Date published: 20 March, 2026
Date last updated: 20 March, 2026
Armed forces, Commissioning, Specialised commissioning

Clinical commissioning policy – urology and gynaecology procedures

Circumcision

The clinician proposing this intervention is not required to secure prior approval from the Armed Forces Health Commissioning team and can proceed with treatment if the criteria in the relevant policy are met.

Adult penile circumcision for personal, social, cultural and religious reasons is not routinely funded by the NHS England Armed Forces Health Commissioning team.

Policy: Adult penile circumcision is considered a low priority treatment and will only be provided for a small number of therapeutic reasons in line with these guidelines.

Absolute indications for circumcision

  • penile malignancy, or
  • traumatic foreskin injury where it cannot be salvaged, or
  • prevention of urinary tract infection in patients with an abnormal urinary tract, or
  • balanitis xerotica obliterans, or
  • persistent phimosis in children approaching puberty, or
  • recurrent balanoposthitis, and
  • formally documented discussion of the risks and benefits of foreskin preserving surgery versus penile circumcision using a shared decision-making framework

Medical indications for circumcision for adults (over age of 18 years)

  • balanitis xerotica obliterans (BXO) (chronic inflammation leading to 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
  • phimosis in adults leading to paraphimosis or difficulties in erection.

The clinician proposing this intervention will make the decision to treat based on the criteria set out above.

If the patient does not fully meet these criteria the clinician may submit an application for exceptional funding.

Penile Circumcision for children and young people under 16 years

Refer to EBI Penile circumcision.

Female circumcision

Female circumcision is prohibited in law by the Female Genital Mutilation Act 2003 and is the subject of multi-agency guidelines from the Department of Health and is not commissioned.

Evidence base

Vasectomy

Vasectomy under local anaesthetic

The clinician proposing this intervention is not required to secure prior approval from the Armed Forces Health Commissioning team and can proceed with treatment if the criteria in the relevant policy are met.

NHS England will fund vasectomy under local anaesthetic when the following criteria are met:

  • the patient understands that the vasectomy is permanent and irreversible, and the reversal of sterilisation operation would not be routinely funded by the NHS, and
  • the patient is certain that their family is complete, and
  • the patient has sound mental capacity for making the decision as emotional instability or equivocal feelings about permanent sterilisation are contraindications to vasectomy, and
  • the patient has received counselling about the availability of alternative, long-term and highly effective contraceptive methods and these are either contra-indicated or unacceptable to the patient, and
  • The patient understands that sterilisation does not prevent or reduce the risk of sexually transmitted infections, and
  • the procedure will be carried out in a primary or community care setting under a local anaesthetic, using a non-scalpel method where possible (Faculty of Sexual and Reproductive Healthcare, 2014), and
  • patients are advised that after a vasectomy procedure they will need to use effective contraception until Azoospermia, an absence of spermatozoa, has been confirmed by two consecutive semen samples with no spermatozoa seen.

Patient should also be aware that there is a risk of failure of this procedure. The failure rate of vasectomy (i.e., the presence of motile sperm in the ejaculate post-vasectomy) is 0.05%.

If there is no primary or community care setting locally available for patients, the procedure should be carried out in a secondary care setting under local anaesthetic. 

Patients who have undergone a vasectomy would not qualify for NHS England Armed Forces health funded fertility treatment in the future, even if the procedure has been successfully reversed. Vasectomy reversals are not routinely funded by the NHS.

If the patient does not fully meet these criteria the clinician may submit an application for exceptional funding.

Vasectomy under general anaesthetic

The clinician proposing this intervention is required to secure prior approval via Blueteq from the Armed Forces Health Commissioning team.

Patients who require a vasectomy under general anaesthetic must meet one of the following criteria:

  • anatomic abnormalities, such as the inability to palpate and mobilize both vas deferens or large hydroceles or varicoceles; or
  • past trauma and scarring of the scrotum; or
  • acute local scrotal skin infections; or
  • electro-surgery in contraindicated in certain types of pacemakers.

Patient anxiety or fear of the procedure is not considered in an application for funding as there are alternative methods of effective contraception.

Evidence base

Reversal of sterilisation

Whilst reversal of sterilisation can be an effective procedure, sterilisation is undertaken with permanent intent. Patients seeking sterilisation should be fully advised and counselled (in accordance with Faculty of Sexual and Reproductive Healthcare and Royal College of Obstetricians and Gynaecologists guidelines) that the procedure is intended to be permanent.

