The controversy surrounding circumcision is understandable. It’s an age-old topic that calls to the forefront a slew of religious, medical, ethical and cultural concerns. But in east Idaho, the deciding factors behind circumcisions appear to weigh heavily on cost and culture concerns.
By Chantelle Summers, for The Post Register’s Medical Guide Fall/Winter 2013
The controversy surrounding circumcision is understandable. It’s an age-old topic that calls to the forefront a slew of religious, medical, ethical and cultural concerns.
But in east Idaho, the deciding factors behind circumcisions appear to weigh heavily on cost and culture concerns.
“Circumcision is controversial not just among patients but among doctors,” said Dr. Cory Brown, pediatrician at Bingham Memorial Hospital.
He explained most doctors take their “marching orders” from the American Academy of Pediatrics, a professional association comprised of over 60,000 members in the U.S.
In 2012, the AAP revised its “neutral” stance on circumcision, announcing scientific evidence has shown the health benefits of circumcising a newborn boy outweigh the risks. However, the revised policy fell short of recommending routine circumcision for all newborn boys.
While representatives from Blue Cross of Idaho, Regence Blue Shield of Idaho and PacificSource Health Plans confirmed coverage of routine neonatal male circumcision for its members, Idaho Medicaid does not cover the procedure.
“Idaho Medicaid follows the recommendations of the AAP, which does not recommend routine newborn circumcisions,” said Tom Shanahan, public information manager of the Idaho Department of Health and Welfare.
“Should the AAP begin recommending routine circumcision, Idaho Medicaid would pay for them.”
Dr. Douglas Cottrell of Seasons Medical in Rexburg said he believes some parents with Medicaid or no insurance choose not to circumcise due to the cost of the procedure.
Most circumcisions are now performed in a physician’s office rather than a hospital setting. In a doctor’s office the fee is around $300, he said.
Coleen Niemann, EIRMC Marketing and Community Relations Director said if a circumcision is performed following delivery, before the infant is discharged from the hospital, the fee is $179 as part of EIRMC’s OB package. Should a patient come in at a later date for circumcision, the hospital’s flat fee for an uninsured person to get circumcised is $4,670. That does not include the physician’s fee or the anesthesia fee.
Last year’s statement from the AAP brings to light the health benefits circumcision can have, although Brown stated he sees them as “modest benefits at best.”
Cottrell said there have always been health concerns supporting circumcisions—such as a decreased risk for a urinary tract infection (UTI), sexually transmitted diseases (STDs) and penile cancer.
Many believe circumcision promotes better hygiene when the foreskin is reduced.
Brown said in east Idaho, he believes the majority of parents choose to circumcise for “purely cultural” reasons. Often if the father is circumcised, or the infant has older brothers who are, then it’s done to avoid feelings of embarrassment later on.
“I think that in the intermountain area, it’s a very conservative community—a particular culture that leans toward doing circumcisions,” said Cottrell.
He explained the percentage of circumcisions performed in other regions of the U.S. range from a low of 30 to 40 percent to a high of 80 to 90 percent.
Brown said, “Idaho still has a pretty high percentage rate of circumcision compared to California, where circumcised males are the minority. It’s definitely a cultural thing.”
He estimated Idaho’s percentage rate of circumcised males at 50 to 60 percent.
Cottrell said most parents have their minds made up at the time of delivery.
In his experience, parents who choose not to circumcise “feel that maybe it affects sexual performance at a later date as an adult, others feel it’s an unnecessary procedure, while some feel it’s a primitive or more brutal procedure based out of religion of the old days,” he said.
Ultimately, Brown and Cottrell agree the decision is one that parents should make and that doctors should not persuade one way or the other.
For a newborn, the circumcision procedure, which removes the excess foreskin covering the head of the penis, lasts 10 to 20 minutes and is usually performed within the first two weeks of life. Brown said even up to six weeks is normal while a newborn’s nervous system is still immature and the bleeding is a lot less.
“Most babies do well and sleep through the procedure,” said Brown.
Cottrell said the most popular methods of circumcision for a newborn involve the use of a Plastibell device or a Gomco clamp.
A Plastibell device is a clear, plastic ring that cuts circulation off to the excess foreskin of the penis, which falls off as a scab within five to 10 days. With the Gomco clamp, the excess foreskin is removed immediately, leaving a “healing surgical site.”
“There really is no science to say one is safer or better than the other,” he said.
“If parents have done some reading and feel like they have a preference, we just arrange for the physician who does it the way they prefer,” said Cottrell, as the method of use depends on where the doctor trained.