Canadian Pediatrician says wait until 11 to circumsize

Tara - posted on 04/07/2011 ( 21 moms have responded )

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By Sharon Kirkey and Michael Fraiman, National Post, with files from Postmedia News · Apr. 5, 2011 | Last Updated: Apr. 5, 2011 11:16 PM ET

A new study has reignited the ongoing debate over circumcision, with a provocative new suggestion by a leading Canadian researcher: Wait until boys are 11 or 12 before they are circumcised, and allow them a say in the decision.

Dr. Noni MacDonald, professor of pediatrics at Halifax’s Dalhousie University, says that since the potential benefits of circumcision only begin to set in once males become sexually active, there may be merit in offering circumcision to young boys “rather than their baby brothers.”

She makes the provocative suggestion in the latest issue of the Canadian Medical Association Journal, in response to new evidence from large trials in Africa concluding the benefits of male circumcision in cutting the risk of HIV in heterosexual men there.

“The [infant] isn’t at risk of HIV and sexually transmitted diseases, because they’re not sexually active, so why are we rushing to do it at that time?” Dr. MacDonald said. “If you’re really going to do this, we need to think of the timing. Why aren’t we offering it to peripubertal boys, when it’s going to be relevant?”

The Canadian Paediatric Society is in the process of trying to decide what to say about the topic. Several committees are reviewing the African data, said executive director Marie Adèle Davis. The Ottawa-based group’s current position is that the benefits and harms of circumcision are so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns.

Circumcision rates in Canada are falling, but it remains one of the most frequently performed surgical procedures worldwide.

Dr. Neil Pollock, a Vancouver-based doctor who has performed more than 30,000 circumcisions, says routinely postponing the decision on the procedure is off the mark.

“If it makes sense to do it later in life, it makes sense to do it earlier,” he said in an interview.

He adds that having the surgery while in infancy makes it safer and less painful for the baby, and less costly for the medical system.

“Parents are always called upon to make decisions for their children, what they believe to be in their best interest,” he said. “If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.”

Because Canada has a much lower HIV rate than Africa, it isn’t clear how applicable the African studies are to the North American experience.

A recent U.S. analysis estimated that neonatal circumcision would reduce the 1.87% lifetime risk of HIV among men, but only by about 16%.

“It’s not a huge decrease,” noted Dr. MacDonald.

To those squeamish about a procedure that is deemed to be too painful and uncomfortable for a pre-teen, she says: “Why are we fine with doing it to a baby but not a young man?

“It’s curious that a painful elective procedure of no major benefit to the infant until years later would ever be deemed more acceptable than the same procedure for a peripubertal boy,” Dr. MacDonald writes in the CMAJ.

What’s more, unlike infant boys, older boys can give consent. “The baby gets no choice, the parents make the decision,” she said. “An 11-, 12-, or 13-year-old boy could really make a decision on their own about this.”

National Post, with files from Postmedia News

http://www.nationalpost.com/news/Study+s...

Wouldn't it be nice if the Canadian Pediatric Society made this their recommendation to go alongside the following "..The Ottawa-based group’s current position is that the benefits and harms of circumcision are so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns."

Times they are a changing...

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Ez - posted on 04/07/2011

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He adds that having the surgery while in infancy makes it safer and less painful for the baby



Bullshit.



When a newborn can bleed out with a blood loss of only 1oz, and they can't access substantial post-op pain-killers, I will NEVER understand the assertion that it is better to do it at birth. Just because they don't remember the pain doesn't make it better *head/desk*.



For most intactivists, this would be an acceptable compromise. For those pro-circers who cling to the African HIV 'study' (I used inverted commas because it was so flawed it barely qualifies) as reason to cut, there should be no problem with leaving the procedure until puberty. That way, at least the owner of the penis can voice his opinion.

Merry - posted on 04/08/2011

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That would be awesome if it became the norm to wait until 11 years.

Except the entire world might need some education about how to NOT clean under the foreskins! I can't believe how many people claim intact boys have such problems when actually the parents caused the problems just from messing with the darn thing!

