Saskatchewan physicians warned to stop performing infant male circumcision. Procedure called “imprudent if not improper.”

A strongly worded and unambiguous memorandum from Dr. D. A. Kendel, Registrar of the College of Physicians and Surgeons of Saskatchewan, was sent to members of the College on February 20, 2002, warning bluntly that, “Where there is little evidence of expected benefit from a surgical procedure, but well recognized risk of surgical complications that may cause harm, it would generally be considered imprudent if not improper for a surgeon to perform such a surgical procedure.”

“You can, and should, respectfully decline to perform the prodedure just as you respectfully decline to carry out other requested medical acts that you regard to be inappropriate.” the memo states.

The legal ramifications of such clear and categorical statements coming from a provicial regulatory body on physicians who continue to perform infant male circumcision despite the lack of medical evidence of any significant benefit for the procedure remain to be clarified.

  Unique anatomical structures of foreskin described in new web site

Although the male foreskin, or prepuce, has been the focus of intense debate for many years, there has been nearly no scientific study of its anatomy and function. Often described as a “fold of skin”, the foreskin in fact contains unique structures which aid it in performing its mechanical and sensory functions.

Canadian researchers including Dr. John R. Taylor, MB, MRCPEd, FRCPC have been instrumental in this research. Dr. Taylor is the co-author of two anatomical studies of the prepuce; he and his colleagues first described the ridged band in the British Journal of Urology in 1996.

A new web site has been created to demonstrate the anatomy and function of the ridged band of the prepuce.

  National Post reports on court challenge to Canadian Criminal Code

Canada's National Post newspaper, in its February 12, 2001 edition, reports on the Association for Genital Integrity's preparations to challenge the ban on female genital mutilation in Canada's Criminal Code as being discriminatory against males, who are not given similar protection, under provisions of the Charter of Rights and Freedoms .

“Every day in this country a quarter of the boys that are born are having this procedure performed on them without their consent and without any medical need. We don’t see why half of our society should be protected by a law and not the other half,” said Dr. Arif Bhimji, a Newmarket emergency room physician.

News release regarding the court challenge.

Detailed information about the legal challenge referred to in the National Post article can be found at http://www.courtchallenge.com

  Ontario Human Rights Commission changes position on male circumcision

In its statement on female genital mutilation, the Ontario Human Rights Commission has removed untruthful statements about male circumcision, based a complaint from a Toronto physician.

Dr. Arif Bhimji complained that, under the heading “FGM and Male Circumcision,” the old statement wrongly claimed male circumcision was “done without damaging the organ itself, and that there is minimal danger of short- or long-term infection as a result of the procedure, let alone loss of life. Also, there is no observable negative impact on male sexual activity.”

For further details, read the press release issued by The Circumcision Information Resource Centre and an article in the National Post on January 17, 2001.

As a result of the National Post article, an Amnesty International Section Director who is also a Bermudian Human Rights Commissioner has called the OHRC’s new revised policy on Female Genital Mutilation (FGM) “discriminatory” and “absolutely misguided.” A press release on the Commissioner’s position was released by the Toronto group Intact.

  Circumcision dispute in New Jersey court

A case is currently in the New Jersey family court to determine if a three-year-old boy will be circumcised against his father's wishes. At the age of two, the child’s pediatrician allegedly recommended forced foreskin retraction in direct contradiction to the American Academy of Pediatrics' guidelines on care of the intact penis. By forcing the foreskin back, inflammations occurred. The child has experienced no medical problems since the manual foreskin retractions were ceased in June of 2000, but the pediatrician recommended circumcision and the child's parents are in disagreement.

Read more about this case.

  UN Grants NOCIRC Roster Status

In July 1999, the Economic and Social Council of the United Nations granted Roster status as a non-governmental organization (NGO) to the National Organization of Circumcision Information Resource Centers (NOCIRC), based in San Anselmo, California, USA.

