VICTORIA B.C.: Human Rights group criticises CPS policy

Children's Health and Human Rights Partnership (CHHRP)
September 9, 2015

Canadian Children's Rights Group Questions New Circumcision Policy

VICTORIA, BRITISH COLUMBIA-- A just released policy on infant male circumcision by the Canadian Paediatric Society (CPS) was judged today by the Children's Health & Human Rights Partnership (CHHRP) to be a step in the right direction, but was "nevertheless 'predictably inadequate' with respect to several specific issues."

CHHRP Medical Director Dr. Christopher Guest, MD, FRCPC, said the new policy is consistent with international paediatric associations that affirm infant boys should not have their healthy foreskins routinely removed.

Citing the position of the CPS that recognizes the unique sensory functions of the male foreskin, Dr. Guest asserted that, "A growing number of medical associations now recognize that an intact penis with a foreskin contributes to sexual pleasure for the male and his partner." According to Guest, in 2010 the Royal Dutch Medical Association concluded, "the foreskin is a complex erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts."

"Circumcision alters the structure of the penis, which inevitably alters function. Long term harm to men from infant circumcision has never been studied" Guest said. Despite this, Guest says men are reporting long-term adverse consequences at the Canadian-based online Global Survey of Circumcision Harm. Although the CPS failed to include it, Guest says scientific evidence has emerged that supports these men's claims. In 2011, Dr. Morton Frisch published findings in the International Journal of Epidemiology showing that in Denmark, where circumcision is rare, 'circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in their female partners, notably orgasm difficulties, dyspareunia [difficult or painful sexual intercourse] and a sense of incomplete needs fulfilment.'

Guest faulted the CPS for inclusion of  "convenient untruths, "most notably a discussion of HIV being lower in circumcised men. He says such claims are based on methodologically weak African trials, which contradict global HIV trends, for example the United States, which has a high circumcision rate, yet a significantly higher rate of HIV infection than Sweden and Japan where circumcision is rare. "Even if the African trials were scientifically valid, they cannot be used to justify infant circumcision because infants are not sexually active persons," he said. "Soap and water and safer sex practices, including condoms, can prevent disease."

According to Guest, the CPS failed to include crucial information from a 2012 report by the International NGO Council on Violence Against Children, which CHHRP sent to the CPS in 2014. The report stated that "non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence."

"Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany, and others confirm that there is no justification for circumcising infants in the absence of medical urgency," Guest stated. "The CPS is out of step with those medical associations, who also urge an end to the practice due to ethical and human rights concerns."

Although the CPS concluded that routine infant circumcision is not recommended, and that the benefits of the surgery do not outweigh the risks (contrary to a 2012 claim by the American Academy of Pediatrics), Guest contends that the position statement is still insufficient due to its ambiguity in leaving the decision up to parents. "Parents are not physicians. They do not have the medical knowledge to decide if surgery is medically indicated for their child," Guest asserted. He went on to say that, "Leaving a decision about medically unnecessary surgery up to parents is an ethical failure on the CPS' part. Where else in medicine do physicians place this burden on parents, in order to obviate their own professional responsibility?"

"Preservation of bodily integrity is a basic and universal human right that the CPS must articulate clearly in future statements," Guest said. "We Canadians, as well as our institutions and government, have an obligation to protect that right for all citizens, regardless of gender or age."

The Children's Health & Human Rights Partnership was established in 2012 as a partnership of professionals in the fields of medicine, ethics, and law to further public education regarding non-therapeutic genital surgery on Canadian children.


Earlier story

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 POSITION STATEMENT Newborn male circumcision Posted: Sep 8 2015 Abstract 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". ]

VANCOUVER: Doctors should revisit circumcision policy

Vancouver Sun
March 13, 2013

Pediatricians should revisit their circumcision policy

by Christopher L. Guest Co-Founder, Children's Health and Human Rights Partnership

Re: Pediatricians update circumcision policy; new statement from Canadian doctors offers parents a more neutral position on loaded issue, March 4

Most physicians are sadly ignorant of the sexual and mechanical function of the human prepuce.

The prepuce is richly innervated, erogenous tissue, containing thousands of sensory neuroreceptors such as Meissner's corpuscles. Many of the most sensitive regions of the penis are located along the inner prepuce and are needlessly amputated by circumcision.

