from the Vancouver Sun...

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Registered: 07-07-2003
from the Vancouver Sun...
Thu, 04-14-2011 - 2:55am

With full acknowledgement to the Vancouver Sun and authors Dr Ed Shoen and Dr Neil Pollock I copy below a useful article published 12 April 2011

You can reach the article on the newspaper's website at:http://www.vancouversun.com/health/skinny+circumcision/4599446/story.html

In response to the article by Sharon Kirkey (Circumcision best left to prepubescence, disease expert says) published April 4 in The Vancouver Sun, we wish to share further relevant information to help readers gain a deeper understanding of the issues that frequently arise in the circumcision debate.

We agree with the health benefits of circumcision that were highlighted in the article, and add that many health care providers today feel that those benefits outweigh the minor complications, and these benefits accrue from infancy through old age. Some argue that an uncircumcised male infant may have a lifetime health disadvantage.

Many people wonder why having a foreskin poses a risk. The basic problem is that the inner layer of the foreskin is a mucous membrane, like the lining of the cheek. It is moist, delicate, tears easily, and harmful germs tend to stick to and/or invade it. It contains a large number of specialized cells (phagocytes) to trap and destroy invading organisms, but in some instances, such as HIV, these cells trap the virus but are unable to destroy it, thus aiding its introduction into the body.

As Kirkey's article pointed out, repeated studies have shown that circumcision is 50 to 60 per cent protective against HIV/AIDS in heterosexual men.

Other sexually transmitted infections (STIs) are also more likely in uncircumcised men. These include human papillomavirus (HPV), genital herpes, trichomonas and bacterial vaginosis. HPV causes both penile and cervical cancer. Penile cancer is found almost exclusively in uncircumcised men and cervical cancer is twice as common in women with uncircumcised partners. Sexual pleasure and power are not significantly affected by circumcision.

We disagree with the suggestion, made by Dr. Noni Macdonald in Kirkey's article, to wait until prepubescence to circumcise boys. This is because the advantages of circumcision begin in infancy. In the first year of life, uncircumcised boys are 10 times as likely to get serious urinary tract infections (UTIs), with possible future kidney damage. Dr. Tom Wiswell provided the original evidence in the 1980s after studying over 200,000 deliveries from the Armed Forces files. In addition to preventing UTIs, newborn circumcision prevents childhood foreskin infections, and inability to retract the foreskin (phimosis). It also promotes better genital hygiene, particularly in infancy and old age, when self-cleaning can't be done.

The newborn period is the "window of opportunity" for circumcision. Newborns are very resilient, have high levels of endorphins, heal faster, and their thin foreskin rarely requires suturing. Notwithstanding this, local anesthesia should always be used in newborn circumcision, because when administered properly, it prevents pain for the baby. The complication rate is under 0.5 per cent, 10 times less than if the procedure is done later when the foreskin is thicker, bleeds more and needs stitches. The serious risks and costs to the patient are higher later in life, because general anesthesia and hospitalization is generally considered to be required.

From my (Dr. Pollock's) own experience of safely completing in B.C. more than 30,000 newborn circumcisions, I feel strongly that in experienced hands, newborn circumcision is a quick (under 30 seconds start to end), safe, and a virtually painless procedure. Significant post-operative bleeding is rare.

Many people opposed to circumcision argue against it based on the evaluation of a specific benefit compared to the overall risk. However, when the many small cumulative benefits of circumcision are compared to the overall risks, the benefit-to-risk ratio is significant.

Parents considering newborn circumcision should seek a knowledgeable medical professional who is able to provide an unbiased summary of both the benefits and risks so that parents can make an informed, independent decision.

When choosing a circumcision provider, the experience of that provider, more than which technique or instrument is used, is the key to safe outcomes.

Dr. Ed Schoen is based in San Francisco and Dr. Neil Pollock is a physician in Vancouver.

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