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Published August 27, 2012, 11:40 PM

Parents of baby boys weigh value of circumcision

FARGO – For some parents, the decision of whether or not to circumcise their baby boys is a struggle. For others, it’s very clear.

By: Tracy Frank, INFORUM

The Great Mom Debate

The Great Mom Debate is an occasional series on parenting topics, addressing issues women often debate socially and within themselves. If you have an idea for our Great Mom Debate or if you would like to participate in future topics, please contact Forum reporter Tracy Frank at tfrank@forumcomm.com.

FARGO – For some parents, the decision of whether or not to circumcise their baby boys is a struggle. For others, it’s very clear.

Kristen Toutges, who lives in the Fargo-Moorhead area, is strongly opposed to circumcision. She started researching the issue more than four years ago when she was pregnant with her son and says it’s not medically necessary and is more harmful than beneficial.

“I was automatically against it because I didn’t want to hurt my child if I didn’t have to,” she said.

For years the American Academy of Pediatrics has said circumcision has potential medical benefits and advantages as well as risks but scientific evidence was not sufficient to recommend routine circumcision.

But Monday, the AAP updated its policy statement to say new scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys.

The health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis, lower risk of penile cancer, lower risk of cervical cancer in sexual partners, and lower risk of urinary tract infections in the first year of life, according to the AAP.

The benefits are enough that infant male circumcision is covered by most insurance, but it’s ultimately a decision parents should make, taking their religious, ethical, and cultural beliefs into account, the AAP stated.

Dr. Ted Kleiman, an Essentia Health pediatrician in Fargo, said 70 to 80 percent of people have their sons circumcised in this area.

He said parents don’t often ask for recommendations, but if they do, he tells them it’s not medically necessary. Most kids who aren’t circumcised don’t have problems, but for males not able to bathe regularly (such as soldiers in combat), an intact foreskin can cause problems, he tells parents. It can also cause issues for elderly men in nursing homes, he said.

Every case of penile cancer is in an uncircumcised man, and there are about 100 to 200 cases of penile cancer a year nationwide, Kleiman said.

But problems with bleeding and infection can occur with any surgical procedure, he said.

A study published in 2010 in Thymos Journal of Boyhood Studies estimates 117 baby boys die from circumcision complications each year.

Roughly 55 percent of the 2 million males born in the United States each year are circumcised, down from 79 percent in the 1970s and 1980s, according to the report.

Johns Hopkins researchers released a report Aug. 20 warning that declining rates of U.S. infant male circumcision could add more than

$4.4 billion in avoidable health care costs if rates over the next decade drop to 10 percent, the levels now seen in Europe.

The added expense stems from new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners because removing foreskin hinders bacteria and virus buildup in the penis’ skin folds, the report states.

The analysis showed that, on average, each male circumcision not performed cost $313 more in illness-related expenses.

Circumcising infants can cost anywhere from $150 to $800, according to various online sources.

Dr. Stephanie Hanson, a Sanford Health pediatrician in Fargo, said circumcision is typically done in the hospital within 24 to 48 hours of birth.

Babies are swaddled and given a pacifier with a sugar solution, which research shows diminishes pain in infants, she said. They are then given a numbing shot at the base of the penis, she said.

“It’s really important to us that our babies have good pain control,” Hanson said. “This is a surgical procedure just like any other kind of minor surgery.”

She said most babies tolerate it pretty well, but occasionally the wound heals incorrectly.

“If it’s severe enough, they need to see a urologist and sometimes have a repeat surgical procedure,” Hanson said.

There can also be problems with bleeding, infection and cosmetic risks when the penis doesn’t look like parents expected or there is scarring or adhesions, she said.

“I definitely council parents before I do the circumcision, but ultimately I feel it’s their decision,” Hanson said. “I really want to make sure parents take this decision seriously and put a lot of thought behind why they want to do a circumcision.”

For babies not circumcised at birth, some men then have the procedure done as adults.

Dr. Theodore Sawchuk, a Sanford urologist, said circumcision is not commonly done on adults.

Sawchuk estimates he performs one or two adult circumcisions a month. Rarely, young adults have it done as a personal preference, he said.

Making the decision

Julie Burmeister, of Fergus Falls, Minn., had all three of her boys circumcised after learning the pros and cons from their doctor, she said.

