The History of Circumcision

I am the mother of a son, and many of my close friends and family members are also parents of little boys. If you are one, too, you know that one of the first questions that comes up when you give birth to a boy is whether or not you’re going to have him circumcised. After considering it, our family decided not to. Our religious tradition does not require it, and after reviewing the current medical literature on the subject, which no longer routinely recommends circumcision, we opted against it. However, I do recognize that this is the decision we made for our family. Many people in my circle made a different decision, and I’m not writing here to pass judgment on you either way.

There’s something about circumcision that I find interesting, all the same. It’s still very commonly practiced here in North America (current estimates are that about one third of Canadian boys, and slightly more than half of US boys, are circumcised). In contrast, in most European countries, the rate is well under 20%. In the UK the rate for children under 15 is around 3.8%, and in Denmark it’s 1.6%. So why the difference? Why do we still routinely circumcise a large number of baby boys on this side of the pond, when it’s fallen so far out of favour on the other?

It's a boy!
When we found out we were having a boy, we had to make a decision about circumcision

For the answer, you need to look at the history of circumcision. Throughout the 17th, 18th and most of the 19th centuries, circumcision was rare in North America. There are a few factors that combined to cause Americans to consider circumcision not so much a cultural practice as a medical necessity. One of the first shifts is often credited to Dr. Lewis Sayre, who, in 1870, apparently cured a child’s paralysis by circumcising him. He became convinced that a constriction of the foreskin could cause all kinds of problems, and he lectured widely on the subject. Many other doctors became convinced as well, and within 20 years the foreskin was blamed for a wide variety of medical problems, including insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, insanity and cancer.

The Victorians were also big on cleanliness, and as germ theory caught on, circumcision also became more popular. The idea was that by removing the foreskin it would be easier to keep the penis clean, and therefore it was good for the health. Plus, with increasing cleanliness on the part of doctors, there were fewer complications from the procedure.

However, the argument for circumcision that seems by far the most bizarre to most people today, including me, comes out of puritanical Victorian ideas towards sex. There was a widespread belief that masturbation could lead to masturbatory insanity. The idea was that circumcision could provide a cure. John Harvey Kellogg, of corn flakes fame, was one big proponent, and he advocated that the procedure be performed without using an anesthetic. The idea was that the pain, both from the immediate procedure and then afterward as the wound healed, would put an end to any ideas that a boy might have.

Teeny tiny little toes
After Jacob was born, I was glad to not have to deal with circumcision

Many of the same factors that caused circumcision to catch on here in North America were also present throughout the English-speaking world. While circumcision never really caught on in Continental Europe (hence the extremely low rates in countries like Denmark), it was routinely practiced in the United Kingdom. So why are the rates so different today? In 1949, the newly-formed National Health Service removed circumcision from its list of covered procedures in the UK, following a study by Douglas Gairdner. Here in Canada, the health care system didn’t follow suit for some 45+ years. British Columbia was the first province to stop covering circumcision, in 1984. The last Canadian province to stop covering the procedure was Manitoba, which only removed it in 2005.

I don’t know what things are like in the UK, but as a Canadian who is used to having all my medical procedures fully covered, the idea of paying several hundred dollars out-of-pocket for a medical procedure feels foreign to me. While I do pay some monthly medical insurance costs, those are low, and I never have to pay anything beyond that to access medical care. Whether I’m having a baby, rushing to emergency room, or visiting my doctor, it’s all covered. I suspect that the fact that circumcision isn’t covered has contributed to the lower rates in the UK, and the dropping rates in Canada. In the US, where paying for medical care is the norm, I would expect that this would be less of a factor. That’s only my guess, though.

I’m happy to say that my son hasn’t had any problems, and I don’t regret our decision not to have him circumcised at all. It was the right choice for our family. While everyone else has to make the decision for themselves, it’s interesting to me to see how geographical and historical factors have impacted that decision, and will undoubtedly continue to impact it for as long as people are having baby boys.

