – https://www.cps.gov.uk/cps/news/former-surgeon-found-guilty-causing-harm…[5] R v Adesanya, The Times, 16-17 July 1974[6] The Guardian, 2008 – https://www.theguardian.com/uk/2008/aug/27/ukcrime.islam[7] s1(5) Female Genital Mutilation Act 2003[8] General Medical Council, 2013: Personal beliefs and medical practice – https://www.gmc-uk.org/-/media/documents/personal-beliefs-and-medical-pr…[9] British Medical Association, 2019: Non-therapeutic circumcision of children – practical guidance for doctors https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-…[10] Lempert et al., Non-therapeutic penile circumcision of minors: current controversies in UK law and medical ethics, 2023 – https://journals.sagepub.com/doi/full/10.1177/14777509221104703[11] NHS, 2022: Circumcision in men https://www.nhs.uk/conditions/circumcision-in-men/[12] British Association of Urological Surgeons, 2024: Circumcision https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Circumc…[13] https://jewishmedicalassociationuk.org/wp-content/uploads/2019/05/Freque…

Competing interests: Non-financial interests: The National Secular Society campaigns to protect boys from non-therapeutic circumcision until they are old enough to decide for themselves whether they wish to undergo the procedure.