More parents choosing to skip circumcision

Majority of boys don't get surgery, but some doctors still doing it

Katherine Dedyna, Times Colonist
Published: Thursday, January 31, 2008

Victoria mother Kira Antinuk has a motto she wishes parents and doctors would adopt for the baby boys of B.C.: "May the foreskin be with you."

When she was pregnant with her son Dante, now four, she saw a video clip of a circumcision that changed her life -- galvanizing her into working against the removal of healthy tissue in normal babies.

Along with caring for Dante and newborn daughter, Kiana, Antinuk devotes up to three hours daily to posting on family-oriented websites based in the U.S., where the circumcision rate is higher than in Canada.

Kira Antinuk, holding one-month-old daughter Kiana, is against circumcision for her four-year-old son Dante and advocates against the procedure.

The majority of babies in B.C. are no longer routinely circumcised. The provincial health plan stopped paying for the procedure years ago, and Victoria hospitals provide only medically necessary circumcisions. In 2006, that totalled two babies at Victoria General Hospital.

But there are still three MDs performing circumcisions in Victoria. Two of them interviewed by the Times Colonist estimate they perform more than 300 circumcisions between them in a year while a third could not be reached for comment.

"That's hundreds too many," Antinuk, 27, says. Without religious or medical reasons "doctors should not be allowed to do it."

Dr. Catherine Stubbs of Oak Bay says by doing circumcisions, she's providing a service for parents who feel shamed by other parents, prenatal educators and even doctors in doing what they think is best for their sons.

"Doctors lie to patients right now," Stubbs says. "They tell them it's not available; they tell them it's going to cost them $500; they tell them it will scar their children for a lifetime. There are many, many circumcised men in this world that are perfectly enjoying their penises, and their wives are."

She performs one to four circumcisions per week. Retired physician Chorkie Chan says he has been circumcising about three infants a week, filling in for another physician on maternity leave. Both charge about $75 for the procedure.

University of Victoria medical ethics expert Eike Kluge agrees with Antinuk that circumcisions should stop, except when medically necessary.

"It's mutilation," says Kluge, a former director of ethics for the Canadian Medical Association. "For physicians to engage in this is, in fact, to act ethically inappropriately."

The College of Physicians and Surgeons of B.C., the regulatory body for doctors, is upfront about calling circumcision of baby boys a "medically unnecessary intervention" without therapeutic value, but would not comment on the allegation that circumcision is mutilation.

Registrar Dr. Morris VanAndel won't be pushing for a ban, saying "a degree of discretion" is appropriate for doctors. Moreover, because the majority of physicians, especially younger ones, want no part of circumcision, the practice will run its course without "thou shalt not" edicts, he expects.

Doctors are required to get informed consent, meaning parents must be made to understand all the drawbacks.

The college's 2005 position paper notes many ethical concerns and the possibility of babies bleeding to death -- the fate of Vernon infant Ryleigh McWillis in 2002.

The idea that doctors accede to parents who want their sons circumcised to "be like daddy" strikes Antinuk as a cruel deprivation of boys' rights to intact bodies.

But Stubbs maintains she will not circumcise a boy only for that reason. Both she and Chan say their most common request is from parents who knew of uncircumcised men who suffered urinary tract infections or tight foreskins.

Kluge says the research does not support the infection notion. "People come down with appendicitis. Are you therefore going to give an appendectomy to everybody?"

While religious arguments could trump security of the person provisions of the Charter of Rights, Kluge notes that the Jewish and Islamic religions, which require circumcision, have persons trained to do them, negating the need for physicians to be involved.

Trained mohels do "a better job," claims Victoria Rabbi Meir Kaplan, who disagrees that circumcision is mutilation.

Kaplan defends the infant practice, saying that Jewish males would not be happy undergoing a more painful procedure under general anesthetic in adulthood instead of a 10-second tradition at the age of eight days.

Antinuk hopes a B.C. man will launch a lawsuit over his own infant circumcision -- a tough decision to take.

"You would have to bare your genitalia, symbolically, in public," Kluge says. That man would have to sue his parents for their decision.

The B.C. college has been approached by men circumcised as infants, but the complaints went nowhere because the doctors were retired or dead.

Female genital mutilation has been against the law in Canada since 1997 and Antinuk says the college should extend the same protection to boys.

Meanwhile, Stubbs has had only two circumcised baby boys who have had late bleeds in her 35 years of practice and once in a while, a baby requires a stitch or silver nitrite.

She uses both topical and local anesthetic. Many of the babies she circumcises nurse or even sleep during the procedure. "The majority of babies can be done totally pain-free."

CIRCUMCISION NUMBERS

AIDS LINK QUESTIONED

Last year, the World Health Organization hailed circumcision as a way to combat HIV in ravaged areas, citing evidence showing a 60 per cent drop in infection rates in circumcised men in South Africa, Uganda and Kenya. Circumcision removes specialized Langerhans cells in the foreskin that readily attach to viruses, including HIV.

But the U.S. Centers for Disease Control and Prevention recently concluded circumcision did not affect susceptibility among American black and Latino men, whose HIV rate is several times higher than for whites. In the U.S., men having sex with men is the major cause of HIV; in Africa it is male-female intercourse.

PROS AND CONS

According to the Canadian Pediatric Society, of every 1,000 circumcised boys:

- 20 to 30 will experience too much bleeding or infection

- two to three will have more serious complications such as too much skin removed or more serious bleeding

- 10 will need a second circumcision because of "poor result" in the first

Of every 1,000 uncircumcised boys:

- seven will be hospitalized for a urinary tract infection before they reach age one
- 10 will have a later circumcision for medical reasons, such as a scarred opening of the foreskin because of recurrent infections and will require general anesthetic.

VICTORIA STATISTICS

About 2,000 boys were born in Greater Victoria last year. The circumcision rate has slipped from 22 per cent a decade ago, to about 15 per cent, judging by estimates made by two local physicians doing the procedure.

Seventy circumcisions were done at the Victoria General and Royal Jubilee hospitals during 2006-07.

Of those, 30 were done on boys under 15 (including two under age one) and 40 on males over age 15.

© Times Colonist (Victoria) 2008