What’s your stance on circumcision?

Pro Circumcision by Astrid Van Den Broek

“The thing is – people of your socioeconomic status really don’t do that anymore.” 

I sat open-mouthed, trying to get my infant son to open his mouth and nurse. My mouth was gaping at the doctor’s response to my request about circumcision. Gross presumptions about my socioeconomic status aside, what I failed to point out to her thanks to my bleary, mom-of-a-newborn state was that circumcising was not some thoughtless decision. Who would inflict that kind of pain on a baby without sound thought behind it?

No, my husband and I decided long before we knew we had a boy that if we had one, we would have him circumcised. We talked to friends about how their sons handled it and got tips on how to ease our baby’s pain. 

The decision wasn’t based on religion – Jewish boys, for instance, are traditionally circumcised – but on health reasons. As the World Health Organization reports, “Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percent.” While that was the predominant health concern that guided our decision, we found other benefits as well: circumcision also lowers the chance of boys developing urinary tract infections (UTIs). It helps prevent penile cancer if the boy is circumcised in childhood. And it makes it easier to wash and keep the genital area clean.

According to a 2013 study in the journal Canadian Family Physician, of the 230 parents surveyed, almost 62 percent of parents supported circumcision for hygiene reasons while the second highest reason was preventing infection and cancer. So with all of those positives piling up, how could we not give our son all the health benefits he deserves?

Con Circumcision by Kristi York

The Canadian Paediatric Society’s position statement on circumcision is clear and decisive: “Circumcision of newborns should not be routinely performed.” An article from their parent resource site, Caring for Kids, explains that “Circumcision is a ‘nontherapeutic’ procedure, which means it is not medically necessary.” 

Necessity was the deciding factor in the case of my oldest son. He spent the first week of his life in the neonatal intensive care unit. He had an IV in his head, a feeding tube and multiple vital-sign monitors on his body. When we were finally able to bring him home, my husband and I firmly felt that he had been through enough. We had no personal, cultural or religious factors swaying us either way. We simply couldn’t fathom putting our baby through another painful procedure unless it was absolutely essential.

We heard about vague “hygienic reasons”, but in our minds, that wasn’t enough to justify circumcision. Dr. Michael Dickinson, a pediatrician in Miramichi, N.B., confirms: “Care of the uncircumcised penis is not difficult or complicated. For the first few years of life, typically nothing special needs to be done – simply soaking in the tub is sufficient.” 

Another common issue is “matching” Dad. Dr. Dickinson says, “After 20 years in practice, I have yet to meet a child or young man who was upset or traumatized because his penis was different than his father’s. Most boys couldn’t tell you if their father was or wasn’t circumcised.”

When our second son was born four years later – this time without complications – we opted to leave him “as is” as well. After all, our instincts had already led us to a decision that turned out to be endorsed by pediatricians across Canada.

Dr. Courtney Manser, a family physician in Ontario’s Niagara region, weighs in:

When deciding whether or not to recommend a medical procedure, a physician must first carefully weigh the risks and benefits.

Circumcision is not a risk-free procedure as it carries with it a 0.2 to 2 percent risk of complication (most notably that of infection).

The most studied benefit of circumcision is a reduction in urinary tract infections (UTIs) in infancy from 1 to 2 percent in non-circumcised infants to about a 0.1 percent risk of UTI in circumcised infants.

Since the risk of getting an infection from the circumcision procedure is similar, if not slightly greater than the risk reduction in UTIs, this benefit is not great enough to recommend it to the general population.

Some studies have shown a reduction in HIV transmission as well as a reduction in penile cancer among circumcised males, however, neither of these topics are well studied and the discussion surrounding them is not straight forward.

In Canada, the HPV vaccine, Gardasil, can help protect against penile cancer if that is a parent’s concern. In some instances, circumcision may be recommended in infants who have an increased risk of UTIs, such as those born with a condition known as posterior urethral valves. However, the Canadian Paediatric Society does not currently recommend circumcision as a routine newborn procedure.

 

Originally published in ParentsCanada magazine, May 2014.