“NOCIRC now has official representatives at UN Headquarters in New York and the UN office in Geneva. NOCIRC's participation will be especially important as discussions continue about the relationship between male circumcision and HIV/AIDS in Africa. NOCIRC will continue to advocate education, hygiene and the use of condoms as the most effective defense against all sexually transmitted diseases, including HIV/AIDS. Although the UN recognizes the right of females to keep their genitals intact, it has yet to recognize that same right for males. NOCIRC will work to impel the UN to acknowledge and address the forced and coerced genital cutting of males as a violation of human rights as well.”
—(NOCIRC Annual Report, Spring 2000)

  Parents settle $10 million lawsuit over botched circumcision in Cleveland, Ohio

The parents of a Medina, Ohio boy whose penis was mutilated during a routine circumcision settled their $10 million lawsuit yesterday with the doctor who performed the surgery and Medina General Hospital, according to an article in Cleveland Live on March 25, 1999.

“If this was your son and I told you I’d give you $10 million for this to happen to him, you wouldn't take it,” said William Beyer, who represented the family of Ian Carque, now 4 years old. Beyer said the impact of the injury would not be known for years.

  Children kidnapped and mutilated in South Africa.

The Sunday Times, South Africa’s largest circulation weekly newspaper, reported in its March 14, 1999 edition on the existence of “circumcision camps.” Teenagers, both boys and girls, are being abducted, circumcised against their will, and held for ransom.

Judas Moletsane, 18, who had already been circumcised, was kidnapped and taken to a camp several times but managed to escape. However, in December he died in a camp. This week, his father, Teboho Moletsane, 69, held back tears as he recalled the events. He said he was ready to pay a R350 ransom when he was told his son had died.”

Read the full story.

  The American Academy of Pediatrics releases 1999 statement on circumcision

The 1999 AAP statement on circumcision was released in the March 1 issue of Pediatrics. For a summary of the statement, as well as links to extensive news coverage of this event iduring the month of March, click here.

  Study casts doubt on urinary tract infection/circumcision link

The Lancet has published a recent study by Toronto researchers, which involved almost 60,000 boys born in Ontario between 1993 and 1994. It found that infant boys who were intact (not circumcised) had, at most, a 3.7 times greater risk of being admitted to hospital with a bladder or kidney infection than circumcised infants. The risk of admission for a urinary tract infection in the first year of life was 0.7% for intact boys versus 0.2% for circumcised boys, and the risk decreased with age in both groups.

The study suggests 195 circumcisions would need to be performed to prevent one hospital admission for urinary tract infection in the first year of life.

Since a conservative estimate of the number of significant complications of circumcision is 2-3%, this would mean that circumcising nearly 200 boys to prevent one urinary tract infection would result in at least 4 boys suffering a major complication to prevent one easily treatable urinary tract infection.

Read the original study here: To T, Agha M, Dick PT, Feldman W. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. Lancet 1998; 352: 1813-16.
Read media coverage of this study from:
   The Ottawa Citizen: New report debunks health benefits of circumcision
   The National Post: New study questions need for circumcision

  Circumcision not of value in preventing cancer of the penis: American Cancer Society

The American Cancer Society does not have a formal guideline statement on circumcision. However, two officials of the ACS sent a letter to the American Academy of Pediatrics in February 1996 discouraging them from continuing to promote circumcision as a preventive measure for cancer of the penis. Because the letter was circulating on the internet, and the officials were no longer connected with the ACS, the ACS later issued a statement clarifying their position on circumcision.

“Penile cancer is extremely rare in the United States and accounts for less than one half a percent of cancers diagnosed among men and less than one tenth of a percent of cancer deaths among men.”

“Proven penile cancer risk factors include having unprotected sexual relations with multiple partners (increasing the likelihood of human papillomavirus infection), and cigarette smoking.”

“The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis.”

While the ACS stresses that the letter sent by its former officials was a personal correspondence and not the official position of the ACS, their clarification essentially restates and confirms the statements made in the letter. Elsewhere, in a discussion of prevention and risk factors, the ACS further adds: “It is important that the issue of circumcision not distract the public's attention from avoiding known penile cancer risk factors.”

  Men’s Health magazine runs ‘Separated at Birth’

The August 1998 issue of Men’s Health contains a well-researched article by Mark Jenkins which asks ‘Did circumcision ruin your sex life? The doc robbed you of 240 feet of nerves when he removed your foreskin. Maybe it’s time for the cutting to stop.’

