[CIRP Note: This article was published in both the Edmonton Journal and the Calgary Herald. A letter to the editor that was published in the Calgary Herald is appended at the end.]

Circumcision debate isn’t over yet

Parent and doctor advocates reopen the snipping issue

Chris Zdeb
Journal Staff writer
Edmonton

EDMONTON - To snip or not to snip, that is still the question for parents of newborn baby boys even though circumcision rates continue to decline in Canada.

“It’s a huge issue,” says Dione Chambers, who says she and her husband were split on what to do with their son Tanner, now two.

“I was against it just because it seems to be the norm not to do it and because our doctor doesn’t support circumcision, but he (her husband) was adamant (circumcision) was the way it was going to be because of family history.”

Chambers did a lot of research online and through books, looking at the pros and cons of both sides and found enough information to sway her to her husband’s side.

“It was a stressful decision at the time and I was really kind of regretting it the day of, but I have no regrets now,” she says.

Nothing stirs up debate like circumcision because once people have decided where they stand on the issue, they’re unlikely to change their opinion, says Dr. Peter Nieman, a Calgary pediatrician who speaks for the pediatric section of the Alberta Medical Association. He toes the line of the Canadian Pediatric Society and the American Academy of Pediatrics which is that circumcision is unnecessary surgery. He won’t do it, but believes it should be done by an experienced surgeon and will help parents who want it, to find one.

Circumcision or the removal of the foreskin of the penis became a standard medical procedure in the western world in the mid to late 1900s.

It’s now considered “cosmetic surgery” since research began to emerge questioning earlier studies that said the procedure staved off serious infections, cancer and AIDS, and people became more aware of the pain caused to the baby.

The procedure is now done with local anesthetics, but babies used to be snipped with no pain relief. One study carried out before the use of anesthetics found boys who were circumcised were more sensitive to pain when they got their immunizations at a later age, than boys who weren’t circumcised.

“It was almost as if they had a memory of pain because of the circumcision,” Nieman says.

Alberta parents have had to pay for the procedure themselves since circumcision was deinsured in 1987.

The procedure is done in doctors’ offices and on an outpatient basis in hospitals, but Nieman remembers when it was part of the hospital delivery for parents who asked for it. Hospital administrators, hoping to discourage parents from snipping their baby boys, introduced a “tray fee” of $15 to $20, supposedly to cover the cost of cleaning the instruments used in circumcision.

It didn’t really discourage parents, Nieman says, so many hospitals just stopped doing circumcision. He estimates 20 to 30 per cent of baby boys are circumcised in Alberta today, down from around 60 to 80 per cent, 20 years ago.

Dad James Sutter says it cost $260 to have his seven and a half month old son Zachary, circumcised at the Grey Nuns Hospital, almost twice as much as it cost for his son Josh, who is three, and more than four times the $60 it cost to have his oldest son snipped 10 years ago.

“We knew right away we wanted them circumcised,” say Zachary and Josh’s mom Susan. “We still discussed it, but we didn’t disagree. It was partly medical and partly what’s been done in the family in the past.”

Sutter says the decision was based on the fact that it’s easier to keep a circumcised penis clean reducing the risk for bacterial infections. When he heard of one husband who had to be circumcised at the age of 25, he figured it was better to get the procedure done when the boys were small. “It’s better for them in the long run.”

Nieman says most circumcisions are done because fathers who are circumcised want their sons to look like them.

“The moms are like: ‘I don’t want this done. My poor son. But I love my husband and he’s the boss, so we’ll do it,’ ” Nieman says. “I think you’d see a lot less circumcisions if moms made the decision.”

Dr. Edgar Schoen, an outspoken proponent of infant male circumcision, says Canadian moms must be wimps, or words to that effect. American mamas make the decision of whether or not to circumcise their sons, he says, and a growing number of them want it done for all the medical reasons opponents of circumcision reject.

“There’s a growing body of published medical scientific research about the medical benefits of circumcision that a sophisticated American public is becoming more and more aware of,” he says.

Schoen cites some of the “15, 20, 30” studies in his new book Ed Schoen, MD on Circumcision. Among their findings: circumcised men don’t get penile cancer and are more resistant to getting syphilis and AIDS when exposed to them; they are 10 times less likely to develop urinary tract infections and severe kidney infections that can cause permanent kidney damage.

On the other hand, opponents of circumcision have only “anecdotes and testimonials” to back up their case, Schoen says.

Aside from the medical evidence is the social advantage that comes with being circumcised, he says.

“In the U.S. if you’re not circumcised, it means generally that you’re an immigrant, the son of immigrants or you’re very poor.”

Schoen says it’s a tragedy that anti-circ groups have successfully lobbied legislatures in 13 states, including California, not to cover the cost of circumcision for welfare patients.

“Poor people in this country know if a boy is uncircumcised and somebody sees him in the locker room that ... he’s at a social disadvantage so they scrape together enough money to pay for circumcision even though they can’t afford it.”

Hospital-based statistics show approximately 55 per cent of American male infants are circumcised, though Schoen argues the rate is actually around 80 per cent because the numbers don’t include procedures done in doctors’ offices or during religious ceremonies.

“The American public is way ahead of the pediatric organizations in their support of circumcision,” he says.

The reason the American Academy of Pediatrics continues to say circumcision is medically unnecessary is because it doesn’t want to admit that it’s wrong, says Schoen, who chaired a task force on circumcision for the Academy in 1989. Eventually even they won’t be able to ignore the evidence, he says.

Anti-circ crusaders say the U.S. is the last bastion of circumcision in the developed world, but Schoen says it’s actually the first bastion. He’s confident as more information about the medical benefits of circumcision gets out, helmet-heads (the circumcised) will eventually outnumber anteaters (those who are not) in most countries.

[Illustration]
Colour Photo: Canadian Press, file / This baby seems not too happy about having his first operation. Circumcision rates in Alberta are probably around 20 to 30 per cent, says one expert.

Letter, Calgary Herald, Sept. 25, p. A15:

Circumcision - Re: “Circumcision debate isn’t over yet,” Sept. 15.

The central issue in the circumcision debate is the ethics of performing an irreversible, medically unnecessary operation on an infant. Although some studies have found circumcision may have medical benefits, these benefits are marginal and disputed.

Circumcision’s risks are well-documented. Occasionally, the complications are serious. Three years ago, a baby boy died after his circumcision in Penticton, B.C.

Exposing children to such levels of risk, for a questionable benefit, would never be tolerated in any other health care context.

Medical regulatory bodies in Canada have begun issuing formal policies discouraging infant circumcision.

In 2002, the College of Physicians and Surgeons of Saskatchewan advised doctors to convey the message that this is not a recommended procedure. In 2004, the College of Physicians and Surgeons of British Columbia released a policy noting infant circumcision “is particularly difficult in regards to human rights.” The College of Physicians and Surgeons of Alberta has refused to provide any formal guidance on circumcision.

Dennis Harrison
Vancouver, B.C.