Circumcision or not?

A snip of the tip wasn’t on Danae Elon’s mind when her husband walked into the kitchen with a question: “What are we going to do if it’s a boy?” It was two months into her pregnancy and the couple hadn’t really talked about circumcising their first child.

Phillip Toitou

Phillip Toitou

OTTAWA — A snip of the tip wasn’t on Danae Elon’s mind when her husband walked into the kitchen with a question: “What are we going to do if it’s a boy?”

It was two months into her pregnancy and the couple hadn’t really talked about circumcising their first child.

“Right there and then, I understood (that) . . . this is going to be really challenging for the two of us,” Elon said.

“Because he of course became concerned, knowing that I would probably throw a fit at the idea. And yet for him it was very important.” Her husband, Phillip Touitou, is a French-Algerian Jew who came from what she describes as a “traditional family.” He lost his father at a young age and wanted to honour his memory by circumcising their son. But Elon, who grew up as a secular Jew in Israel, wasn’t sure about the idea. So she made a film about it.

Elon’s documentary, It’s a Boy, which airs Wednesday on TV Ontario, takes a lighthearted look at the medical and religious issues around male circumcision as the couple grapples with their decision.

Circumcision is a surgical procedure to remove a layer of skin, called the foreskin, that covers the head of the penis. The surgery carries risks and benefits, although serious complications are rare.

The Canadian Paediatric Society says circumcision slightly lowers the risk of developing penile cancer later in life. One of every million men who are circumcised develop cancer of the penis each year, compared to three out of every million men who are not circumcised.

The most common complications from the surgery are too much bleeding or infection. The pediatric society says those complications occur in 20 to 30 boys out of every 1,000.

Two or three of every 1,000 boys will need treatment for more serious complications, such as heavy bleeding or removing too much skin. And about 10 babies out of 1,000 may have to be circumcised again because it wasn’t done properly the first time.

Circumcision appears to slightly lower the risk of urinary tract infections. Two boys out of 1,000 who are circumcised will be hospitalized with a urinary tract infection before their first birthdays. That number rises to seven if the boys are not circumcised.

Some studies, including one published last year in the New England Journal of Medicine, suggest circumcision can lower the risk of sexually transmitted infections.

Researchers from Johns Hopkins University monitored the sexual activity of nearly 3,500 men in Uganda over a period of up to two years.

The researchers found circumcision lowered the risk of infection with herpes by 25 per cent and the cancer-causing human papillomavirus (HPV) by a third. It’s not clear whether the benefits carry over to other places in the world with lower HIV infection rates.

Dr. Prakesh Shah, a neonatologist at Mount Sinai Hospital in Toronto, said scientists are keeping an eye on studies suggesting circumcision lowers the risks of getting sexually transmitted diseases. “The issue is in hot debate,” he said.

The Canadian Paediatric Society currently does not recommend routine circumcision for newborn boys. And most provinces don’t cover the cost of the procedure. Circumcision rates have been slowly declining in Canada for decades. Almost half of Canadian boys and men were estimated to be circumcised in 1970. That figure has now dropped to less than a third.

The most recent Maternity Experiences Survey, conducted in 2006 and 2007 by the Public Health Agency of Canada, found that nearly 32 per cent of baby boys were circumcised. Circumcision rates were highest in Alberta and Ontario, each at around 44 per cent. Nova Scotia had the lowest at about seven per cent.

Health and hygiene were the reasons given most often, followed by a desire to be like the father, brothers or peers. Fewer than a fifth of people gave religion as the reason for circumcising their baby.

“In the early ’60s, it was like a totally religious procedure, a ritual,” Shah said.

“And we were finding in those data, in the research, that there was not much benefit for it. And that’s where the enthusiasm dwindled.”

Danae Elon says she’s not sure she and her husband would have their three sons circumcised if they had to do it all over again.

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