Circumcise? Or not?
That's a question parents consider before the mother gives birth to a son. But in Siouxland, the answer doesn't require much debate.
"Most parents have made up their minds before you even discuss it with them," says Dr. Amir Andrawis, a family practice physician with the Sergeant Bluff Family Medicine Center. "They'll bring it up before I will. They'll say, 'When is he going to be circumcised?'"
Locally, the numbers are significant. At St. Luke's Medical Center, approximately 90 percent of the boys born in 2004 and 2005 were circumcised. At Mercy Medical Center, that figure was between 75 and 80 percent. But, according to Mercy spokesperson Rick Wollman, it could be higher. "We don't know what happens to them after they go home."
Nationally, fewer newborn males are circumcised. According to Dr. Ann Rehan, a pediatrician with Prairie Pediatrics and Adolescent Clinic P.C., approximately 60 to 70 percent of newborn males are circumcised. Worldwide, that number drops to 10 percent.
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So why is the Midwest still a standard bearer for the procedure - considered "cosmetic" by most physicians? Tradition, for the most part.
"Most dads who are circumcised want their sons to be circumcised," Andrawis says. Several religions favor circumcision but "from a medical standpoint, there's no evidence to suggest that you should have it done."
Sure, proponents can point to some statistics - uncircumcised men have a slightly higher risk of penile cancer, but the disease is rare. One out of 100,000 circumcised men and three out of 100,000 uncircumcised men will get the disease. Additionally, circumcised men face a smaller risk of contracting a sexually transmitted disease. But, as Rehan points out, "behavior gets you an STD. To blame it on the foreskin is wrong."
More likely, Andrawis says, parents consider the "locker room" factor - "They might have memories of kids who weren't circumcised and were made fun of. 'That's not going to be my kid.' A lot of times, it's just peer pressure."
The Jewish and Muslim religions encourage circumcision; some cultures do, too.
Andrawis, in fact, spent time in Kenya and watched as boys entering manhood were circumcised. "Most of the time they were circumcised in an operating room. But some were done out in the bush, too. That was cruel."
In the United States, most circumcisions are performed 12 to 24 hours after the child is born. "They're already in the hospital, they're in a controlled setting and you want to make sure the anatomy is normal and the baby is urinating," Andrawis says. "After it's done, you can see if there are any complications."
The procedure takes 15 minutes or less.
Rehan says most physicians use a Gomco clamp - a device that fits over the head of the penis and ensures a uniform cut. She and Andrawis are among the local physicians who use numbing medicine to alleviate any pain. "If you use the medicine, they're relatively content during the procedure," she says. "If you don't use it - and I know physicians who don't - the baby will cry."
Problems? "You can cut off too little skin or too much skin," Rehan says. "The cosmetic outcome isn't that desirable. It's a judgment call."
Some boys aren't able to be circumcised for several reasons. The penis may be too small, for example. Or there may be problems with the anatomy. The opening may not be located where it's supposed to be on the penis. "You don't circumcise that baby because you need to use the foreskin in repair," Rehan says.
Later in life, a man could require circumcision if he has problems pulling the foreskin back.
In healthy babies, however, it's simply a cosmetic choice.
As Rehan says, "A lot of people have to have their appendixes taken out later in life, but we don't do that at birth."
So the procedure often is viewed as a "custom," not a necessity.
In most states, circumcision is still covered by health insurance. In Canada, it is not. There, the number performed has dropped significantly.
Both Andrawis and Rehan figure the United States could follow suit. "As we become more ethnically diverse, we'll see a decline," Andrawis says.
"In Mexico, it was never a custom, so they didn't do it," Rehan says.
The practice didn't actually become a phenomenon until the '30s. Statistics show 34 percent of American males were circumcised in 1932, 60 percent were in 1935. "Three years later," Andrawis says, "it almost doubled." By 1960, approximately 80 percent of American males were circumcised. The number peaked in the '70s, then began a steady decline.
Initially, it was thought to reduce masturbation. Then, proponents suggested it was a matter of cleanliness. But, Andrawis says, "in a culture like ours, hygiene tends to be fairly decent and urinary tract infections seem to be less of an issue." Besides, says Rehan, it's actually easier to keep an uncircumcised baby's penis clean because the foreskin doesn't retract during the first couple of years. "As soon as it starts to come back, you teach your son to clean it with soap and water."
Organizations - such as NORM, the National Organization of Restoring Men - say men who are circumcised lose penile sensitivity and may not experience full pleasure during sex. They advocate "restoring" the foreskin through surgery or the use of stretching devices.
Because it's difficult to find men who have experienced sex uncircumcised and circumcised, experts say surveys are often skewed or inconclusive.
Sensitivity, however, would diminish somewhat if the penis is no longer covered. "Think of your face," Rehan says. "Your skin is constantly exposed to the air. It's probably less sensitive than a part of your body that's always covered with clothes."
Still, is that a reason to avoid circumcision?
For most people, surveys and medical findings don't matter.
"Some people think a circumcised penis looks better," Rehan says.
"In the end," adds Andrawis, "it's just a matter of choice."