The prepuce also acts as a linear bearing mechanism, providing a unique gliding motion during sexual intercourse.

Removing healthy, functional genital tissue from powerless infants is medically unethical and Canadian physicians should refuse to participate in this disgraceful practice. Parental preferences and cultural traditions should never trump contemporary medical ethics and the fundamental human right to bodily integrity.

When will the Canadian Paediatric Society (CPS) recognize that the boy is the patient, not the parents? Let him decide for himself, when he is older, and able to consent.

CANADA: Ethicist plays down circumcision policy change

Canadian Medical Association Bulletin
February 5, 2013

ETHICS CORNER: CIRCUMCISION

by Dr. Jeff Blackmer, Director of Ethics, CMA

What advice should a physician give to parents considering whether or not to have their baby circumcised?

For some parents, the decision is easy because of religious tenets or family tradition. For others, it involves a struggle to balance competing evidence. In Canada this evidence is evaluated and the medical standard is set by the Canadian Paediatric Society (CPS), which since 1996 has held that “circumcision of newborns should not be routinely performed.”

However, in August the American Academy of Pediatrics (AAP) updated its 1999 policy on circumcision and cited evidence showing that the procedure offers some potential benefits, including lower risk of urinary tract infection (UTI), penile cancer and sexually transmitted disease (STD) infection.

There are, of course, provisos. For instance, most UTIs occur in the first year of life and can be avoided with proper hygiene, and the lower STD rates appear applicable only to certain populations, such as gay men. As well, most of the studies that were consulted by the AAP did not involve North American men. So what should doctors do when parents seek their advice? I would point out that the AAP guidelines do not advocate circumcision as standard practice and state that the final decision should be left up to the parents, as is currently the case. The CPS is currently reviewing the evidence and expects to release an updated statement of its own. Until then, its current advice stands.

So, despite all the recent publicity related to the AAP, not much has changed. Some parents will always choose circumcision, some will always reject it, and some will decide based solely on the evidence. The role of physicians in this decision-making process is simply to remain up to date on the evidence and do all they can to help parents make an informed decision.

Earlier story

CANADA: Paediatricians foreshadow circumcision policy change

O Canada
March 3, 2013

Canada's pediatricians set to reveal new policy on circumcision

The Canadian Paediatric Society is preparing to revise its position on circumcision.

Canada’s pediatricians are about to update their advice on whether baby boys should be circumcised, revising their stand for the first time in 17 years.

Their review comes as new Canadian research suggests half of expectant parents would consider circumcision if they had a son — and that the single most important factor is the circumcision “status” of the father.

The Canadian Paediatric Society’s old policy, issued in 1996, opposed routine circumcision of newborns.

The new statement is expected to be more neutral.

“There isn’t going to be a ‘prescription’ for Canadian males in terms of circumcision,” society president Dr. Richard Stanwick, chief medical health officer for the Vancouver Island Health Authority, told Postmedia News.

The organization has been struggling to put forward a balanced position “that captures the risks, and the benefits, but is also respectful of personal preferences [whose?], religious issues and many other things that dictate this decision,” Stanwick said.

The issue is so loaded with emotion and controversy that the new statement has been three years in the making. “There are very strong opinions on both sides of this issue,” Stanwick said.

“We know that we’re wading into something that, no matter what we write, will not be strong enough for probably either side.”

Last year, the American Academy of Pediatrics announced that the health benefits of newborn male circumcision outweigh the risks, a move that provoked demonstrations by anti-circumcision activists who view the procedure as genital mutilation of newborns. [No, who view it as unethical.]

The old policy deemed circumcision medically unnecessary for the “well-being of the child.”

But after a special task force reviewed more than 1,000 studies published over the past 15 years, the American doctors’ group now says that circumcision provides protection against urinary tract infections, penile cancer and the transmission of some sexually transmitted infections, including HIV.

The organization isn’t recommending universal circumcision. Instead, it says the final decision should be left to parents.

Circumcision involves the surgical remove of some, or all, of the foreskin from the penis. It is one of the most common surgical procedures performed worldwide. In hospitals, the procedure is usually performed by obstetricians soon after birth.

“Clearly there has been a lot of literature around the potential role of the avoidance of infection,” Stanwick said.

