Can Med Assoc J 1993; 149(1), p. 16.

"Male and female circumcision in Canada" (letter.)

I applaud CMAJ and Dr. Eike-Henner Kluge for the publication of
Kluge's article "Female circumcision: When medical ethics confronts
cultural values" (Can Med Assoc J 1993; 148: 288-289).

It is high time that the medical profession took a more definitive
stand on the issue of circumcision. I agree with Kluge's reasoning
and conclusions that the circumcision of girls and boys is unethical
and is "nonconsensual mutilation of a minor for nonmedical reasons."

I am pleased to read  that the College of Physicians and Surgeons
of Ontario has banned the practice of female circumcision and hope
that other provinces will follow suit.

Male circumcision is still widely practised. Frequently the decision
to circumcise is not grounded in religious or cultural identity.
In my discussions with parents who have opted for circumcision of
their infants, their reasons stem from complete ignorance ("doesn't
it prevent bladder infections and problems with small foreskins?")
or ambivalence or bewilderment (neither parent is really quite sure
why it was done, since there was minimal discussion beforehand, or
the father had been circumcised and the couple thought it was "just
done").

In Canada we now have a medical-legal responsibility for full
disclosure before consent is given for any medical treatment.
Circumcision as practised at present often does not involve full
disclosure. Many parents remain unaware of how it is actually done;
they do not realize that the procedure is excruciatingly painful
and is often performed without any anesthetic or analgesia. This
is inexcusable in light of the very simple and safe regional block
of the dorsal nerve of the penis, which, done properly, can provide
complete anesthesia for the procedure. (1)

Circumcision without analgesia is not only unethical, it is barbaric.
It is our fault as physicians that this is allowed to continue.

As long as circumcision is practised, physicians must ensure that
parents are fully informed about it. we should emphasize that it
is painful and insist that proper analgesia be administered.

Mary E. Lynch, MD, FRCPC
Victoria General Hospital
Halifax, NS

Reference

1. Cousins MJ, Bridenbaugh PD (eds): Neural Blockade in Clinical
Anesthesia and Management of Pain. 2nd ed. Lippincott, Philadelphia,
1988: 657, 685.