Would You Circumcise This Baby?

An 8-day-old boy, just before his circumcision, on August 11, 2009.Photo: Amy Arbus

To cut or not to cut. The choice loomed the moment New Yorkers Rob and Deanna Morea found out, three months into Deanna’s pregnancy, that their first child was going to be a boy. Both had grown up with the view of circumcision as something automatic, like severing the umbilical cord. To Rob—white, Catholic, and circumcised—an intact foreskin seemed vaguely un-American. Deanna, African-American and also Catholic, dismissed the parents who don’t circumcise their children as a “granola-eating, Birkenstock-wearing type of crowd.” But that was before they knew they were having a son.

Circumcision is still, as it has been for decades, one of the most routinely performed surgical procedures in the United States—a million of the operations are performed every year. Yet more Americans are beginning to ask themselves the same question the Moreas did: Why, exactly, are we doing this? Having peaked at a staggering 85 percent in the sixties and seventies, the U.S. newborn-circumcision rate dropped to 65 percent in 1999 and to 56 percent in 2006. Give or take a hiccup here and there, the trend is remarkably clear: Over the past 30 years, the circumcision rate has fallen 30 percent. All evidence suggests that we are nearing the moment (2014?) when the year’s crop of circumcised newborns will be in the minority.

Opposition to circumcision isn’t new, of course. What is new are the opponents. What was once mostly a fringe movement has been flowing steadily into the mainstream. Today’s anti-circumcision crowd are people like the Moreas—people whose religious and ideological passions don’t run high either way and who arrive at their decision through a kind of personal cost-benefit analysis involving health concerns, pain, and other factors. At the same time, new evidence that circumcision can help prevent the spread of AIDS, coupled with centuries-old sentiments supporting the practice, are touching off a backlash to the backlash. Lately, arguments pro and con have grown fierce, flaring with the contentious intensity of our time.

The idea of separating the prepuce from the penis is older than the Old Testament. The first depiction of the procedure exists on the walls of an Egyptian tomb built in 2400 B.C.—a relief complete with hieroglyphics that read, “Hold him and do not allow him to faint.” The notion appears to have occurred to several disparate cultures, for reasons unknown. “It is far easier to imagine the impulse behind Neolithic cave painting than to guess what inspired the ancients to cut their genitals,” writes David L. Gollaher in his definitive tome Circumcision: A History of the World’s Most Controversial Surgery. One theory suggests that the ritual’s original goal was to simply draw blood from the sexual organ—to serve as the male equivalent of menstruation, in other words, and thus a rite of passage into adulthood. The Jews took their enslavers’ practice and turned it into a sign of their own covenant with God; 2,000 years later, Muslims followed suit.

Medical concerns didn’t enter the picture until the late-nineteenth century, when science began competing with religious belief. America took its first step toward universal secular circumcision, writes Gollaher, on “the rainy morning of February 9, 1870.” Lewis Sayre, a leading Manhattan surgeon, was treating an anemic 5-year-old boy with partially paralyzed leg muscles when he noticed that the boy’s penis was encased in an unusually tight foreskin, causing chronic pain. Going on intuition, Sayre drove the boy to Bellevue and circumcised him, improvising on the spot with scissors and his fingernails. The boy felt better almost immediately and fully recovered the use of his legs within weeks. Sayre began to perform circumcisions to treat paralysis—and, in at least five cases, his strange inspiration worked. When Sayre published the results in the Transactions of the American Medical Association, the floodgates swung open. Before long, surgeons were using circumcision to treat all manner of ailments.

There was another, half-hidden appeal to the procedure. Ever since the twelfth-century Jewish scholar and physician Maimonides, doctors realized that circumcision dulls the sensation in the glans, supposedly discouraging promiscuity. The idea was especially attractive to the Victorians, famously obsessed with the perils of masturbation. From therapeutic circumcision as a cure for insomnia there was only a short step toward circumcision as a way to dull the “out of control” libido.

