Circumcision numbers cut back at Victoria hospital

Doctors re-examine issues surrounding painful procedure

Sandra McCulloch
Times Colonist

Friday, February 20, 2004

It was once considered a minor operation that caused male infants no pain and reduced health risks.

"I did circumcisions as an intern -- the kid screamed for a bit, you put a soother in his mouth and that was it," said Dr. Peter Seland, a urologist and deputy-registrar with the B.C. College of Physicians and Surgeons.

That was 40 years ago and a time when infant males were routinely circumcised.

Circumcision is the surgical removal of the sleeve of skin and tissue that normally covers the head of the penis.

A generation ago, anesthesia wasn't used and parents were assured that infants couldn't feel pain.

Now Seland says he feels terrible -- because we now know that circumcision causes pain in the short- and long-term.

"It didn't cross your mind you were causing long-term harm," Seland said a in telephone interview from Vancouver on Wednesday.

He has recently chaired an ethics committee that examined issues surrounding circumcision for the college.

The issue came to the forefront recently with the release of a coroner's report on the death of a Vernon infant circumcised at Penticton General Hospital in August 2002.

Coroner Chico Newell urged hospitals to inform parents that any amount of bleeding is bad -- an infant can die from losing just one ounce of blood.

Newell said the parents of one-month-old Ryhliegh McWillis weren't properly informed about danger signals to watch for in post-operative care.

The province doesn't keep track of the number of circumcisions done each year. But the Vancouver Island Health Region says the procedure is becoming rarer at Victoria General Hospital.

This past year, only 15 of 1,414 male infants born at VGH were circumcised, or about one per cent. That's less than a third of the number done four years ago -- 47.

Circumcision is now uncommon except in Jewish or Muslim communities, said Seland.

"It varies significantly in regions. (Circumcisions) are more common in the Interior."

A draft of the ethics' committee report will be before the college next month, he said. The report examines the history of male circumcision and its role in cultural and ethnic circles. It outlines the proposed medical benefits and evidence of risks.

"What we're attempting to do with this document is have physicians and parents weigh the medical and ethical issues that are there and find their own balance and make their own choices," Seland said.

However, we now know circumcision is far from painless for the infant. The evidence is now "overwhelming" that circumcision is extremely painful, said Seland.

"When I was doing circumcisions in 1964, I shrugged off the issue of pain," he said.

At that time, half of all infant boys were circumcised. The mindset of parents then was "like daddy, like son."

After examining the so-called benefits and risks of circumcision, Seland said the bottom line is that circumcision doesn't particularly help or harm an infant.

"Having looked at the pros and cons, it appears to be more or less at an even balance."

The emotional issues surrounding circumcision are far more complex, Seland said.

"It's a very polarized area within the community," he said.

The decline of popularity of the procedure is due to doctors presenting parents with the real risks and limited benefits, he said.

Seland said the pain issue "is a very important aspect."

© Copyright 2004 Times Colonist (Victoria)