UNDER THE KNIFE: Circumcision rates have fallen dramatically since doctors concluded there are no valid reasons to justify the procedure

By:  David Johnston
     Southamstar Network

Montreal  --  Six years ago, Christos, a 24 year old student at
Concordia University, went to a medical clinic and had his penis
circumcised.  He did it purely for cosmetic reasons.

"I'd get comments from females who thought an uncircumcised penis
was ugly," he says.  "And at the gym, most of the guys were
circumcised and the fact that I wasn't made me feel different.  I
didn't want to feel different."

Today, Christos regrets his decision.  Three months ago, he
joined a foreskin-restoration support group in Montreal.  Like
the 25 other participants, Christos is trying to restore his
foreskin by manually stretching the skin on his penile shaft over
the glans, or the tip or knob, of his penis.  He says he can't
get used to "being uncovered" and he finds his penis has become
less sensitive without a foreskin.

Christos' support group is the only one of its kind in Montreal,
although a similar group exists in Vancouver and there are plans
to set one up in Toronto.  The groups are more common in the
United States, particularly California, though by no means part
of the mainstream of male sexuality.  Still, their very existence
is part of a larger trend in North America: the massive change in
public attitudes toward male circumcision.

A generation ago, 60 per cent of Canadian newborn boys were
circumcised, with rates rising to 80 per cent in English Canada
and 90 per cent in the United States.  But with the birth of baby
boomers' own children, circumcision rates have fallen dramatically
--  to an estimated 25 per cent in Canada and 60 per cent in the
U.S., according to various studies.

Most health-care practitioners now discourage the procedure.
Where circumcision was once thought to have clear hygienic
benefits, the Canadian Pediatric Society plans to issue a
statement in October saying there are no valid medical reasons to
justify routine infant male circumcision, says Dr. Eugene
Outerbridge of the Montreal Children's Hospital, chief consultant
to the society's fetus and newborn committee.

While Jews and Muslims circumcise as a religious rite, North
America is the only continent in the world where circumcision has
been adopted for non-religious reasons, principally hygiene.  In
Britain, the infant circumcision rate is 1 per cent.

Christos' Montreal support group meets monthly to exchange
information.  Everyday in the privacy of their own homes, group
members stretch the skin on their penile shaft as much as they
can without it hurting, then use surgical tape to attach it to
the glans.  Once the skin has been stretched enough to naturally
cover half of the glans, they attach a weighted device to the
tape to help pull the skin the rest of the way over the glans by
force of gravity.  The whole process takes up to three years to
complete.

Members follow instructions contained in a book entitled The Joy
Of Uncircumcising written by Jim Bigelow, the founder and
director of UNCIRC, an anti-circumcision lobby group in the U.S.

"Yes, you can stretch skin on the penile shaft  --  but only as
an adult, not as a child," says Dr. Yves Homsy, a urologist
affiliated with the Montreal Children's and Ste. Justine
hospitals.  "But it's really time-consuming and you must really
want it (a restored foreskin) to do it."

Most foreskin-restoration groups are offshoots of lobby groups
like UNCIRC.  Most of those groups are no more than 5 years old,
their growth paralleling the rise of the political wing of the
North American men's movement.  Founded seven months ago, the
Montreal group is still trying to find a doctor to work with it.

The change in public attitudes toward circumcision predates their
activism by some two decades.  Attitudes started changing in the
1960s, when a back-to-the-earth counterculture came to value
breastfeeding, natural childbirth and the uncircumcised penis
precisely for their natural qualities.

In the 1970s, a series of studies persuaded most health-care
practitioners that there is no medical indication for
circumcision.

Those studies moved British Columbia in 1984 to remove infant
circumcision from its list of eligible procedures under its
medicare plan.  Quebec and Alberta followed suit in 1987, and
Ontario last October.  Most clinics and hospitals in those four
provinces now charge between $80 and $135 for an infant
circumcision.

Medicare covers only circumcisions required for medical reasons,
the most common one being a treatment for phimosis, or a tight
foreskin.  Many cases of phimosis are caused by parents who try
to retract a boy's foreskin before it naturally is able to
retract, in most cases by age 3.

No one seems clear on the purpose of the foreskin.

Gray's Anatomy (1989) makes not even a faint suggestion of its
raison d'etre.  Some North American anatomy textbooks have even
gone so far as to eliminate the foreskin from their
illustrations.

"We really do tend to talk about the penis much more than we know
about it," says Dr. John Taylor, a pathologist at the Manitoba
Health Sciences Centre.

Taylor set out to change that, and examined the foreskins of 22
deceased adult men in his morgue.  His very elementary finding
--  that the inside of the prepuce contains highly specialized
nerve endings, and that anatomically "the prepuce very much
resembles the lip"  --  was  considered newsworthy enough by the
British Journal of Urology that it accepted Taylor's foreskin
study for publication.

Taylor found the inside of the foreskin contains a band of ridged
skin, the ridges holding a number of round nerve endings.  Those
round nerve endings rub up and down the penile shaft during
intercourse, leading Taylor to postulate that the purpose of the
foreskin is to encourage the ejaculatory reflex.

The medical literature is totally silent on a related question:
the relationship between sexual performance and circumcised state
among middle-aged and older men.

After circumcision, the skin of a male's glans keratinizes  --
thickens and toughens up.  If a man's sex drive declines as he
gets older, does a thin-skinned glans allow him more sexual
sensation than a thick-skinned one?

This question, unfortunately, stands at the unstudied frontier of
male sexuality.

(Reprinted from the Montreal Gazette)


(Transcribed 6 December 1996)