To Cut or Not to Cut

"There are very strong opinions on both sides of this issue. We know that we're wading into something that, no matter what we write, will not be strong enough for probably either side.
"Clearly there has been a lot of literature around the potential role of the avoidance of infection. But this also has to be balanced off against the fact that this is still a surgical procedure, and it is not without risk."
"Any shift in policy would have to ensure 'are there enough skilled professionals around to do this, so that we don't have a complication rate that is unacceptable and so that we're not seeing males being significantly harmed by not having the properly trained people to do it'."
"It would be great if we had absolute answers, but on this one, I don't think we will.  At the end of the day ... it will very much be influenced by dad's status, as well as the cultural and religious issues."
Dr. Richard Stanwick chief medical health officer, Vancouver Island Health Authority

Back to the status quo in Canada. Almost. To a time when most medical practitioners acknowledged the all-around benefits to be had in circumcising newborn males. The most obvious of reasons being personal hygiene, as well as decreasing the opportunities for future health complications and not the least, transmission of disease to sex partners.

And then, what was commonly accepted as a good health and hygiene measure suddenly fell out of favour, with claims that male babies were being disfigured and worse, and the backlash that ensued ensured that far fewer circumcisions were taking place at Canada's hospitals. The cultures whose customs deemed this a necessary component of religious faith were stigmatized by their refusal to halt circumcisions.

Papers were written condemning the practise, as one that exposed babies to excruciating pain whose memory would accompany them throughout their lives. Men complained that the procedure diminished pleasure in sex, and had the effect of committing an atrocity upon a helpless child. And then saner heads began to point to research that verified the usefulness in health outcomes with circumcision.

The American Academy of Pediatrics announced last year that health benefits accruing to men through newborn circumcision far outweigh any risk related to the procedure. Anti-circumcision activists raged against genital mutilation of newborns. The doctors' group felt, after review of a thousand studies published over the last 25 years, that it is undeniable that the surgical procedure provides protection against urinary tract infections, penile cancer and the transmission of some sexually transmitted infections, including HIV.

Now the Canadian Paediatric Society is prepared to update their advice on circumcision. "There isn't going to be a 'prescription' for Canadian males in terms of circumcision", however, announced society president Dr. Richard Stanwick. The issue calls for a position "that captures the risks, and the benefits, but is also respectful of personal preferences, religious issues and many other things that dictate this decision."

What took so long to arrive at this 'balanced' approach? Despite the hysteria of a minority who refuse to recognize the procedure as an important health advantage, and that even smaller minority who will go to any measures to reverse a procedure that they claim has ruined their lives by undergoing reconstructive surgery to replace the foreskin, over half of the Canadian public feel circumcision is useful.

That percentage rises to 82% when the father of the baby is himself circumcised. In the U.S. circumcision rates are on the increase, currently at 61% of men. Canada's current circumcision rate is half that. A situation that may be on the cusp of changing.