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To circumcise or not to circumcise

Tuesday, October 27th, 2009 by:

I didn’t take the decision to have my sons circumcised lightly. Before my first son was born I read countless studies and articles on the pros and cons of circumcision. Most dramatic for me was the drastic reduction in sexually transmitted infections (especially HIV) in circumcised males. In the end, I decided to have my son circumcised, but I am not in the Canadian majority.

Based largely on the death of one infant from post-circumcision hemorrhage, the Canadian Paediatric Society (CPS) has strengthened its stand against neonatal circumcision. The CPS recommends that circumcision of newborns should not be routinely performed. As a result, all provincial health insurance plans have removed non-therapeutic male neonatal circumcision from the schedule of covered procedures due to a “lack of health benefit.”

The result is often a somewhat shady cash transaction that has resulted in a huge reduction of neonatal circumcisions. In 1994 neonatal circumcision was performed on about 20 percent of Canadian male neonates. By 2005, this number declined to 9.2 percent. Circumcision rates are on the rise in many other countries due to the potentially live-saving health benefits of reduced infections and possibly even cancer rates.

Canadian doctors argue that Canada has condoms and good hygiene which counteracts and circumcision benefits seen largely in third world countries. Do you agree?

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19 Responses to “To circumcise or not to circumcise”

  1. Stacey Says:

    I believe it should be my son’s choice. How do I know if he will be sexually active without protection or not? I don’t. I will do my best to teach him what it right, but he still makes that decision. And if he does, it is up to him to deal with the consequences. If he wants to have cosmetic surgery to change his penis, then that is also up to him. Not my choice.

  2. Rean Cross Says:

    I’m not sure where you got your facts on this one. According to What Mothers Say: The Canadian Maternity Experiences Survey which was released by the Public Health Agency of Canada in the spring, the circumcision rate in Canada in 2006 was almost 32%, ranging from a high of 44.3% in Alberta and 43.7% in Ontario down to 6.8% in Nova Scotia. Most are performed for perceived health reasons or “to look like dad”.

    The HIV studies that everyone reacted to several years ago were performed in developing countries in Africa where questionable research practices were used including payment to participants, where the strains of the virus differ significantly from those found in North America, and where there are significant alternate sources of infection, such as unsafe surgical practices, which were not adequately controlled for.

    I’m not sure why parents choose to perform surgery on their children to prevent a disease they may or may not come across when they are older. It may be wiser to allow our boys to choose what happens to their bodies when they are old enough to make that choice for themselves.

    There is a reason why no medical association in the world recommends routine male infant circumcision.

  3. Stacy Says:

    Just read your blog and wanted to say that you I agreed entirely. Stopping covering circumcision at birth is penny wise and pound foolish. The actual cost of a circumcision should be very small relative to the costs of additional cases of cancer, std’s, HIV treatment, and the necessity of adult circumcision. Its not that uncommon to for males to need on later in life. My brother needed to be circumcised later in life and I don’t want to risk putting my son through that. Plus, I have yet to meet a single man that wasn’t happy to be circumcised, but a lot of uncircumcised guys seem to wish they had been snipped.
    I have done a lot of research on circumcision and thought you might find these links helpful:
    general health:
    http://www.modern-psychiatry.com/circumcision.htm
    http://www.circinfo.com/parents_guide/gfp.html
    http://au.tv.yahoo.com/sunday-night/video/-/watch/13629907/
    http://www.youtube.com/watch?v=Jlk_cPPqTAM
    STD’s
    http://vids.myspace.com/index.cfm?fuseaction=vids.individual&VideoID=56849737
    http://www.physorg.com/news86339340.html
    http://www.msnbc.msn.com/id/15593753/
    Sexual effects/sensitivity
    http://www.mcgill.ca/newsroom/news/?ItemID=26068
    http://discusshiv.com/tag/orgasm/
    http://www.cbc.ca/health/story/2007/07/27/circumcision-sensation.html
    Cervical Cancer:
    http://www.consumeraffairs.com/news04/fishman/2006/circumcision.html
    http://www.npr.org/templates/story/story.php?storyId=1141513
    trends:
    http://www.jurology.com/article/PIIS0022534705604193/abstract
    http://health.usnews.com/articles/health/healthday/2008/12/23/circumcision-rates-too-low.html
    Discussion groups:
    http://community.babycenter.com/groups/a1236385/choosing_to_circumcise
    http://www.cafemom.com/group/13109
    http://messageboards.ivillage.com/iv-ppnoforeskin
    Even the World Health Organization is recommending it now:
    http://www.who.int/hiv/mediacentre/news68/en/index.html
    http://www.who.int/entity/hiv/mediacentre/MCrecommendations_en.pdf
    As well as the CDC:
    http://www.msnbc.msn.com/id/22425001/vp/32537110#32537110
    Hope it was okay to pass that on to you?

