Circumcision is going out of style. The rate of male infant
circumcision in Canada has dropped significantly from
roughly 48% in 1970 to 13.9% in 2003, with provincial
rates varying widely. But it's still a touchy subject,
leaving physicians caught in the crossfire of a debate
charged with medical, psychological and cultural implications.
And all the while, a new trend is emerging in its place:
more and more men are seeking to restore what someone
else decided should be cut away. For these males, foreskin
restoration is the order of the day.
TO
CUT OR NOT TO CUT?
As far back as 1975, the Canadian Pediatric Society
(CPS) issued a position statement advising there's no
valid medical indication for neonatal circumcision.
In 1996, the CPS decried the procedure "should not be
routinely performed."
"Doctors are under no obligation
to circumcise a child at the request of parents," explains
Dr Walker. He says the ranks of those who'll do it are
dwindling.
Still, doctors remain free to do
as they see fit. In fact, in the only two provinces
where the College of Physicians and Surgeons has formally
advised doctors not to perform the operation —
Saskatchewan and British Columbia — rates remain
well above the national average, at 16.7% and an estimated
20% respectively.
The CPS guidelines aren't the only
impetus for circumcision's fall from grace. By 2004,
every provincial health insurance board — save
Manitoba's — had de-listed the procedure. So if
parents still want the snip, they've got to foot the
bill themselves. "We didn't see a big change initially,"
says Dr Walker, "but it's happening gradually."
That's encouraging news for human
rights groups who have argued for years that circumcision
is tantamount to female genital mutilation, which is
outlawed by the Criminal Code of Canada.
BODY
AND SOUL
Still, there are those who maintain circumcision prevents
disease. Evidence that circumcision reduces the risk
of penile cancer, HIV and urinary tract infections (UTIs)
can indeed be found in the medical literature, but Dr
Walker says that evidence has to be put into context.
"Cancer of the penis has an incidence of one in several
hundred thousand males over 70, and it isn't lethal,"
he explains. And while studies have shown the relative
risk of HIV infection is lower in circumcised males,
Dr Walker says the evidence is questionable and argues
that whether circumcised or not, the only way to avoid
HIV is never to have unsafe sex. As for UTIs, "the rate
of infection in circumcised infants is lower, it's still
less than one percent in those who aren't," he says.
The reality is that circumcisions
are primarily performed for cultural or religious reasons.
The brit milah — the covenant of circumcision —
was God's first command to Abraham and the defining
mark of his chosen people. And the ritual remains widely
practiced in both the Jewish and Muslim faiths. But
regardless of personal religious beliefs or medical
fact, the choice of whether or not to circumcise an
infant is legally the parents' to make.
REVERSING
THE DAMAGE
That's a problem for a growing number of men who resent
not having had a say. Others complain that the prepuce,
or foreskin, is a sensory organ that enhances sexual
pleasure. Still others want to regain their "natural
status" for physical and emotional wholeness or aesthetics.
These men are taking matters into their own hands and
"restoring" their foreskin — either surgically
or by gradually stretching the leftover skin. But it's
never quite the same.
"Once you cut off nerves and blood
supply, you can't get it back again," says Adam Greenberg,
coordinator of the Toronto chapter of the National Organization
of Restoring Men (NORM). "We try to restore those emotional
and physical scars."
Founded in 1989 in San Francisco,
NORM is a non-profit support group for men to share
advice about non-surgical restoration techniques. The
gay community was targeted for this outreach, since
the founders felt that they tended to be more open about
matters concerning sexuality. And though homosexuals
still represent the majority of NORM's membership, heterosexuals
are catching on.
"You can work with what you have
and expand it," says Mr Greenberg, who's been working
on his own restoration for 32 months, "you just have
to be patient." Non-surgical restoration is based on
the principle of tissue expansion: maintaining constant
outward tension on the shaft of the penis to induce
the skin to grow. Tape and weights, elastic straps or
manual stretching can all be used — an impressive
selection of devices are even available online.
Dr Robert H Stubbs is a Toronto
plastic surgeon who's performed both adult circumcisions
and restorations. "Surgical restoration is highly risky
because penises are attached to men, and they never
comply," he says. "I usually try to talk them out of
it." But he will perform the five-hour, $10,000+ multi-stage
operation if there's enough donor tissue — which
is taken from the scrotum — and he feels the patient's
on board.
Ultimately, the circumcision decision
is the most personal choice a man can't make. But bringing
the trend towards restoration out of the shadows may
eventually give them the voice they've never had.
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