The story includes comments from men circumcised as adults who report differences in their sexual experiences, as well as information on recent research on the unique erogenous nature of the foreskin, and examines the myths of medical benefits of circumcision. Photos of an actual circumcision accompany the piece.

  U.S. National Public Radio's "All Things Considered" segment on circumcision

NPR's acclaimed program "All Things Considered" devoted a twelve minute segment to the growing number of Jewish parents who are questioning circumcision on their August 24, 1998 program. The segment includes interviews with parents who chose to carry out a naming ceremony without cutting for their newborn sons. Dr. Ronald Goldman gives some historical perspective of Jewish questioning of circumcision.

Listen to the program segment. (Requires RealPlayer)

  Salon Magazine runs story entitled 'Circumcision in America'

The online magazine Salon published a story in the October 26, 1998 "Mothers Who Think" section by Debra Ollivier entitled "Circumcision in America: How did a medically pointless procedure become a routine practice performed on a majority of American males?

..."Despite medical and religious debunking, long-standing cultural biases keep the practice of circumcision alive."

..."The fact that so many circumcised American men, and mothers, nurses, and obstetricians are ready to defend the practice in the face of contrary epidemiological evidence is a certain giveaway to hidden, unconscious motives and disturbed emotional feelings about the penis and sexual matters in general."

..."The mother of all myths, now locker-room gospel, is that a circumcised penis is more hygienic than an intact one."

Read the complete four-part series written by this Jewish mother of an intact son.

  Newborns feel pain differently than adults: research

An article in the London Sunday Telegraph on August 2, 1998 reports on research showing that newborns feel pain longer and more sensitively that adults.

Maria Fitzgerald of University College London writes in the Medical Research Council's journal that “Reports in clinical and psychological literature indicate early injury or trauma can have long-term consequences on sensory or pain behaviour that extend into childhood or beyond.”

Newborn circumcision is often done without any anesthesia. Even when done with anesthesia there is pain with injection of the anesthetics. Once anesthetics wear off in a couple of hours, there is pain throughout the healing period.

  Mothering magazine prints “The Case Against Circumcision” by Paul M. Fleiss, MD

The cover story of the winter 1997 issue of Mothering magazine was entitled “Where is my foreskin: the case against circumcision” by Dr. Paul M. Fleiss. For back issues, contact Mothering at mother@ni.net or call 1-800-984-8116.

This well-documented article traces the origin of circumcision in America as an anti-masturbation measure, examines the many myths of medical benefits for the procedure, and tries to educate readers on the functions of the foreskin, why circumcision violates an infant’s human rights and why it violates a physician’s code of ethics.

“The natural penis requires no special care. A child’s foreskin, like his eyelids, is self-cleansing. Forcibly retracting a baby’s foreskin can lead to irritation and infection. The best way to care for a child’s intact penis is to leave it alone.”

“A circumcised father who has mixed feelings about his intact newborn son may require gentle, compassionate psychological counseling to help him come to terms with his loss and to overcome his anxieties about normal male genitalia.”

To read more of the article, go to the CIRP website’s version.

  Circumcision without anesthesia unacceptable says AMA

A new study found circumcision so traumatic that doctors ended the study early rather than subject any more babies to the operation without anesthesia.

The researchers discovered that for those circumcised without anesthesia there was not only severe pain, but also an increased risk of choking and difficulty breathing (apnea), which occurred in two out of eleven infants before the study was halted.

Read a summary of the story on the CNN website.

Read the abstract of this study by J. Lander and others published in the Journal of the American Medical Association, Dec. 24 1997, Vol 278 (24):2157-2162 (on the JAMA website) or the full text(on the CIRP website).

According to the editorial comments accompanying the study, as well as a strongly worded notice in the AMA’s Science News Update, circumcision without anesthesia is no longer acceptable! The most commonly used forms of anesthesia, EMLA cream and dorsal nerve blocks, were not completely effective. “Ring block” anesthesia, a more invasive and delicate technique which is hardly ever used in the U.S., was more effective. The study only followed the infants for six hours after the procedure, so we can assume even those given ring block anesthesia experienced pain once the anesthetic wore off.