Foreskin friendly: Washington has one of lowest circumcision rates in U.S.

To circumcise or not to circumcise? That is a question apparently on the minds of internet users in Washington.

The Estately blog reports that circumcision — surgical removal of the foreskin from the penis — is among the state’s most popular search terms on Google.

Supporters, including the general medical community, say circumcision prevents infection. However, opponents call it a barbaric procedure that poses health risks for babies.

In spite of the online interest, Washington has one of the lowest circumcision rates in the U.S.

In 2012, the Jewish Daily Forward reported that 15 percent of boys born in Washington were circumcised. The top-ranked state is West Virginia, with a rate of 87 percent, according to the Forward’s research

The report also suggests that circumcision rates are lower in the 18 states where Medicaid doesn’t cover the procedure, including Washington.

Several websites list “foreskin-friendly” physicians in each state. Dr. Lin Jiang is the lone Olympia physician frequently cited as “foreskin friendly.” Jiang told The Olympian that she regularly performs circumcisions, but urges care in the procedure.

Dr. Jiang said foreskin-friendly friendly physicians do not forcibly retract an uncircumcised child. Forcible retraction can cause bleeding and pain because the foreskin is initially attached by a thin membrane, but naturally retracts — for washing, as an example — when the child gets older, according to several medical sources.

Jiang agrees with the American Academy of Pediatrics suggestion that circumcision reduces the likelihood of infections, erectile pain and more.

“We saw so many complications,” Jiang said of uncircumcised patients, some of whom need the procedure later in childhood.

Some people forego the procedure to avoid paying out of pocket, Jiang said. Despite the support in the medical community, and regardless of cultural or religious reasons, circumcision is ultimately a parent’s choice.

“Just like immunizations,” Jiang said, “we don’t force them.”

The procedure has spawned an anti-circumcision movement in the U.S., with the Intact Network as one of the most prominent. The non-profit organization has chapters in all 50 states.

Intact Washington, combined with its Seattle sub-chapter, has a total statewide membership of 640, said co-director Rena Andersen.

Andersen moved to Seattle from Denmark about 13 years ago. Circumcision is uncommon in Europe, and as a registered nurse, Andersen said she never saw complications from patients who were uncircumcised.

When she became pregnant, Andersen was adamant about keeping her son’s foreskin intact — and finding a foreskin-friendly pediatrician.

“I figured he was born with it, I’m sure there’s a reason that it’s there,” said Andersen, who was shocked at the procedure’s prevalence in the U.S. “American doctors are not educated on how to take care of it. The one thing they learn about the foreskin is that they have to cut it off.”

Intact Washington has organized several demonstrations to spread awareness of the anti-circumcision cause, but has stopped short of trying to lobby for a statewide ban. Andersen referred to a failed effort in 2011 to ban circumcision in San Francisco.

“I’m not sure Washington is quite ready for a ban,” she said, “but more and more people get on board every day.”

According to a study from Thymos: Journal of Boyhood Studies frequently cited by anti-circumcision advocates, about 117 infants die from circumcision-related complications annually in the U.S. However, those statistics have been disputed, and the CDC reported in 2010 that no circumcision-related deaths were found.

Andersen noted that some men choose to undergo surgical foreskin restoration.

The procedure has declined nationwide since 1979, most notably in the Western U.S. where the rates are lowest, according to the Centers for Disease Control. In 2010, the rate in the West hovered at 40 percent — a 37 percent decrease since 1979. Meanwhile, the latest data show circumcision rates in the Midwest and Northeast exceed 65 percent.

Overall, the national circumcision rate has declined from about 65 percent in 1979 to about 58 percent in 2010, according to the CDC, which reports that about 1.5 percent of cases experience medical complications.