In the thirties, another argument for routine circumcision presented itself. Research suggested a link between circumcision and reduced risk of penile and cervical cancer. In addition to the obvious health implications, the finding strengthened the idea of the foreskin as unclean. On par with deodorant and a daily shower, circumcision became a means of assimilating the immigrant and urbanizing the country bumpkin—a civilizing cut. And so at the century’s midpoint, just as the rest of the English-speaking world began souring on the practice (the British National Health Service stopped covering it in 1949), the U.S. settled into its status as the planet’s one bastion of routine neonatal circumcision—second only to Israel.

The Egyptians practiced circumcision as early as 2400 B.C.Photo: The Art Archive/Ragab Papyrus Institute Cairo/Dagli Orti

That belief held sway for decades. Men had it done to their sons because it was done to them. Generations of women came to think of the uncircumcised penis as odd. To leave your son uncircumcised was to expose him to ostracism in the locker room and the bedroom. No amount of debunking seemed to alter that. As far back as 1971, the American Academy of Pediatrics declared that there were “no valid medical indications for circumcision in the neonatal period.” The following year, some 80 percent of Americans circumcised their newborns.

What changed? The shift away from circumcision is driven by a mass of converging trends. For one, we live in an age of child-centric parenting. New research suggests that the babies feel and process more than previously thought, including physical pain (see “How Much Does It Hurt?”). In a survey conducted for this story, every respondent who decided against circumcision cited “unwillingness to inflict pain on the baby” as the main reason. The movement toward healthier living is another factor. Just as people have grown increasingly wary of the impact of artificial foods in their diets and chemical products in the environment, so too have they become more suspicious of the routine use of preventive medical procedures. We’ve already rejected tonsillectomy and appendectomy as bad ideas. The new holistically minded consensus seems to be that if something is there, it’s there for a reason: Leave it alone. Globalization plays a part too. As more U.S. women have sex with foreign-born men, the American perception of the uncut penis as exotic has begun to fade. The decline in the number of practicing Jews contributes as well. Perhaps as a reflection of all of these typically urban-minded ideas, circumcision rates are dropping in big coastal cities at a faster rate than in the heartland. In 2006, for example, a minority of male New York City newborns were circumcised—43.4 percent. In Minnesota, the rate was 70 percent. Circumcision, you could say, is becoming a blue-state-red-state issue.

The Moreas considered all of this and more, having imbibed more information about both the pros and cons of circumcision during the last four months of Deanna’s pregnancy than they care to recall. They still hadn’t decided what to do until the day after their son, Anderson, was born. Then, when a nurse came to take the boy to be circumcised, the decision came clear to them. “We didn’t want to put him through that—we didn’t want to cut him,” says Deanna. “It’s mutilation. They do it to girls in Africa. No matter how accepted it is, it’s mutilation.”

And yet, the pendulum is already swinging back. Earlier this year, the New York Times published a front-page story noting that the Centers for Disease Control was considering recommending routine circumcision to help stop the spread of AIDS. The idea was based largely on studies done in Africa indicating that circumcised heterosexual men were at least 60 percent less susceptible to HIV than uncircumcised ones. The story promptly touched off a firestorm, with pro- and anti-circumcision commenters exchanging angry barbs. The CDC will now say only that it’s in the process of determining a recommendation.

Caught at the crossroads of religion and science, circumcision has proved to be a free-floating symbol, attaching itself to whatever orthodoxy captures a society’s imagination. Its history is driven by wildly shifting rationales: from tribal rite of passage to covenant with God to chastity guarantor to paralysis cure to cancer guard to unnecessary, painful surgery to a Hail Mary pass in the struggle with the AIDS pandemic. There’s no reason to think a new rationale won’t come down the pike when we least expect it. Our millennia-long quest to justify one of civilization’s most curious habits continues.

Would You Circumcise This Baby?