“Most little boys don’t always keep themselves clean, and so it was a matter of both cleanliness and health reasons,” she said.

They also didn’t want their kids to have to deal with the possibility of needing circumcisions as adults, Burmeister said.

Amanda Jacobson from Ulen, Minn., who now lives in Virginia, is 14 weeks pregnant and said while she doesn’t yet know her baby’s gender, she and the baby’s father have discussed circumcision.

“We have friends who have had their children circumcised and friends who haven’t had their children circumcised, so it’s kind of a controversial topic for us,” she said.

She said they plan to circumcise because the baby’s father said it looks better and it would be easier to take care of.

“When they get older and have to be in a nursing home or taken care of by family, I don’t want to put that burden on somebody else,” Jacobson said. “And when they’re older, there’s a greater risk of infection.”

Betsey Johnson, of rural Cass County, N.D., had her sons circumcised and said it’s a decision that each family should make based on their beliefs.

“All of the males in my family and my husband’s family have been circumcised, so I never would have thought to not do this,” she said.

But she said it bothers her that over the past few years some insurance companies and Medicaid have stopped covering the cost of circumcisions.

“This change has made it impossible for many families who don’t have the means to pay for this to circumcise their children,” she said. “I worry that there will now be a large cluster of male children who will possibly be teased and singled out because when they were born their parents could not pay to have this done.”

Blue Cross Blue Shield of North Dakota’s standard benefit plans cover circumcision, but some self-funded plans may not, said Najla Amundson, BCBSND public relations manager.

Those opposed to infant circumcision say the risks don’t outweigh the benefits.

Melissa Kindelspire of Page, N.D., works at a local birthing center and said that while she must remain neutral on the topic at work, she is personally against circumcision, which she said is a cosmetic procedure. She did not have it done on her son.

“To do a surgery on all newborn boys that maybe could slightly reduce the chance of a rare illness is not a reason to do the surgery because the surgery has risks too,” she said. “You’re trading the risks of a UTI with the risk of a surgical complication, a surgical infection, or hemorrhaging.”

Toutges agrees.

“If we’re going to be practicing medicine by removing body parts just in case, then it makes more sense to be removing the breast tissue,” she said. “Even men are more likely to get breast cancer than penile cancer.”

Kindelspire said a lot of people think circumcision is just a quick snip, but it’s actually a more involved procedure. She encourages parents to watch the procedure on YouTube so they know what they’re having done on their infants and to look up the benefits of the foreskin so they know what they’re taking away.

“I don’t feel like people are making wrong decisions. I feel like they’re making uninformed decisions,” she said. “Everything on our body is there because it performs a function.”

Toutges said her research has shown her that the foreskin is like an eyelid that protects the penis and keeps urine and feces from entering the urethra when baby boys are in diapers.

It also has sexual benefits, including preventing the head of the penis from becoming calloused and desensitized, she said.

“It doesn’t make any sense,” she said of circumcision. “People say it might prevent STDs, but when are we going to start lining up girls to cut them to see what it might prevent? That’s not medicine.”

Zenas Baer is a Hawley, Minn., attorney who has handled several circumcision cases. He’s also a father of boys who were not circumcised (even though he is), and said baby boys should have the same rights as baby girls, who are legally protected from any alteration of their genital tissue.

“Cutting off the most erogenous, sensitive tissue of that child’s body, to me is an affront on the human right of that infant,” he said. “It is treating the baby as though he was personal property and chattel to be sculpted as the parent might think it appropriate.”

In talking to parents, the most prominent reason Baer said he’s heard for circumcising their children is because the father is circumcised and they don’t want their sons to be teased in the locker rooms.

“Under any other circumstances, this would be criminal assault in the first degree,” he said. “It is using a sharp knife to excise, cut away, and dispose of healthy genital tissue without a medical diagnosis, without a medical need. It is simply done at the request of one person to visit that harm on another person who is too young to express his desires.”

Baer said he’s not opposed to circumcision, but he is opposed to parents making that decision for their sons.

“When I thought about my role as a lawyer and the oath that I took, I became more and more convinced that this is a barbaric procedure that is being perpetuated by misinformed or uninformed populace in violation of that infant’s constitutional rights.”