  4. Stacy Says:

    P.S. if anyone wants to email me about this one way or other, they are more than welcome to. stacy.stack@yahoo.com

  5. Nancy Ripton Says:

    We got our stats from CIRP and the Canadian Paediatric Society which states that circumcision rates have dropped drastically in Canada since 1996.

    Circumcision is a very personal choice and there are many reasons for and against. That being said many of the HIV tests in Africa were very credible. Granted sexual practices are different in North America but it is naive to believe every male always practices safe sex.

  6. Caroline Says:

    There was a study from the 1980’s that found the number one factor in whether or not a baby was circumcised was the circumcision status of the father. I think it is unfortunately still true in North American society (though worse in the US), that many circumcised men are adamant about doing it to their sons.

    I think this is one of the main reasons that mothers look for medical benefits to the procedure, even though it is clearly obvious that foreskin is not pathological. 80% of the world’s men are not circumcised. Of those who are, the majority of them are Muslim. The HIV studies in Africa are not sound- they are laughed at by the rest of the the medical world. The United States is now known as the country obsessed with circumcision and finding benefits from it where none exist.

    I know that parents who choose this really believe they are doing the right thing. But looking for reasons to justify circumcision begs the question. Why are we doing something to our kids that we need to dig for reasons to justify?

    It is VERY difficult when the father of your child wants to circumcise. Some guys just won’t hear anything else. But it’s not his penis. It’s not your penis. Your son’s penis will be just fine as long as it is left alone. Once he is old enough to become sexually active, he can decide for himself, based on his own behavior, if the arguments regarding health are convincing enough for him.

  7. Joel Says:

    Being that I own a foreskin, I find much of this discussion complete nonsense. It is perfectly healthy, and if you think about it, other body parts are much more likely to cause problems in someone’s life, yet we don’t cut them off of children to prevent it.

    It bothers me when people seem to forget that we’re talking about sexually sensitive, erogenous genital tissue. The foreskin contains thousands upon thousands of nerve endings, similar to those found in the fingertips and lips.

    You know though, if an adult believes it would be of benefit for them to be circumcised, then let them choose it. If someone believes it would be of benefit for them to have their inner labia, or their clitoral hood removed, so be it. But, its different when those choices are not made by the INDIVIDUAL.

    when studies show that the risks of the PROCEDURE itself outweigh the “potential” benefits, then its really quite clear that the motivations are not medical. Especially when we’re talking about part of a man’s genitals.

    Also, the studies showing a link between STDs and HIV and circumcision status are flawed. But even if they weren’t, lets not forget that these are behaviorally-transmitted diseases, it is nothing like an airborne virus that strikes at random. It is not okay to cut a part off of anyone’s genitals just because you don’t think they’ll be capable of safe sex when they are older.

    We need to stop making up excuses to do this to healthy children.

  8. Stuart Says:

    You made an incorrect decision:

    A video produced by the nocirc organisation:
    http://www.youtube.com/watch?v=AHVvB1oHAgg

    Care is a lot easier with intact, non-circumcised boys as there is nothing to do. The foreskin is unretractable in infancy so it should be left alone. No cleaning under it or pulling it back is required. Doctors who know about the foreskin advise to leave it alone:
    http://www.kidshealth.org.nz/index.php/ps_pagename/contentpage/pi_id/266

    Circumcised boys require a lot more care.
    Circumcised boys are in discomfort because there is an open wound. This wound can easily become infected. It can also become irritated by ammonia in the urine.
    The remaining skin after the foreskin is severed can re-attach to form a skin bridge. Basically it is a whole lot of extra hassle (that usually nobody tells you about). This site shows in graphic detail the terrible consequences that can occur:
    http://www.circumstitions.com/Complic.html

    There is also likely to be negative psychological effects to circumcision:
    http://www.cirp.org/library/psych/goldman1/

    Circumcision removes a functioning part of the penis. Many circumcised men do not know what they have lost:

    The foreskin contains many specialized nerves on it’s underside. When the foreskin is moved up and down it is very pleasurable. Circumcised men have lost this ability to masturbate easily as there is no gliding effect. Circumcised men often have to resort to artificial lubrication in masturbation and sex. See here for the function of the foreskin:
    http://www.circumstitions.com/completeman/

