[LChoy]

Originally Posted by Lchoy

This topic is one of those things that will become controversial no matter what because it deals with:
- Parenting
- Ethics/morals/religion/consent
- The penis



For me, I have also recently had to think about this decision as we are expecting a boy early next year. I also have a background in health policy and work in an evidence based health organization

I will say to the OP that you question is quite timely, as the Canadian Paediatric Society very recently reviewed their position on newborn circumcision.

As of Sept 2015, the Society has maintained that they do not recommend the procedure for every newborn male. The American society has also reviewed their position, and also do not recommend it (citation needed)

http://www.cps.ca/documents/position/circumcision

Note the study is reviewing the procedure based on medical evidence only, and does not take into account of religious and ethical reasoning behind their decision

While there is some evidence that circumcision may convey some positive benefits, the risk/reward ratio is so balanced, and with availability of other procedures and options that can convey similar benefits (use of contraceptives, HPV vaccines), that it is challenging to make definitive recommendations for the entire male newborn population in Canada.

At the end of the day, it is ultimately the parents decision, and it should be made with all of the facts on the pros and cons of having the procedure done. If you do have the procedure, please ensure that it is done at the hospital by the OB doctor. While the numbers show most of the time everything is done correctly, the stats behind complications due to this procedure is higher than expected.

Lastly from a policy perspective, based on the decision, it is likely the procedure will remain uncovered by universal health care.

I posted this in the last circumcision thread, but since this one is still going, I figure I post it here as well.

Just some addition information to answer some of the questions I've seen in this thread:

I attached the CPS benefit and risk table. This can help illustrate what the numbers show from their review:

TABLE 1: Potential risks and benefits of neonatal circumcision

Outcome/Effect size (reference)

Potential risks
Minor bleeding/ 1.5% (combined)
Local infection (minor)/ NNH = 67 [39]
Severe infection/ Extremely rare
Death from unrecognized bleeding/ Extremely rare
Meatal stenosis/ NNH 10–50 (<1% when petroleum
jelly is used)

Potential benefits
Prevention of phimosis/ NNT = 67 [7]
Decrease in early UTI/ NNT = 111 – 125 [16]
Decrease in UTI in males with
risk factors (anomaly or
recurrent infection)/ NNT = 4 – 6 [15]
Decreased acquisition of HIV/ NNT = 298 (65 – 1231 depending
on population) [28]
Decreased acquisition of HSV/ NNT = 16 [32]
Decreased acquisition of HPV/ NNT = 5 [32][35]
Decreased penile cancer risk/ NNT = 900 – 322,000 [36][37]
Decreased cervical cancer risk
in female partners/ NNT = 90 – 140 [35]

HPV Human papillomavirus; HSV Herpes simplex virus; NNH Number needed to harm; NNT Number needed to treat; UTI Urinary tract infection

Also I checked the latest American Pediatric Society recommendation. I was wrong in my post above as they do recommend for parents that choose it, as they also describe a benefit to having it done.

"Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it."
http://pediatrics.aappublications.or...ent/130/3/e756

I think it's interesting that the Canadian society actually says not recommended for all boys, but the Americans just leave it as recommended if parents choose it. Similar findings, but the message is slightly different.

Also something interesting between Canadians and Americans is the rate of circumcision. Canada is about 30%, and Americans are closer to 60%. I don't have the figures internationally, but I would expect a higher rate in middle east countries, and lower for Europe, Australia, and Asia.

Lastly, the thing I most stress is to have the procedure done by trained professionals in a health care sitting:

"It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers." (AAP)

Although this didn't help in the original post

Anyways, debate away as both the US and Canada regulatory body leaves the decision ultimately to the parents

LChoy