Making the Cut |
No easy answer in circumcision debate
It used to be a simple choice. If dad was cut, chances are the kid would be too. Today, though, the circumcision issue has become for many a medical and ethical minefield.
“I know people who do and I know people who don’t,” says Linda Lewis, editor of Today’s Parent magazine.
“Certainly we get lots of letters when we publish articles on it. It’s a really hotly contested topic.”
Circumcision in Canada has been on the wane for years, but since no agency tracks circumcisions performed outside hospitals — and most are done in doctor’s offices or private homes — determining the rate of decline is a matter of guesswork.
“It’s not in freefall, that’s clear, but the rate has been declining,” says Dr. Robin Walker, of the Canadian Paediatric Society (CPS).
“It’s safe to say that it’s not as routine as it was.”
According to the CPS, circumcision is still often performed in Western Canada and Ontario. Historically less common in the Maritimes, the procedure is now almost non-existent there.
Parents may decline circumcision for a number of reasons: Concern about possible complications, including bleeding, scarring, infections and excessive skin removal; fear that removal of the foreskin will reduce sexual sensitivity later in life; or simply because they have to pay for it, since it’s no longer covered under any provincial health care plan.
Most doctors agree circumcision lowers the risk of urinary tract infections and penile cancer, but as Walker points out, penile cancer is extraordinarily rare — occurring in around one in 100,000 men. Infections are also rare and easily treated.
Robin Gayley and her husband, Roland, are two Calgary parents who chose not to circumcise their son, Rowan.
“I guess for us it was just that it’s unnecessary,” she says.
Roland is circumcised, but Gayley says that didn’t factor in their decision.
“I don’t think it’s necessary for a child to look like his dad,” she says.
“The kid will understand... I think a major reason people circumcise is just that some moms don’t know how to deal with the foreskin, they don’t know how to clean it and take care of it and how to educate their sons to.”
Besides, she adds, if Rowan decides he does want to be circumcised one day, he can make the decision himself.
“We understand that view,” says Walker. “There are people who say that doing it on a baby, even with parental consent, may not be ethical. I know that physicians’ colleges in B.C. and Saskatchewan have come out somewhat strongly against the practice, partly for that reason.”
Indeed, The College of Physicians and Surgeons of Saskatchewan issued this strongly worded 2002 memo: “Infant male circumcision is often treated as a very minor procedure with virtually no risk of significant complications. That is frankly not true.”
The memo cited a 1993 study in the British Journal of Surgery putting the complication rate between 2% to 10% (most of which are minor), a rate critics say mitigates any benefits.
On the other hand, the CPS’ own current statement is more moderate, stating the benefits and harms are too evenly balanced to recommend routine circumcision, but for the same reason they don’t recommend against it.
“(Parents’) decision may ultimately be based on personal, religious or cultural factors,” it reads.
Dr. Stephen Wainer, a pediatrician at the Peter Lougheed hospital, feels many people are giving the issue more attention than it’s worth.
“In the greater scheme of things, it’s a trivial issue,” says Wainer, who routinely performs circumcisions.
CIRCUMCISION
THE PROS
- Reduces risk of urinary tract infections.
- Reduces risk of contracting STDs (still under debate. A recent study in South Africa found that circumcision may reduce HIV transmission, but the study was not completed.)
- Reduces risk of penile cancer.
THE CONS
- The foreskin is densely packed with nerves and blood vessels and forms a protective covering over the head of the penis. It also provides lubrication. Many advocates claim that removing it therefore reduces sexual sensitivity.
- Circumcision has led to complications from excessive bleeding and infection in the past. But many say that complications resulting from circumcision are far fewer than those averted by it.
VOLUME CIRCUMCISIONS
Beyond the medical debate, circumcision is still a requirement of many religions and cultures.
For instance, the nearly two-year-old son of King Mohammed was circumcised earlier this year in Morocco, prompting thousands of countrymen to also go through the procedure in a massive show of solidarity for the prince.
Some 5,000 boys were circumcised in Casablanca, Morocco’s largest city.