    Without the foreskin protecting the glans, circumcised men lose further sensitivity. The glans (head of the penis) dries out. It also brushes on underwear causing the skin to toughen. See here for the full damage done:
    http://www.noharmm.org/IDcirc.htm

    There are good reasons to believe that sex is better for the woman as well, if the man has his foreskin intact:
    http://xrl.us/foreskinfunctions

    Men in Britain, Ireland, France, Germany and Italy, along with the rest of Europe don’t get circumcised and they all do as good if not better than countries where circumcision is more common. So all in all it is best to be as nature intended. No medical association actually recommends non-therapeutic infant circumcision:
    http://www.circinfo.org/parents.html

    History: Non-religious circumcision only started in English-speaking countries in the late 1800’s. The main reason was to prevent masturbation. More info can be found at this at this site:
    http://www.historyofcircumcision.net/

    Rates of circumcision:
    Circumcision rates have dropped in the USA to 60%.
    http://www.circumstitions.com/USA.html
    In Canada and Australia the rate has dropped to less than 10%. In Britain the rate is less than 1%. Only 20-25% of the world are circumcised, 2/3 of these are Muslim.

    Once it is gone it is gone, so it is wrong to make that decision for someone without their consent.

  9. Laura Says:

    “Drastic reduction in STDs” ???? If this was true why does Israel have an identical rate of HIV to majority uncircumcised Sweden?

    Why in Britain are cut gay men 20% MORE likely to report being HIV+.

    Why does America where 80% of adult men are genitally reduced have 3 TIMES the HIV rate of Britain, where only 16% of adult men report being cut?

    If folds and flaps of genital skin are a hygiene problem why haven’t you had yours cut off? This is a huge example of misandry – you are demonising normal male bodies for properties which yours has too… And you and I both find it harder to effectively wash in all our crevices than a boy or man – because we can’t even see them….

    I’m frankly disgusted at the double standards constantly being pushed by women in this area….Take the plank out of your eye

  10. Hugh7 Says:

    “the drastic reduction in sexually transmitted infections (especially HIV) in circumcised males.”
    Simply not true. In at least six African countries, according the National Health and Demographic surveys, the HIV rate among circumcised men is HIGHER than among the non-circumcised. Studies in developed countries have failed to find any protection against the older STDs.

    Women considering circumcising sons to protect them from HIV should consider that one study (in Rakai, Uganda) found that the partners of circumcised men were no less likely to get HIV – in fact 12% of the partners of intact men got it, compared to 18% percent of the partners of circumcised men, but they cut the test short before it could reach statistical significance. Women are already at much more risk from men than men are from women; circumcising men might make it even greater.

    A quick look at Stacy’s links indicates they all reflect the prevailing pro-circ bias. circinfo.com is the site of Prof. Brian Morris who never saw a reason for circumcising he didn’t like (including “to prevent ‘bathroom splatter'” and “to prevent zipper injuries”) and cherry picks his data shamelessly. The McGill study of penile sensitivity didn’t measure the foreskin… and so on.

  11. Greg Says:

    I’m in total favour of circumcision and personally believe it should be more directed by the father than anyone else. When it comes down to it, there are overwhelming health benefits and it looks better. Right, I’m going to let my boys decide when they get older. Who’s kidding who. Get it done in the first 2 wks of birth and ask them if they remember. I don’t!!! In addition, most fathers want their boys to look like them as well.nn1

  12. David Blackman Says:

    The constant mis-information that is being expounded on circumcision is absolutely shocking, and it is interesting t hat much of the focus on this issue is around infant circumcision, while the wider spectrum of this debate as it relates to our growing and aging male population is either ignored or never discussed.

    While there is no question that the circumcision rates are down in Canada, the current circumcision statistics that are often being bantered around by groups like CIRP and the Canadian Pediatric Society do not reflect the actual number of circumcisions being performed in this country.

    For example, correspondence I have exchanged with the Canadian Institute of Health Information regarding their figures, I was informed that the CIHI is aware that many infant circumcisions are being performed in other settings. While this information is noted in their methdological notes, there is often no mention when these figures are quoted, that many infant circumcisions are being performed in hassel free private clinics, therefore current statistics being given out to the public is not an actual reflection of the number of circumcisions really being performed.

    Contrary to what is forever being bantered around that male children are being circumcised to look like daddy, this too is not an accurate reflection as to why many families are still having their sons circumcised.

