The circumcision decision

Right off the bat, parents of newborn boys in the US are faced with an important and irreversible decision: should their son be circumcised? Currently, the odds a newborn boy will be circumcised are 1 in 1.74, or 57%.

The custom of removing the penile foreskin has existed for millennia as a rite of passage in the Jewish, Muslim, and various other religious traditions. In the 20th century, circumcision became a routine surgery for millions of male infants born in the US whose parents were acting less in response to a religious mandate than to health and cultural concerns.

But the numbers have been falling of late. In the 1930's, about 30% of men were circumcised; 40 years later, 80% were. That large percentage led some doctors in the 1970's to question if the majority of male babies actually benefited from the surgery. As a result, the number of circumcisions began to decline. Today, 57% of US newborns have the operation.

Circumcision rates differ depending on where a baby is born. The Midwest leads the nation in percentage of newborns circumcised: 1 in 1.27 (or 78.7% of) Midwestern parents opt for circumcision, according to a 1999 federal report. The region with the second highest percentage is the Northeast, with 66.9%, or 1 in 1.49, babies circumcised. Next comes the South: 1 in 1.7 (or 58.7% of) newborns will be circumcised there each year. And lastly, the region with by far the lowest circumcision rate is the West: only 31.5%, or 1 in 3.17 baby boys, are circumcised in the American West each year.

Outside the US, rates vary by culture, religion, and national trend. In Madagascar, 98% of males 15 and older are circumcised. In the United Kingdom, only 6% are.

Arguments abound for and against circumcision. Proponents in the US say that it increases hygiene, decreases a male's risk of contracting HIV or getting penile cancer, lowers the likelihood of UTIs in infants, and, of course, for many it remains a religious rite. Opponents say that hygiene is taken care of by merely washing the penis (something one hopes all boys are taught to do, regardless), that penile cancer is extraordinarily rare, that HIV prevention can be accomplished through safe sex practices (condom use, abstinence, blood tests, etc), and that it is unethical to make a lifelong decision for a child who has no say in the matter.

Several studies published in 2007 argued for circumcision as a way to reduce the transmission of HIV. Two studies, one from Kenya and the other from Uganda, and both published in The Lancet, demonstrated that circumcised men were about half as likely to get HIV in 24 months as uncircumcised men. The Kenyan study involved 2,784 uncircumcised men 18 - 24; nearly half (1,391) were given a circumcision. Most of the men (91.4%) had a follow-up medical check after 24 months: by then, 22 circumcised men and 47 uncircumcised men had contracted HIV. Another study published in the journal Pediatrics tracked 510 male newborns in New Zealand for 25 years and came to the conclusion that circumcision cut the rate of both contracting and transmitting STDs, including HIV, by up to 50%.

But, as the authors of the Ugandan study warn, it could be dangerous to rely too heavily on circumcision to prevent disease; note that in the 1980's, during the first flare of HIV transmission in the US, the majority of sexually mature men were circumcised.

"Circumcision provides only partial protection," the authors note. "There is a critical need to practice safe sex after circumcision (limiting the number of sex partners and consistently using condoms)." Of the young Ugandan men studied, only 14% reported consistent condom use.

Fortunately, young American men are likelier to use condoms. The odds a sexually active male high school student used a condom during his last sexual encounter are 1 in 1.46 (68%).

Currently, neither the American Academy of Pediatrics nor the American Medical Association recommends routine circumcision. Instead, both institutions recommend that doctors discuss the possible risks and benefits of the surgery, and then leave it to parents to make an informed decision.

The British Medical Association goes further, suggesting that the child's input is also important, when available: "The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view." One possibility for parents divided on the issue is to wait until a boy is sexually mature, and old enough to decide for himself.

Read More Articles