Circumcision: Yes or No?

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Increasingly, the answer is ‘no’ when it’s a question about circumcising your newborn baby boy – a process that removes the foreskin covering the head of the penis and part of the shaft. The discussion is happening in many places, including the living rooms of parents-to-be and the corridors of medical practices.

Dr. Robin Walter, Halifax-based past-president of the Canadian Paediatric Society (CPS), is in the ‘no’ camp. He says the CPS’s long-held position is based on medical and scientific research that showed no evidence to support circumcision as a ‘medically necessary procedure’. Walker says circumcisions were traditionally a cultural issue with parents choosing the procedure for their sons based primarily on whether the fathers were circumcised themselves. Nevertheless, the percentage of baby boys going under the knife has fallen significantly in recent years as every provincial medicare system across the country has removed it from funded medical procedures.

“In Ontario, two-thirds of boys used to be circumcised, now it’s less than one-third. It’s rarely done east of Quebec. It used to be a boy who wasn’t was the exception, now it’s the reverse,” says Walter. Figures from the American Academy of Pediatrics (AAP) back up his claims. In 1970 it was estimated that between 69 percent and 97 percent of all boys and men in the U.S. had been circumcised, compared to 48 percent in Canada and 24 percent in the United Kingdom. The procedure is rarely performed in northern European countries, Central and South America and Asia.

One of the reasons Walker is anti-circumcision is the tiny risk of complications resulting from the surgery. “A little bit of bleeding or infection is relatively common. Serious complications are rare,” he says.

New evidence shows the possibility that certain sexually transmitted diseases, such as HIV, may be harder to pass on when a male is circumcised. However, Walker says that research should carry more weight in places such as sub-Saharan Africa where education regarding the use of condoms has been relatively ineffective.

“In North America, it’s probably not reasonable to suggest that millions or billions of dollars of public funds should be spent when we have largely effective education measures on condom use,” he says.

Dr. Maggie Morris, an obstetrician gynecologist at Women’s Hospital at Health Sciences Centre in Winnipeg, says circumcisions haven’t been performed there for years. But if parents request one for their baby boy, they’ll provide a list of physicians and sites where they can get it performed. “It will be done outside the hospital and there will be a tray fee charged. Twenty years ago you could have had it done in hospital at no charge,” she says.

Circumcisions aren’t just a personal choice, they are also a right of passage in some religions. For Jewish people, the bris is a ceremony to welcome infant boys into a covenant between God and the children of Israel on the eighth day of the child’s life. It is followed by a celebratory meal.

Unnecessarily inflicting pain on a helpless baby is one of the major arguments against circumcision. Walker says if the decision to circumcise is made, he strongly recommends the use of a local anesthetic to avoid both short- and long-term pain for the baby. “It’s a simple thing to provide and should always be given. There’s no justification for causing the kind of extreme pain it causes in newborns,” he says. Walker says research has also shown that boys who are circumcised without an anaesthetic have altered perceptions of pain for the rest of their lives. “They will feel pain worse than those who had an anaesthetic. That’s not a small thing,” he says.

Morris says while circumcision can cause pain or trauma to the baby, “they seem to forget about it quickly and go back to what they were doing.”

Morris notes many baby boys achieve a small measure of payback with the doctor by peeing on them during the procedure. “That happens all the time,” she says.

Grant, a 42-year-old from northern Ontario, made sure his son was circumcised. “I was one of the unlucky statistics.” When Grant was in his 30s, his foreskin began to, literally, strangle his penis. “I had paraphimosis. My foreskin could not be retracted at all. I began to have trouble urinating and intercourse was out of the question. I ignored it for a while and tried to stretch it back, but then I ended up in emergency to have a circumcision.” Grant admits the whole ordeal was traumatic and rarely discusses it, but he was adamant that his sons would not go through what he had.

When evaluating whether to circumcise an infant, it’s difficult for parents to look far into the future and consider how their decision will affect their son’s sex life. Sue, a single, 37-year-old woman in Calgary, says she prefers the unsnipped version. “I’m pretty sure I’m in the minority. The majority of my long-term relationships have been with uncircumcised men. I’m comfortable with an uncircumcised penis. My first boyfriend was uncircumcised. It was the first thing I knew,” she says. Sue says it’s also her experience that uncircumcised men have a greater enjoyment of sex. “Whenever I enter into a relationship and if and when it enters the sex stage and I find he has an uncircumcised penis, I’m excited. I find it a lot easier to pleasure a man who is uncircumcised in terms of oral sex because there’s skin that moves,” she says.

Sue doesn’t understand the “like father like son” justification for deciding in favour of circumcision. “Do you sit around with your son when he’s older and naked and compare? Guys don’t do that,” she says. But Jennifer, a divorced mom of two boys had them both circumcised. “I know I had a hard time performing oral sex on a partner who wasn’t circumcised, and I asked my friends who agreed,” she says. “I just didn’t want either of my boys to experience rejection when they’re older.” Jennifer’s ex-husband wasn’t circumcised, and so it was a bone of contention between them. “When he realized he wasn’t getting ‘it’ as often due to my aversion, he relented for the boys. I’m sure it hurt his feelings though.” But, Jennifer wonders, with so many uncut males now, will her boys be the minority?

Either way, it’s a decision parents need to discuss before a baby is born.

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