“But this also has to be balanced off against the fact that this is still a surgical procedure, and it is not without risk.”

Those risks can include bleeding and hemorrhage, infection, inflammation and tightening at the end of the penis [and major complications, loss of the penis and death.]

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,” Stanwick said. [Not any shift, only a shift towards recommending it. Sounds like he's gearing up for a major increase, and needing to recruit!]

The new policy statement is expected to be released before the pediatric group’s annual meeting in June.

“It would be great if we had absolute answers, but on this one, I don’t think we will,” Stanwick said.

“At the end of the day . . . it will very much be influenced by dad’s status, as well as the cultural and religious issues.” [What other surgical procedures are influenced by the father's status, cultural or religious issues?]

A new study found that the circumcision rates are heavily influenced by whether or not the father is circumcised.

University of Saskatchewan researchers, in a study published in the journal Canadian Family Physician, surveyed 230 parents attending prenatal classes in Saskatoon.

Overall, half — 56 per cent — said they would consider pursuing circumcision if they had a son. In cases where the father of the expected baby was circumcised, 82 per cent were in favour of circumcision, versus 15 per cent when the father wasn’t circumcised.

According to the researchers, Canada’s current circumcision rate is 32 per cent. In the U.S., rates are increasing, to 61 per cent of men, they said. [No, it is slowly falling,and 61% is approximately the rate at which babies are being circumcised.]

VICTORIA, B.C.: Rally against private circumcision clinic

Monday Magazine (Victoria, B.C.)
April 12, 2012

Foreskin rally calls for ban on infant circumcision

Verbal battle erupts over specialized private clinic

By Danielle Pope

Have you hugged your foreskin today? A passionate rally this week is calling on the government and Victoria residents to show the normally shy body part a little bold love — or at least protection.

The “Whole World/Whole Children” rally is set to gather outside one of the newest private health-care offices to start offering circumcision, Diversified Health Clinic at 1063 Fort, on Friday, April 13, at 11:30 a.m. The group will then march to the legislature lawns and finish with a protest and speeches. But while foreskins may not be an issue paramount in the minds of many (save expectant parents), rally organizers say this affects all of us more than we think.

“What this really comes down to is a human rights issue,” says Glen Callender, speaker at the event and founder of the Canadian Foreskin Awareness Project. “When you consider that infant female circumcision was banned in Canada in 1997 and is now considered a criminal offence, why is the genital mutilation of an infant male any different?”

Kira Antinuk, a local mother and nursing student who organized the rally, says that the impetus for the protest came when her organization, Victoria Circumcision Resources, heard about Dr. Neil Pollock, a Vancouver-based physician who is known for being outspoken on the issue of circumcision, bringing his practice to the Island.

“We were really concerned to hear that Dr. Pollock . . . was planning on opening up a genital-cutting clinic in Victoria,” says Antinuk. “This is not acceptable on the Island, and it shouldn’t be acceptable in B.C. at all. I don’t think a lot of people are aware of this yet.”

Pollock says he has performed over 35,000 circumcisions —...

...

B.C. was the first province to pull Medicare funding from circumcision back in 1984, with all other provinces following suit after research showed it was no longer a necessary medical procedure. In 2009, the B.C. College of Physicians and Surgeons stated the procedure should be delayed until the child can make his own decision, and the Canadian Pediatric Society now states on its website the relative risks of the foreskin being left intact alongside the proven risks of removing it.

Since circumcisions are no longer covered provincially or performed in hospitals, private health clinics are left to pick up the slack from parents and some adults still wanting to perform the procedure. That privatized bias is exactly what concerns Callender, who says clinics are now preying on misinformed parents to push the invasive procedure onto children who cannot give their consent.

“Criminal law protects the foreskin of a girl, the hood of her clitoris, but not of a boy — yet it’s the same translated body part,” says Callender. “So much of what we hear about why circumcision is ‘good’ is misinformation from years ago, or even old wives tales, but the tales stick. We have to recognize the severe and detrimental impacts not only of making a decision for an individual who cannot consent, but that this is a form of assault, and we need the government to say ‘No more.’”

...

Callender emphasizes that the rally is not an effort to prevent circumcision on the whole — it’s a plea to halt the procedures on infants, ...

UPDATE
4/17/2012

A YouTube video of the rally (6:32).