Via its website, the NHS provides advice to the public about a variety of health conditions. Regarding labiaplasty, the NHS³¹ states that ‘it should not be done on girls younger than 18’
The reason given is ‘because the labia continues to develop beyond puberty and into adulthood’.

Regarding circumcision in boys, the NHS³² states that ‘it is a relatively simple procedure’, and that ‘it is rare for circumcision to be recommended for medical reasons in boys’. There is no indication given that there may be similar concerns about the future growth and development of a male child's genitalia as those described above for children with female genitalia.

Postponing labiaplasty until adulthood is strongly recommended to help adolescents achieve a well-informed decision regarding an irreversible procedure with possible adverse esthetic and functional outcomes’.

For patients lacking capacity, doctors must take the action, ‘least restrictive of the patient's rights and freedoms including their future choices’ and plan for foreseeable changes in capacity. Also, that ‘if [doctors] don’t have consent or other valid authority on which to carry out a particular intervention, [doctors] must not proceed with it” except in an emergency.
The GMC decision-making and consent guidance is consistent with the GMC's core guidance—Good Medical Practice³⁸—which advises registered doctors that they must:- ‘Make the care of [their] patients [their] first concern’;
- ‘Prescribe drugs or treatment … only when… satisfied that this serves the patient's needs’;
- ‘Provide effective treatments based on the best available evidence’.
The updated guidance begins: ‘Shared decision-making and consent are
fundamental to good medical practice’. Doctors are required to:
- ‘Respect [their] patients’ views about health’;
- ‘Ensure that decisions are both informed and voluntary’;
- ‘Be aware of other situations in which patients may be particularly vulnerable or susceptible to pressure’.

The final paragraph of this section reiterates the selective focus by the GMC on MUPC. Doctors are instructed to offer parents the opportunity to ‘invite their religious adviser to be present during the [religious circumcision] procedure’. In the absence of any associated discussion of possible child safeguarding considerations, this overtly permissive advice (on MUPC) appears to be in conflict with the official GMC position that it has no ethical position on MUPC

The phrase “best interests” appears over 50 times in the BMA toolkit which states that ‘Doctors must act in a child's best interests’ and that ‘parental preference alone does not constitute sufficient grounds for performing [MUPC] on a child unable to express his own view’. Yet the balancing test recommended by the BMA guidelines to assess a child's best interests in this matter, pits child-centred factors against parental factors. Parental factors regarding MUPC will inevitably relate to the cultural or religious preferences of a child's family. The result is that ‘parental preference alone will have sufficient force to neutralise all other child-centred items on the list’. The BMA's best interests test – a test, moreover, which underpins its whole guidance – is ‘therefore incoherent’.³⁶

The 2019 BMA NTMC toolkit introduced two changes (in italics below) into the section on medically necessary circumcision. The BMA continues to regard as unethical, circumcision solely for medically necessary reasons where less invasive approaches are available. However, when a parent desire this (solely medically necessary) surgery for social and cultural reasons the BMA no longer regards this as necessarily unethical.

The BMA guidelines assert that: ‘Male infant circumcision does not require a medical professional’.^k Here, not only are the usual requirements for safe surgical care omitted, the usual safeguarding concerns are considered neither relevant nor necessary.The BMA had been made aware of the serious, sometimes life-threatening complications from infant circumcision, occasionally reported in the UK media some of which have only come to light through freedom of information requests.⁴⁸ Yet the word ‘safeguarding’ appears only once in the BMA toolkit, specifically in the context of FGM.

Yet before the motion was put to vote, the medical ethics committee chair announced⁵⁴ to the meeting: ‘I would like you to disregard Dr Lempert's interesting comments’ – he was alleging that what I had said was not relevant to this motion. When I later asked him why he had spoken out in this way, he replied that some people hadn’t liked what I had said.

As a teenager from the Leeds Jewish community, I studied Judaism and Hebrew, attaining an A level in Classical Hebrew. I consider myself neither religiously nor culturally Jewish, despite the fact that Jewish authorities consider to be Jewish a child born to a Jewish mother (as I myself was), regardless of that person's later beliefs.