Teach everyone how to leave the foreskin alone until it's no longer their business to touch. Then, the vast majority of intact boys will be just fine and would never opt to have parts of their penis cut off.

Krista - posted on 04/07/2011

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To those squeamish about a procedure that is deemed to be too painful and uncomfortable for a pre-teen, she says: “Why are we fine with doing it to a baby but not a young man?

No shit.

Sneaky - posted on 04/08/2011

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“If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.”

Really??? Colour me surprised.

P.S. I'm in love with Dr. Noni MacDonald - you kick ass girl!

Mel - posted on 04/07/2011

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I dont know why people have the need to circumsize at all *sigh* so wrong. Majority of us here in Australia are just fine without the procedure

21 Comments

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Tinker1987 - posted on 04/11/2011

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i didnt get my son circumsised and i wont when he is 11 either! if he chooses to someday thats up to him.I think its cruel for a infant to have it done.they have no say in it but they have to go through the pain.

Tania - posted on 04/08/2011

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That is a crock....My cousin was circumcised as a teen because of a chronic infection and he said it was the worst thing he has ever been through pain wise. If my son wants it done he can do it when he's 18 but I will not incourage it.

Minnie - posted on 04/08/2011

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Can she move a bit more south?



Ugh, that other doctor is an idiot. 'Safer' and 'less painful' if done in infancy?



A recent U.S. analysis estimated that neonatal circumcision would reduce the 1.87% lifetime risk of HIV among men, but only by about 16%.



LOL so this is the statistical reduction our AAP and CDC are basing their review of their position on circumcision on? A 16% reduction of a 1.87% possibility of contracting HIV?



Or are they basing it on a large increase in dough coming in...

Tara - posted on 04/08/2011

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That's not true Jen, she is a professor of pediatrics and so will teach her philosophy to her students who will pass that on to their patients.
She could further change the face of circ in canada.

[deleted account]

No one will listen to her. It will still be "babies won't remember it so might as well do it then."



edited to correct a slight gender error. It's too early.

April - posted on 04/07/2011

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oh sorry Heather that wasn't for you, :) i just wanted to add more to my post. :)

Lady Heather - posted on 04/07/2011

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I don't recall ever disagreeing with this if that was for me April. I think it's fantastic because it would pretty much ensure that it happens super rarely. Win!

April - posted on 04/07/2011

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I think the point is that they are given the option, i still say it's a hell of a lot better than having it done when they are newborns.

Lady Heather - posted on 04/07/2011

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"“If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.”"



Pre-pubescent boys are clearly more clever than we give them credit for. Of course they wouldn't sign up for this. Who in their right mind would? Yes, I totally want you to cut some of my skin off so that I can just wear a condom anyways. SOUNDS GREAT.

April - posted on 04/07/2011

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I knew that, thats what i've been saying all along! LOL



They do that in the Philippines all the time, new borns don't get circumcised. Boys usually get done at around 11-12 years old thats the norm here. Thats what i'm going to do if thats what my son wants. Thats what my husband prefers. I never understood why newborns got circumcised anyway. Western countries have it backwards i think. :/

Krista - posted on 04/07/2011

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I'm comforted by the fact that not only is Dr. MacDonald a pediatrician, she's a professor of pediatrics at a VERY large medical school. That's a lot of doctors who will be taught that foreskins have a purpose, and to leave the damn things alone if there isn't an existing medical problem with them.

Johnny - posted on 04/07/2011

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Yes, I'm going to listen to a guy who has built his entire medical practice on circumcision. He is one of the very few doctors where I live that performs RIC and most people here who want it done go to him. He'd say anything to avoid the hit to his business.

Stifler's - posted on 04/07/2011

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That's some whack shit.. hey son... you're 11 now.. want to be circumcised.. it prevents you from getting STIs. You don't need to wear a condom or anything if you're circumcised. Good parenting there love. The whole procedure is irrelevant fullstop.

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