Correspondent:

SOCIETY OF OBSTETRICIANS
AND GYNAECOLOGISTS
OF CANADA

I would like to comment on the Web site called Sexuality and U, administered by the Society of Obstetricians and Gynaecologists of Canada (SOGC).

Although I think the site overall is excellent, I see problems in the sections dealing with male circumcision. I've been researching circumcision for several years, and letters that I have written on this subject have been published in a number of academic journals including the Lancet, the Journal of the American Medical Association, the Archives of Pediatrics and Adolescent Medicine, and the Journal of Law and Medicine.

In a section called "Boys and Puberty," intended for presentation by educators in front of large groups, sexualityandu.ca explains circumcision as follows:

13. Explain circumcision.

• Important to mention the difference between one penis and another
• Usually it would be done soon after birth
• Removal of covering over end of penis
• Normal either way (no difference in sensation, performance, etc.)
• Something they will have to decide about if they are parents
• No health reason to have it done (not medically necessary, but a personal choice). Boys who have not been circumcised should cleanse beneath the foreskin of the penis regularly.

In my judgment, there are three major problems with the above information. The first problem has to do with the statement that circumcision causes "no difference in sensation, performance, etc." Common sense dictates that cutting off a normal part of a healthy organ has physical and/or emotional effects of some kind. In a paper published in 1996 in the British Journal of Urology, Canadian researcher Dr. John R. Taylor concluded that circumcision removes "an important component of the overall sensory mechanism of the human penis."

Dr. Taylor's groundbreaking research may have escaped the notice of sexualityandu.ca, but it has been widely reported in other media, including national television, radio, the Internet, major daily newspapers, popular magazines, and the Medical Post. For your information, I enclose a short article on foreskin restoration that appears in the current issue of Health Watch, a publication offered free of charge to customers at Shoppers Drug Mart. The article cites Dr. Taylor's research and concludes with the observation that "any man would notice a difference." I also enclose a printout of the index page of a new Web site that describes Dr. Taylor's findings.

The reality is that changes in sexual behaviour caused by circumcision have not been thoroughly investigated. Perhaps the sexualityandu site should note the lack of research in this area, instead of making assertions that have no scientific basis and are contrary to common sense.

The second problem relates to the statement that circumcision is something parents "have to decide about." The difficulty here is that the only kind of surgery parents can authorize on their children is the kind that is medically necessary. If a surgical operation is not medically necessary, then a physician has a professional duty not to perform that operation on an incompetent patient. The reason for this rule is obvious: vulnerable people are entitled to extra protection. Under Canadian law, any physician who performs medically unnecessary surgery on an infant could be civilly and criminally liable, even if the surgery was authorized by the parents/guardians. Dr. Margaret Somerville, founding director of McGill University's Centre for Medicine, Ethics and Law, and one of Canada's top medical ethicists, writes as follows in a recent book entitled The Ethical Canary:

Physicians who undertake infant male circumcision could be legally liable for medical malpractice (civil liability in battery or negligence), which can result in an award of damages simply for carrying out the circumcision even if it was competently performed. They could also, as explained, be charged with criminal liability for assault. In both ethics and law, a physician has a primary obligation of personal care to the patient. This obligation requires the physician both to place the patient first and to first do no harm. Physicians who undertake surgery on patients must prove that it is justified.

Dr. Somerville's comments have been widely reported in the national media, though like the findings of Dr. Taylor, they seem to have eluded the editors of sexualityandu.ca. If the SOGC does not accept Dr. Somerville's interpretation of Canadian law as regards circumcision, then perhaps you could explain why.

The third problem lies in the suggestion that "boys who have not been circumcised should cleanse beneath the foreskin of the penis regularly." Attempts to clean beneath the foreskin before it is fully retractable can cause harm. Usually the foreskin is retractable by the age of 4 or 5, but in some cases it cannot be fully retracted until well past puberty. Premature retraction of the foreskin can give rise to infection, and cause permanent damage in the form of scarring and loss of elasticity.

In the section called "Take a look at your body - ADULTS," the sexualityandu site says that "in uncircumcised males, an additional layer of skin covers the glans, and is referred to as the foreskin." This is analogous to saying that "in uncircumcised females, an additional piece of tissue is found, and is referred to as the clitoris." Just because millions of people around the world believe that certain parts of the human genitals should be eliminated, it doesn't mean that these parts should be labeled "additional" on Web sites purporting to offer scientific information about sexuality.

I hope the SOGC will update its otherwise excellent site on human sexuality to provide accurate, complete and unbiased information about circumcision and the anatomy of the foreskin. Do not hesitate to contact me if I can be of further assistance.

Yours sincerely,

[signed]

D ennis H arrison