* To read the American Academy of Pediatrics' circumcision policy statement, visit www.aap.org. * The National Organization of Circumcision Information Resource Centers: www.nocirc.org * The Circumcision Information and Resources Page, a site tha...
* To read the American Academy of Pediatrics' circumcision policy statement, visit www.aap.org .
* The National Organization of Circumcision Information Resource Centers: www.nocirc.org
* The Circumcision Information and Resources Page, a site that is generally opposed to circumcision, which includes links to information on the history of circumcision: www.cirp.org
* Circlist, an information site that generally endorses circumcision: www.circlist.com/circhome.html
About 12 hours after he was born, Connor Priem was wrapped in hospital sheets and blankets to hold him down as he was prepped for surgery at St. Mary's Medical Center in Duluth.
Dr. Anne Stephen, a pediatrician, injected an anesthetic into the base of the 5-pound boy's penis, causing Connor to cry and fuss for a short time before closing his eyes and going back to sleep. About 20 minutes later, Stephen removed his foreskin as Connor lay quiet and mostly still.
For Stephen, circumcision is one of the most routine and simple procedures she performs. "It takes, max, five minutes," said the physician who is section chairwoman of the Duluth Clinic's pediatrics department.
Circumcision, which dates back to ancient Egypt, is the most common surgical procedure in the United States, one so deeply embedded in the culture that many new parents just assume their baby should have it. But others believe circumcision is not necessary, and some even see it as a violation of a baby's human rights.
"The child suffers a primal wound," said Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers, which has regional centers across the country, including Minneapolis. "That any baby survives this is a miracle to me."
Although some statistics suggest circumcision has been on the rise, numbers may drop because the procedure is no longer reimbursed by Medicaid in 16 states, including Minnesota. And some believe that private insurance companies may soon follow the practice set by the federal government's health insurance program for low-income families.
Connor's parents, Jason Priem and Sherrie Muggli of Cloquet, there was no debate about whether their son would be circumcised.
"I believe it should be done, it helps prevent a lot of stuff," Muggli said. "I think it's safer and more sanitary."
Muggli echoed common reasons for choosing circumcision, which are not necessarily true.
In a 1999 policy statement, the American Academy of Pediatrics said there are some benefits to circumcision, including slightly lower risks of urinary tract infections in the first year of life as well as slightly reduced rates of sexually transmitted infections and penile cancer later in life. However, the academy also said potential benefits of newborn circumcision weren't "sufficient to recommend the procedure."
In other words, it's now "a cosmetic procedure that's not considered medically necessary," said Dr. Lylan Park, a St. Luke's pediatrician. She said the decision is left to parents.
Northland parents prefer to circumcision. The primary reasons are that it's tradition, it's the social norm and that it helps children avoid teasing.
"They don't want their boy to look any different in the locker room," Park said.
That's a common reason heard by Stacy Holden, a yoga instructor for pregnant mothers and their children. She talks to many parents who never thought about the procedure until after a birth and go with it because the father was circumcised.
"They feel like they should look the same," said Holden, who lives in South Range, Wis.
Although her husband is circumcised, their two sons, Coulter, 5, and Cedar, 2, are not. It was a point of contention with many in her family, Holden said, but she and her husband researched the issue and were convinced that circumcision wasn't necessary.
"That's the way they were created, their bodies were whole and complete," Holden said. "If they choose to do it later in life, at least it gives them the option."
It was also easier to choose that route because at the time the couple lived in California, the only area of the country where circumcision is not the norm.
According to a study published in the March 2005 Journal of Urology, circumcision rates in the West were 28 percent from 1988 to 2000. The Midwest, at 71 percent, and the Northeast, at about 70 percent, had the highest rates in the country.
The study also showed circumcision on the rise. Between 1988 and 1991, the national rate was 48 percent. In 2000, it leapt to 61 percent.
Statistics from the Centers for Disease Control, however, show that circumcision is dropping. In 1999, the CDC estimated the average rate across the nation at 65.3 percent. In 2004, it was 57.4 percent.
In Duluth, rates probably are far higher. The BirthPlace at St. Mary's Medical Center says only 4 percent of its baby boys were not circumcised. St. Luke's did not release its statistics, but Park estimated that in her practice nine out of 10 newborn boys are circumcised.
That's in line with the report published in the Journal of Urology, according to Dr. Caleb Nelson, the study's lead author.
"Minnesota is predominantly white compared to other areas of the Midwest," Nelson said, noting that Hispanics tend to have the lowest circumcision rates.
"It's also more high-end from a demographic standpoint," he said. "It's a relatively more affluent state. And the richer you are, the more likely you are to circumcise."
Over the past year, some local pediatricians have seen a small decline in circumcisions, which they attribute mostly to Medicaid.
The Minnesota Legislature passed a law that stopped the state's taxpayer-funded Medicaid plans from covering the procedure beginning in September 2005. An estimated 9,000 to 10,000 newborns will be affected each year, according to the state Department of Human Services, which oversees those health-care plans. The agency also estimates the change will save about $216,000 in fiscal year 2006 and $409,000 in 2007.
Minnesota was one of 16 states to make the change. Wisconsin's public health program, BadgerCare, still covers the procedure. For someone who has to pay for a circumcision on their own, SMDC said the typical charge is $250.
While all major private insurance companies in Minnesota still cover circumcision, many expect that to change.
"The trend is that if Medicaid starts something, others follow suit," Park said.
If that happens, Park predicted circumcision will not be so routine.
"It's going to be a slow progression," she said. "I don't think it's going to be an issue any more in the locker room."
The decision weighs heavily on many Northland parents, said Jana Studelska, a Duluth student midwife who has three uncircumcised boys, ages 8, 10 and 18.
Studelska doesn't have to bring up the topic in her birthing classes, instead, "everybody asks about it. And everybody has very strong feelings."
Studelska said her sons haven't been teased but she has talked to them about why they may look different and how to handle teasing itself.
"What I tell them to say is: 'This is what a penis is supposed to look like,' " she said.
Sara McNeil of Duluth decided not to have her 4-year-old son circumcised and now sees it as an opportunity to educate him about teasing, no matter what the issue might be.
"Kids are teased for all kinds of reasons," she said. "It's our job to empower our kids to handle teasing."
Studelska encourages parents to do research on circumcision and seek unbiased information.
"I really encourage people to ask questions and to go along with their babies so they can be with them and comfort them doing that time," she said.
That's one trend that hasn't changed, Stephen said: "In 17 years, I've only had about three people watch."
BRANDON STAHL covers health. He can be reached at (218) 720-4154 or by e-mail at firstname.lastname@example.org .