Under the Knife: Canada turns away from circumcision

Life Section

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

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 groupis 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, inmost 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 encouragethe 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)

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