This page is concerned with non-therapeutic circumcision, which is the amputation of the foreskin (prepuce) without medical indication. Almost all circumcisions preformed in Canada, and globally, are non-therapeutic. As a result non-therapeutic circumcision is commonly referred to as just “circumcision”. The foreskin is a highly innervated and erogenous double layer of skin that surrounds the glan
of the pen*s. The inner layer contains a mucosa membrane. The foreskin has numerous functions. During infancy, the foreskin is attached to the glans and protects it from urine, feces, and abrasion from diapers/environment. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma, infection, and injury. Without this protection, the glans becomes dry, calloused, and desensitized from exposure and chafing. Additionally 20, 000 specialized nerve endings in the foreskin, the gliding mechanism of the foreskin, and its lubrication functions enhances sexual pleasure for both males and females. During circumcision up to 50% of the skin on the pen*s is removed. On average this equates to a loss of 100 cm2 on the adult male pen*s. How is infant circumcision preformed and what are the risks? The baby is placed spread out on his back upon a board called a circumstraint. His arms and legs are strapped down to this board so that he can’t move. His genitals are scrubbed and covered with antiseptic. The foreskin is then torn from his glan and crushed and/or cut off using a circumcision device. The three main devices used in Canada are: mogen (recently went bankrupt), plastibell, and gomco clamp. Overall the procedure is very painful and traumatic for the infant. As a result some babies pass out. In Canada and the United States anesthetic is generally not used. However even if it is, the procedure is still extremely painful. The immediate risk of complications is between 2% to 10%. This includes excessive bleeding, infection, complications from anesthetic (if used), heart failure, surgical mistakes such as loss of glan or entire pen*s, and even death. The last reported death occurred in 2007 in Ottawa. The baby was circumcised using the plastibell device. Though it is estimate that as many as four deaths occur each year in Canada. Long-term risks include extensive scarring, skin bridges, meatal stenosis (10% of circumcised boys), painful erections, loss of sensation, difficulty ejaculating, tearing/bleeding at the scar, and psychological issues. Overall the long-term complications are not well studied. Gomco Video #1: http://www.youtube.com/watch?v=bXVFFI76ff0
Gomco Video #2 (Canadian): http://www.youtube.com/watch?v=MDuDhkiDdns
Plastibell Video: http://www.youtube.com/watch?v=JCLM6P8tc2E
*Turn on the volume!*
Canadian Context
Circumcision in Canada is increasingly becoming a rare procedure. According to the Canadian Institute for Health Information, in 2007 the rate of infant circumcision across Canada was 6.7%. In Ontario, Toronto has one of the lowest rates of circumcision. Since 1975 the Canadian Pediatric Society (CPS) has not recommend infant circumcision. As a result on April 1st 1994 OHIP ceased funding for infant circumcision. In 2004 (reaffirmed in 2009) the College of Physicians and Surgeons of British Columbia (CPSBC) has clearly stated the circumcision has no medical benefits, that it is an extremely risky procedure, and could be a violation of the child’s rights and a breach medical ethics. Originally circumcision was introduced in Canada, as well as other western English speaking countries, during the mid 1800 to prevent masturbation. Masturbation was blamed for causing many diseases, including: epilepsy, tuberculosis, insanity, and loss of skin. Since then numerous other benefits have been claimed, all of which have been largely disproven, are too small to consider (especially considering the risks), or irrelevant to Canadians. Today many doctors no longer practice this procedure, and many hospitals have banned it. Circumcision continues in Canada for four main reasons. First circumcision has become somewhat of a tradition for some Canadians. In fact this is the number one reason given by parents choosing circumcision. It continues because that is what happened to the father of the child. Second it continues for religious reasons. Third, there is a lot of misinformation and personal bias regarding the subject even among health professionals. For instance doctors that are circumcised (or husbands) are more likely to recommend the procedure, than doctors that are not circumcised. Finally, fourth it continues because it is highly profitable. It is a multi-billion dollar industry. Aside from the procedure itself, profit is made from the sale of materials used during the circumcision procedure. The foreskin is also sold for scientific research and to produce cosmetic products. Additionally because of the loss of sensitivity and natural lubrication, circumcision helps to fuel the lubrication and Viagra industry. Global Context:
Worldwide 15% to 30% of the men are circumcised, meaning that 70% to 85% of men are intact (not circumcised). Annually approximately 13.3 million males are circumcised. The majority of circumcisions occur among males born in Muslim countries, or born to Muslim parents. America and Israel are the only two countries that largely practice infant circumcision. Though rates in America are dropping and it now appears that most infants are not being circumcised. Elsewhere the majority of circumcisions occur after the age of eight. Additionally, no medical society in the entire world recommends the routine circumcision of infants/children. Circumcision & Religion:
Circumcision is practiced in Islam and Judaism. In Islam, circumcision is not required. It is not even mentioned in the Qur’an. Some Muslim parents are now deciding not to have their sons circumcised. In Judaism, circumcision is required on the 8th day after birth. However, some Jews (especially non-‐ practicing and Reform) are no longer having their sons circumcised. In fact most Jews that live in countries that do not practice circumcision (Sweden), do not circumcise their sons. In Christianity, circumcision is not practiced, and is often regarded as being against the religion. Hindus, Buddhists, Sikhs, Confucians, and Taoists also do not practice circumcision. Religious circumcision is increasingly being seen as a violation of the child’s religious and personal freedom. For more information please check out the resources listed below. Also feel free to post on our wall if you have any questions. Resources:
www.cirp.org
^ A comprehensive website on circumcision that has been around for over three decades. It is well cited, and numerous research article have been posted. www.circumcisiondecisionmaker.com
^ A quiz like website that helps parents decide if circumcision is a good decision for their family. It is extremely user friendly. www.circinfo.org
^ A well written and informative site on circumcision. It is written for Australian parents, but Canadian boys are not different in their anatomy. www.drmomma.org
^An extremely popular parenting blog by Dr. Danelle Frisbie. Her blog advocates for the natural parenting. This includes breastfeeding, baby wearing, co-sleeping, not circumcising, etc. www.thewholenetwork.org
^A website that contains various articles on circumcision and intact (not circumcised) care. http://www.cps.ca/english/statements/fn/fn96-01.htm
^Canadian Paediatric Society's position statement on circumcision.https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf
^College of Physicians and Surgeons of British Columbia's position statement on circumcision. For Jewish readers:
http://www.box.com/s/q4jqvvmc1a9q3rtc42j1
Circoncision Montreal: Information regarding male infant/child circumcision/ female circumcision, ci What do we mean by Circumcision? What is the foreskin?
