America’s long affair with the ‘unkindest cut’

Male circumcision lives on the in US after it has largely died out elsewhere.

A European man changing his clothes in a locker room of an American gym stands out as ‘different’.

That’s because in the United States male circumcision, unlike elsewhere, is almost universal. Along with school shootings, the death penalty and baseball, preventative infant male circumcision is one of those American exceptions that foreigners find hard to fathom and Americans hard to explain.

At the end of the 1970s, two thirds of boys born in the US were circumcised shortly after birth. That number had fallen by 10% since then to 58.3% in 2010, according to the National Center for Health Statistics, a sign the tide may be turning. Until it does, the American practice of amputating newborn infants’ foreskins is a weird holdover from a misguided Victorian mania for disease prevention that evolved into a largely unchallenged secular cultural phenomenon.

How did the US, so technologically advanced, become a circumcision outlier?

Let’s start with a definition. The male human at birth has a penis neatly encased in a prepuce, or foreskin, which as the name indicates is a fold of soft skin and nerves covering the organ when not in use for its reproductive function. In circumcision the ‘extra’ foreskin is pulled out in front of the penis and snipped off. Apart from the US, most circumcisions are performed on Jewish and Muslim boys at puberty as a religious ritual. In 2007, the World Health Organisation estimated that one third of the world’s male population is circumcised, of whom two-thirds are Muslim.

The origins of circumcision are unknown, but it could date back to 70,000 years ago in Africa before spreading across the continents. The early date would explain why Paleolithic hunter gatherers like the Aborigines of Australia practice circumcision, and Christopher Columbus reported to have seen it in some New World tribes.

The first documented practice appears on a tomb wall in Saqqara in Lower Egypt, dated at about 2,300 BC. The oldest written mention, a few hundred years later, brags about being able to withstand the pain (they used stone knives) during a mass circumcision. The Egyptian Book of the Dead talks about the Sun god Ra cutting himself, which some have linked back to circumcision. The sources don’t mention why they snipped, and the practice may have been limited to priests.

The Ancient Greeks however, prized the ideal of male beauty and equated a long, tapered foreskin with male beauty (think of the pointy organs of the two bronze statues found in Riace, Sicily).

Circumcision makes its cultural debut in the book of Genesis, where Abraham is circumcised at God’s bidding to get his wife Sarah pregnant. But its purpose in the Jewish faith is mainly ritualistic, not medical. A powerful and permanent covenant between the Jews and their God. Jesus, according to one of the four Gospels, was circumcised, but early the Christian church wisely welcomed uncut converts too, while the Roman Empire banned the practice.

The Catholic Church’s rejection of the ‘ritual’ argument for circumcision relegated the practice to the Jewish and Muslim worlds until the mid 1700s, when masturbation started to be seen as a medical problem causing insanity and disease, besides being a sin. The modern war on the foreskin had begun.

Books like “Onania, or the Heinous Sin of Self-Pollution, And All Its Frightful Consequences, in Both Sexes, Considered” in 1750 arguing that masturbation weakened mind and body were read across Europe and in the United States, causing concern among parents.

The medical profession found a simple solution: do away with the foreskin and children will find it harder to masturbate. By 1891, the president of the Royal College of Surgeons of Great Britain had published a treatise “On Circumcision as Preventative of Masturbation.” Circumcision was still being recommended as a ‘cure’ for masturbation in the 1930s in the US, and by the end of that decade three quarters of American women were giving birth in hospitals where the procedure was available. After World War II, Britain’s National Health System stopped funding the procedure since health benefits could not be proven. Now only about 9% of UK males are circumcised, but the US had no public health system to point the way.

And although masturbation is no longer thought of as a disease, circumcision is still (mistakenly) practised as a low-risk form of cancer prevention and so boys “look like Dad.” Its effectiveness in preventing AIDS and sexually transmitted diseases is still debatable. The practice in the US is slowly receding as awareness of the child’s right to choose grows. Groups like The Whole Network and campaigners calling themselves “intactivists” lobby against the practice.

The American Association of Pediatrics in 2012 said it found that the benefits of infant circumcision exceeded the risks, and leaned in favour of it. A Germany court ruled in the same year that circumcising young boys caused grievous bodily harm. The debate continues.