The issue of circumcision is one dear to my heart. Having been born in
England, grown up there and studied nursing there it may be a surprise to
many North Americans to hear that circumcision is not practiced routinely
over there.  In fact most countries around the world do not practice it
routinely, only for religious reasons or medical necessity. I learned about
a book from one of my students that Edward Wallerstein, a journalist wrote
"Circumcision an American health fallacy", the author did extensive research
on the subject and  looks at the historical evolution of circumcision
particularly in North America he also addresses the religious aspect of the
practice.  In Canada circumcision used to be routine, mostly unanesthetised
and with no after pain medication.

However, with the increased health costs Alberta, Quebec and finally Ontario
have opted out of paying for this procedure, and the Canadian Pediatric
Society no longer recommends it as a routine procedure.  I have spoken with
urologists at our local children's hospital who are opposed to the practice
because of the numerous surgeries they have to do to remove scar tissue from
the urethra and to redo ones improperly done. I have also had a mother tell
me that she had not had her first son done, but decided to have her second
child done and found that he fussed for the first two weeks after and made
it very difficult for her to breastfeed and she regreted her decision.

I am opposed to this procedure because of the pain inflicted on a human
being who cannot say no or stop. I don't believe countries that do not do it
routinely have any higher incidence of urinary tract infections, sexually
transmitted diseases or penile cancer.  I was very pleased to hear that
Terry Lynn Dise takes the time and effort to use anesthetic and pain control
after, however I think parents should be informed that there are no benefits
to this procedure and if on the rare occasion it needs to be done later the
individual will have full benefit of anesthetic and pain medication and will
understand what is happening.  Some people still believe neonates do not
perceive pain as others do and because they have no memory of it it does not
matter, having worked with very small prems I know they feel pain. Everytime
you make an intervention you increase the chances of further problems is it
really worth it?  My own family physician told me at the birth of my son
that my obstetrician would not circumcise because he had lost a baby who
bled to death! That was twenty-one years ago in Canada. Presently
circumcision occurs in about 50% of male babies in Canada. It is a very
emotional subject though and like all beliefs they are held to very firmly.

In Ottawa we have one of the largest Somali immigrant groups in North
America as a result female circumcision is quite a hot issue here the
management of these woman in labour and delivery can be very difficult.
They must be cut to open the vagina this leads to hemorrhaging sometimes and
poor tissue healing and infection after birth. The CMA has made a statement
against the practice, because there were small groups pushing to have it
done. Most of the women I have spoken to who had it performed are very
opposed to it.


Susan Moxley, IBCLC
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