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 said. “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 can’t get used to “being uncovered” and he finds his penis has become less sensitive without a foreskin.

Christos’s support group is the only one of its kind in Montreal, although a similar group exists in Vancouver and another is about to start 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 circumcisions, said Dr. Eugene Outerbridge of the Montreal Children’s Hospital, the 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 one per cent. Some African tribes, including the Zulus, circumcise, as do the Australian aborigines.

Christos’s Montreal support group meets monthly to exchange information. Every day 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 about six months to complete.

Members follow instructions contained in a book titled The Joy of Uncircumcising, written by Jim Bigelow, the founder and director of UNCIRC, an anti-circumcision lobby group in the U.S. Founded seven months ago, the group is still trying to find a doctor to work with it.

“Yes, you can stretch skin on the penile shaft – but only as an adult, not as a child,” said 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. In Montreal, the Circumcision Information Resource Center runs Christos’s group. Other American lobby groups carry acronyms like INTACT and NOHARMM. In Winnipeg, an anti-circumcision lobby is called ETHIC (End the Horror of Infant Circumcision).

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. The change in public attitudes toward circumcision predates their activism by some two decades. Attitudes started changing in the 1960’s when a back-to-earth counterculture came to value breast-feeding, natural childbirth and the uncircumcised penis precisely for their natural qualities.

In the 1970’s, 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, in most cases by age 3.

“I always thought that if we had a boy, we would circumcise him, that we’d want our boy to be like his dad,” said James Lapierre of Pointe Claire, whose first son, Matthew, was born three months ago at the Royal Victoria Hospital. “But at the hospital, they told us it’s not a recommended procedure.”

That’s also what a doctor at Charles Lemoyne Hospital on the South Shore told Richard and Lisa Merlini two months ago after delivering their first son, Jean-Robert.

“The doctor said, ‘We don’t do circumcisions,’ but he said he would go get a surgeon and come back and talk to us,” said Lisa. “He never did. I don’t think that’s right. It’s our personal choice.”

Friends referred the Merlinis to two other hospitals, neither of which offered them a circumcision service. Finally one friend suggested the Jewish General Hospital, which referred the Merlinis to the Tiny Tots Medical Centre on the West Island.

Dr. Murray Katz, the centre’s medical director, performed the circumcision using a mogen device, the surgical instrument favored in traditional Jewish circumcision ceremonies.

Like almost all baby boys who undergo circumcision, Jean-Robert cried the moment he was laid down on his back and his legs restrained with velcro straps, Katz used two mosquito forceps to separate the baby’s foreskin from the glans of the penis. Then he stretched out the foreskin, clamped it together, and brought the scalpel down over the top of the clamp, making sure the glans was safely tucked away on the other side of the clamp.

No anesthesia was used. Jean-Robert cried loudly from the pain, but he ceased crying altogether the moment he was back in his mother’s arms, although his body still trembled for a few minutes.

The whole procedure – from the time Jean-Robert’s legs were bound, to the time when Katz put petroleum-based gauze around the wound – took only two minutes, and cost the Merlinis $80.

“We just thought it would be easier, hygienically speaking,” said Richard, the boy’s father.

Hygiene is the most common reason cited by parents who request a circumcision for a newborn, said Katz. The second most common is a desire on the part of a circumcised father to make his son “like himself.” The third is the desire of parents to ensure their boy doesn’t have to undergo a circumcision later in life.

“The biggest argument for (infant) circumcision is, try having it done when you’re 21 and you need it,” said Katz. “It’s really horrible.”

There is no doubt circumcision confers a statistical health advantage on newborn boys. Studies show that uncircumcised boys are 12 times more likely to contract a urinary-tract infection in the first year of their lives than are circumcised boys.

However, those infections can easily be treated with medication, and the risk of infection is relatively low to begin with – a one in 100 chance compared to a one in 1,200 chance for circumcised boys.

And the lower risk of infection should be weighed against the risk of complications arising from the circumcision procedure, says Canadian Pediatric Society consultant Outerbridge. Most studies report the risk at two to six cases in every 1,000 circumcisions, but Outerbridge cited one study in U.S. military hospitals that reported a complication rate of 19 in 1,000.

Complications are generally minor – excessive bleeding, infection. But Outerbridge said serious complications do occur, including accidental amputation of the glans, meningitis, gangrene of the penis and even death. In the U.S. the death rate has been reported at one in 500,000 cases, or three every year. The risk of complication varies depending on the skill and experience of the surgeon performing the procedure. One Israeli study found a complication rate of only one in 1,000 in Israel.

Although studies used to suggest circumcised men had a lower risk of penile cancer and of infections from sexually transmitted diseases than uncircumcised men, more recent studies have refuted those assertions. What’s more, cases of Jewish men with penile cancer have been observed, leading the Canadian Pediatric Society to conclude that penile cancer has more to do with genetics and environment than a man’s circumcised state.

Why are males born with a foreskin? What, if any, is its purpose? Is the foreskin “a mistake of nature,” as one American research paper postulated? Is it like the appendix, an oddity with no real apparent function?

One’s attitude toward circumcision is colored very much by whether one thinks the foreskin – or prepuce, as it is anatomically known – has any value or function.

Gray’s Anatomy (1989) isn’t much help; it makes not even a faint suggestion of the foreskin’s raison d’être. 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,” said 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 encourage the ejaculatory reflex.

Does that mean uncircumcised men tend as a group to have more problems with premature ejaculation than circumcised men? Robert Gemme, a sexologist at the Université du Québec à Montréal, says the research says no. But Katz of the Tiny Tots clinic points out that circumcision has sometimes been performed as a treatment for premature ejaculation.

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 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.

“Most people get hung up on pleasure,” Taylor said in a tone of exasperation, “but pleasure doesn’t have much to do with the survival of the species. What has to do with survival is the speed of ejaculation and producing offspring as quickly as possible, and as neatly as possible, and getting there before your rivals, and getting it over and done with as soon as possible.

“All I’m saying is the prepuce has as much value to the penis as lips do to the face. Lips are great: they protect the teeth. But they’re also good for kissing.”