NHS England does not routinely commission surgery to reverse the effect of sterilisation or treatment to bypass the sterilisation.

Individual Funding Requests (IFR) for those with exceptional circumstances are rare. People in a new relationship does not constitute exceptionality. IFR can be considered when a couple or an individual requests restoration of fertility following the death of their only living child under 18 years of age and there are no other concerns about the anticipated fertility of the patient or their partner.

Evidence base

Insertion of intrauterine system/device (IUS/D) including Mirena Coil in secondary care

The clinician proposing this intervention is not required to secure prior approval from the Armed Forces Health Commissioning team and can proceed with treatment if the criteria in the relevant policy are met.

NHS England will fund IUS/D fitting in secondary care subject to the following commissioning criteria:

  • documented evidence of a specific medical issue e.g. hysteroscopic investigation/treatment or to manage risk such as hyperplasia, that prevents fitting or removal by primary care; or
  • documented evidence of one or more failed attempts to fit / remove in primary care; or
  • it is to be fitted as part of contraception provided in conjunction with termination of pregnancy, or as part of family planning services; or
  • the decision to fit an IUS/D is made as part of an operative procedure

NHS England does not fund:

  • IUS/D insertion in primary care settings

IUS/D insertion should be undertaken within DPHC primary care practices. Provision is available within MOD regions through DPHC clinical networks and cross referrals across regions. Where DPHC provision is not available referrers should explore NHS contracted GPs with Special Interests (GPwSI) through the Electronic Referral Service (ERS).

Evidence base

Labiaplasty, vaginoplasty and hymenorrhaphy

The clinician proposing any of these interventions is required to secure prior approval via Blueteq from the Armed Forces Health Commissioning team.

Labiaplasty

A labiaplasty is a surgical procedure to reduce the size of the labia minora.

Labiaplasty is not normally funded by NHS England.

Labiaplasty is generally an aesthetic procedure to improve appearance alone and is not normally funded. Requests for labiaplasty will be considered only for the following indications:

  • where repair of the labia is required after severe physical trauma; common consequence of childbirth will not be sufficient reason; or
  • cancer; or
  • significant congenital malformation (this would not include aesthetic issues such as large labia); or
  • endocrine abnormalities such as adrenal hyperplasia or Turners syndrome

Vaginoplasty

Non-reconstructive vaginoplasty or ‘vaginal rejuvenation’ is used to restore vaginal tone and appearance.

Vaginoplasty is considered an aesthetic procedure and is not normally funded by NHS England. Requests for vaginoplasty will be considered for the following indications:

  • congenital absence or significant developmental / endocrine abnormalities of the vaginal canal; or
  • where repair of the vaginal canal is required after trauma

Hymenorrhaphy

Hymenorrhaphy, or hymen reconstruction surgery, is an aesthetic procedure and is not normally funded by NHS England.

In accordance with the Health and Care Act 2022 it is an offence to carry out hymenoplasty (reconstruction of the hymen) with or without consent. It is also an offence to aid or abet a person to carry out hymenoplasty.

This policy does not relate to reversal of female genital mutilation (deinfibulation).

Gender dysphoria

This policy does not apply to genital reconstruction for gender dysphoria.

Evidence base

Further resources

  • Lloyd J, Crouch NS, Minto CL, Creighton SM. (2005) Female genital appearance: ‘normality’ ‘unfolds’. BJOG – An International Journal of Obstetrics and Gynaecology 2005; 112:643-646.
  • British Society for Paediatric & Adolescent Gynaecology (BritSPAG). Position Statement: Labial Reduction Surgery (Labiaplasty) on Adolescents (October 2013)
  • RCOG Ethics Committee (2013) Ethical considerations in relation to female genital cosmetic surgery (FGCS)
  • Moran C, Lee C. What’s normal? Influencing women’s perceptions of normal genitalia:an experiment involving exposure to modified and non-modified images. BJOG 2013; DOI: 10.1111/1471-0528.12578.
  • Bramwell R, Morland C, Garden AS (2007). Expectations and experience of labial reduction: a qualitative study. BJOG An International Journal of Obstetrics and Gynaecology 2007; 114:1493-1499.
  • Independent report – Hymenoplasty: background paper. Published 23 December 2021  
Date published: 20 March, 2026
Date last updated: 20 March, 2026