    While it may be the case in some families, for many families over the years they have had male family members and friends undergo post-natal circumcisions for health reasons opponents are quick to debunk. In addition, many circumcised male children born between the mid 1930s to present were not all sired by circumcised fathers, so this notion that male children are being circumcised to look like daddy is also not an accurate reflection as to w hy parents are still having their sons circumcised.

    Another misconception widely expounded in that males in this country have been routinely circumcised. This is not correct, and Stats Canada who have been collecting statistics on the number of neo-natal and post-natal circumcisions being performed in Canada would verify this point.

    Non-religious males, that is Canadian males not of the Jewish/Islamic faith have not and are not being routinely circumcised at birth. If this was the case, then there would be a larger percentage of circumcised males in this country, and this simply not the case.

    I found it shocking that one contributor indicated that 20% of gay circumcised males in Britain had AIDS, while there was no indication of the AIDS status of the 80% uncircumcised gay males in Britain.

    It is interesting to note that the Canadian Pediatric Society is always touted as the ‘expert’ on the circumcision issue, yet this medical body are not the care givers to our growing and aging male population.

    If past and present medical students in this country were required to spend some time in our STD , Veneral Disease and Urological Clinics the current anti-circumcision attitudes in this country would be greatly reduced.

    Similiarly, if doctors in this country were required to report for statistical purposes the genital status of males being treated for ongoing genital infection problems prior to their post-natal circumcisions, and the same information required about the partners of women being treated for similiar problems, there would also be a mark changed in atittudes towards the circumcision issue.

    I wonder how many Canadians are aware that in the fall of 1980, the Supreme Court of Canada passed a ruling which requires doctors to give both sides to controversial medical issue of which there are two sides to the circumcision issue. If a cross Canada survey was conducted on how parents have been treated when they requested circumcision for their sons, it would reveal that medical opponent have ignored the Supreme Court ruling, and instead of provding parents with an unbiased presentation on the circumcision issue, they have in turned embarked on their own campaign to eradicate circumcision from being performed in Canada.

    Clearly there is a need for this issue to be discussed in an unbiased manner, and less emotional approach than what we have seen over the years. We are all entitled to our opinions, and the often nastiness that has crept into this debate is really uncalled for, and serves no useful purpose.

  13. Hugh7 Says:

    @Greg: “When it comes down to it, there are overwhelming health benefits”
    Overwhelming? Then why doesn’t that show in the health statistics of countries that have never circumcised, in Europe and Scandianavia, or those that used to but have virtually given it up, like the UK, Australia and New Zealand?

    “and it looks better.”
    Beauty is in the eye of the beholder, and it certainly doesn’t look better when it is botched.

    “Right, I’m going to let my boys decide when they get older. Who’s kidding who.”
    Why ever not? Most fathers in the world do (and most sons won’t have a bar of it).

    “Get it done in the first 2 wks of birth and ask them if they remember. I don’t!!!”
    Some say they do, but even if they don’t they’re reminded every day – especially if it doesn’t work so well.

    “In addition, most fathers want their boys to look like them as well.”
    It would be bad luck for the sons of men who’ve lost limbs or eyes if that were true.

  14. Greg Says:

    ….Hugh7 – When making an informed decision it is important to understand both pros / cons. There is far more health benefits in the research material in favour of circumcision. Keep reading…

    Yes, it does look better and kids don’t get teased as much and get a complex later in life..

    I truly can’t believe you would ask your sons if they would want to get circumcised later in life. I would of looked at my parents cross eyed.

    Whom remembers anything when they were 3 years of age, let alone the past couple of months. Get real!

    I can’t even comment on your last point.

  15. David Blackman Says:

    It would appear that one contributor to this column has not read reports coming out of India and China, that health officials in both these countries with a high percentage of uncircumcised males, are now looking at circumcision programmes to deal with their high HIV/AIDS rates.

    At the turn of the 20th Century, there was a move a foot in European countries to start circumcising their male population to reduce Veneral Disease which was quite rampant in many European countries. This move came up against a roadblock, a vast majority of Europeans were against the idea as they equated circumcision with the Jewish and Islamic people, and this is still the main reason why European, Asia and many Latin American countries do not circumcised their males.

    I have asked European male friends of mine why they were not circumcised, and their immediate reply was – “I’m not Jewish.

    How many contributors to this column are aware that it was against the law in the former Soviet Union for any Soviet males to be circumcised, and doctors were hired to actually physically examine Soviet Jewish/Islamic males to ensure they adhering to t he Law.

