Saturday, November 21, 2015

OTTAWA: Canadian Paediatric Society does not recommend "routine circumcision"

CTV News
September 8, 2015

Canadian Paediatric Society re-affirms position against routine circumcision

The Canadian Paediatric Society has released an updated statement re-affirming its position against routine circumcision for newborn males.

The society said recent evidence about the potential health benefits associated with circumcision prompted them to undergo a review of the current medical research. Its last position statement on the matter was published in 1996.

While medical literature has pointed to potential health benefits of circumcision, including the prevention of urinary tract infections and some sexually transmitted infections, the benefits generally don't outweigh the risks, the society said.

"While there may be a benefit for some boys in high risk populations and the procedure could be considered as a treatment or to reduce disease, in most cases, the benefits of circumcision do not outweigh the risks," Dr. Thierry Lacaze, chair of the CPS Fetus and Newborn Committee, said in a separate statement released Tuesday.

The updated statement also included the following recommendations:
Parents of newborn males must receive the most up-to-date, unbiased and personalized medical information about circumcision, so they can weigh the risks and benefits in the context of their own familial, religious and cultural beliefs;
Parents who opt for circumcision should be referred to a practitioner who is trained in the procedure, and whose skills are up to date;
Newborns who are circumcised should be followed-up in the early post-surgery time period;
At the time of discharge from the hospital, parents should understand how to properly care for their son's penis, and be aware of possible complications.
Circumcision has become a contentious issue in Canada, as it raises ethical and legal considerations, in part "because it has lifelong consequences and is performed on a child who cannot give consent," the statement said.

However, waiting until a child is old enough to give consent can increase risks, as doctors [which doctors?]  recommend the surgery be performed within the first week of life. [When he can afford to lose only 35ml of blood, and will not alert anyone that he is bleeding out.]

While circumcision used to be quite popular in Canada starting in the 1950s, rates have declined over the past decades to the current average of 32 per cent, CPS said.

To the original press release
Excerpts from the
Canadian Pediatric Society

Newborn male circumcision
Posted: Sep 8 2015
The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.
The foreskin ...
In the male newborn, the mucosal surfaces of the inner foreskin and glans penis adhere to one another; the foreskin is not redundant skin. The foreskin gradually separates from the glans during childhood. By six years of age, 50% of boys can retract their foreskins, although the process of separation may not be complete until puberty: 95% of boys have retractile foreskin by 17 years of age. Parents may be reassured by their observation of an unimpaired urinary stream in a boy with a nonretracted foreskin. Until this developmental process is complete, the best descriptor to use is ‘nonretractile foreskin’ rather than the confusing and perhaps erroneous term ‘physiologic phimosis’.
Appropriate care for the uncircumcised penis has been well reviewed and should include anticipatory guidance on hygiene and an understanding of the normal nonretractile foreskin. ...
Ethics and legalities of circumcision
Neonatal circumcision is a contentious issue in Canada. The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. [This is new.] Infants need a substitute decision maker – usually their parents – to act in their best interests. [But only when a decision needs to be made. In most of the developed world, genital cutting is not even considered.] Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices.

[This is a very wishywashy policy:
  • It nowhere actually recommends against cutting healthy babies, and sets a very low bar for "medical necessity", barely higher than parental whim.
  • The summary seems to have been written by cutting advocates, with the benefits played up and the risks and harms played down.
  • One of the  three "selected resources" is by cutting fanatic Professor Brian Morris.
  • The table of risks and benefits mentions "unsatisfactory cosmetic results" but offers no figure for their frequency.
  • The cited articles seem largely cherrypicked from the  works of other cutting advocates.
A plus is the emphasis on the normality of infant non-retractility, and the suggested expression " ‘nonretractile foreskin’ rather than the confusing and perhaps erroneous term ‘physiologic phimosis’." But a warning against premature retraction is only hinted at, when it should be explicit and strong, since that is a major cause of the "infections" which commonly make genital cutting "necessary". ]

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