    Further evidence of this view point, a man’s genital status (ie whether he was circumcised or not’) was an identification criteria used by Nazi Germany in their overall mass extermination plan for the Jewish people in Europe. Then of course there is the biblical and historical evidence of how the ancient Romans dealt with the circumcision issue, which wasn’t much different from Nazi Germany’s.

    In the many debates over the circumcision issue, one sees/hears the view being expounded that our male population should be allowed to make this decision at a later age as to whether they will be circumcised or not.

    Interesting enough, not once has it ever been aired/printed as to what males who have gone thru a post-natal circumcision at a later age feel about this.

    Over the years I have repeatedly heard males who have gone thru late circumcisions convey that they wished that their parents had not caved into to the bullying, guilt tripping tactics used by medical opponents to discourage them from having their sons circumcised. I have also heard, and know of families who went thru this, and later their sons had to be circumcised for health reasons opponents are quick to debunk.

    One of the things I have encountered over the years is that those who are opposed to circumcision really do not respect the opinions of others who do not share their point of view. We have seen this at the medical level in the way medical opponents have handled parents requests.

    How many of contributors to this column are aware, there is a move afoot on the part of opponents to have an International Law passed againsts male circumcision. Attempts have already been made here in Canada and the US to have such laws passed in both countries.

    Clearly the issue has to be discuss in a responsible and civil manner, so that both views are fairly aired and respected. There may never been a total agreement on the issue, but at least we can walk away with a better understanding of the issue.

  16. Glenn Says:

    There is a broad and deep pool of evidence that, everything else being equal, non-circumcised males stand a somewhat higher risk of contracting HIV/AIDS (as well other STDs) than do their circumcised counterparts.
    It is also true that the average heterosexual North American male today faces a lower risk of contracting HIV/AIDS than in some other parts of the world. But who knows what the HIV/AIDS infection rate might be in 20 years when today’s babies are at the age of sexual maturity?
    Besides, how can I predict what part of the world my son might choose to live as an adult? I spent a big part of my 20s and early 30s living and travelling overseas and I have friends and colleagues who have contracted, and in the case of at least two people, died of AIDS.
    Our family decided that if we could give our son a better chance of remaining healthy in later life we should not hesitate to do so.
    I held my son’s hand as he was circumcised. It was one of the most difficult things I’ve done, but I have no regrets.

  17. burns anthony Says:

    Thanks for posting this article. I’m unquestionably frustrated with struggling to search out germane and intelligent commentary on this matter. Everybody now goes to the very far extremes to either drive home their viewpoint that either: everyone else in the planet is wrong, or two that everyone but them does not really understand the situation. Many thanks for your concise, pertinent insight.

  18. David Blackman Says:

    Anthony’s observations is a growing reflection of many Canadians who are frustrated by the way the circumcision debate is being discussed.

    Over the past 40 years or so, the circumcision debate in this country has been heavy on emotional, prejudical, guilt tripping anti-circumcision rhetoric thath dominates our web-sites, and much of the rhetoric is not based on sound medical/scientific facts.

    Rather than discussing the issue in a adult and educated fashion, opponents have embarked on abusive and personal attacks on people who do not share their point of view, and medical opponents in this country have also contributed to this rhetoric by their treatment of parents who wish to have their sons circumcised.

    We are all entitled to our views on this controversial issue. The current position of lay and medical opponents treating other Canadians who do not share their point of view with contempt and dis-respect, is simply unacceptable and needs challenging.

    Many web-sites are a ‘pot hole’ of rhetoric that insults people’s intelligence, and this too needs addressing.

    Nancy Ripton made an interesting comment that she was in the minority of parents in Canada who were having their sons circumcision. I beg to differ, she is not. Many parents are having their sons circumcised in private clinics, and increasing number of parents who caved into the anti-circumcision rhethoric, and did not originally have their sons circumcised, are now finding their sons are needing the procedure for health reasons opponents are forever debunking.

    Clearly there is a need for a sound and intelligent discussion on this medical issue, rather than all the negative hype that is the hallmark of the anti-circumcision movement in this country.

  19. circumcision sunshine coast Says:

    I completely support your decision. There are many reasons that families choose circumcision, such as tradition, religion, infection prevention, and some just for plain cleanliness. Personally, I have known quite a few men who have suffered from recurrent infections under the foreskin and those infections can not only be painful but also embarrassing. Whether a family chooses to circumcise or not, that should be the families choice and that choice should be respected.