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    1. Interesting topic, and as a mama to 3 boys, one I thought about tremendously years ago. When we finally decided we went with matching their dad…and since I have a ten year old who would be mortified if I gave out any more info, I’ll just leave it at that;-)
      Michelle’s last post … Autumn Harvests & PlantingsMy Profile

    2. Fascinating, thanks! I have wondered at the continued popularity when it’s not considered medically necessary (though as you say, the rate is dropping). Aside from religious reasons, I can only assume it is people thinking boys need to “match” their dad–which to be honest, I don’t get since baby boys don’t look like men in more ways than one, and if they ever ask about the differences, it’s pretty easy to just be honest (that’s what we did)! I feel very strongly about not making permanent changes to someone else’s body without consent though.
      Andrea’s last post … That’s My BoyMy Profile

    3. In my state (South Carolina) the Medicaid program (health care for very low-income folks) WAS going to stop paying for it, but then they reversed that decision :-( Possibly because foreskins can be sold and used for things like, if I remember correctly, the making of skin grafts for burn victims. But on a related note, today I read that my state’s health insurance, which all state employees get, and our Medicaid program are going to stop paying for elective, just-for-convenience inductions and c-sections! Sure hope that sticks.
      Jenny’s last post … Old toy makeover: A Barbie for IveyMy Profile

      • If US health insurance plans still cover circumcision, that would further explain the difference in rates. It’s almost twice as high in the US as in Canada, and I would suspect that would explain part of the difference, just as I think the fact they stopped covering it in the UK decades ago impacts their rates.

        I have no issues with the selling of foreskins if someone circumcises. After all, why let them go to waste? I feel the same way about placentas. I opted not to keep mine, and so whether it goes to medical research or some other purpose or ends up in the incinerator doesn’t bother me. However, continuing to cover a procedure that medical bodies deem unnecessary just to access foreskins would be highly unethical. It would violate “first, do no harm”.

      • Foreskin is used in skin grafts for genuine medical needs, but it is also used in expensive cosmetics, including a face cream promoted by Oprah. I agree with the idea of wanting stuff not to go to waste, but this does freak me out a little…and I wonder how many doctors and hospitals push circumcision because of the money they can make? After all, that money doesn’t go to the patient.
        ‘Becca’s last post … Sphagnum Moss DiapersMy Profile

        • For me, that’s the crux of it. If someone is encouraging a medical procedure simply to make money, not out of necessity, that’s not okay.

          The face cream thing is a little bit gross, but if you have surplus foreskins, and they weren’t obtained through coercion, I don’t see anything unethical about it. It’s just kind of icky.

          • concerned cynic says:

            Is it ethical for a hospital to offer to circumcise newborn babies, and not reveal the fact that they sell the foreskins to biotech firms? Is it ethical to do this without giving the parents a fraction of the fee paid per foreskin?

            • I’ll return to the example of my placentas. I don’t know what happened to them after I gave them up. They could have been used for any number of things. That doesn’t bother me, and I don’t expect a cut of any profit made from them, quite honestly. Of course, informed consent, letting me know what may or may not happen to my placenta would be ideal. But it’s the encouragement of circumcision for profit without disclosure, rather than using foreskins that would otherwise go to waste, that bothers me.

              If we were to focus on something, for me it would be ensuring that parents are well-informed of the risks and benefits of any medical procedure. If something is unnecessary, then their care providers should be letting them know that. Let’s educate them up front. If they persist anyway, I just can’t that worked up about what happens to something that would otherwise be handled as medical waste, and I can’t see demanding my cut. (That pun wasn’t intentional, but I’m leaving it in because it made me laugh).

    4. Thanks for this post Amber! I love all the history you’ve included. I’m with you, it won’t be something we’ll do if NumNum turns out to be a boy.
      amy lee’s last post … december 2012 vancouver christmas craft fairsMy Profile

    5. Very fascinating post! When we found out our first was a girl, both my husband and I were so relieved not to have to deal with the circumcision decision. Then our second was, and even though I’m Jewish I was leaning toward not – I just couldn’t wrap my mind around doing what seems (to me) like an invasive and non medical necessity procedure on my new baby. My husband (circumcised) was on the fence, but after doing research he also opted to not do it. Though we live in the US, where the rates of circumcision are high, the area we live (Brooklyn) has a lot of families who opted not to. What makes me uncomfortable is when people blindly agree to it just because it’s the “norm” without doing any research. I don’t hold judgement either way, but feel it should be an informed decision.
      -Dana
      Dana’s last post … Pumpkin Soup in the CountryMy Profile

    6. “Matching their dad”? What kind of reason is that?
      http://www.circumstitions.com/Images/looklike.gif
      Brava to Dana! Bucking an ancient tradition takes guts, but if nobody does, it’ll just carry on, like the story of the woman who cut the ends off her meatloaf without knowing why, but that’s what she’d been taught, when it turned out her great-grandmother had done it make it fit in the pan.

    7. I still wish I could have talked my husband out of having our son circumcised. He was set on it for the “matching” reason, and simply didn’t bother to read the information I sent him on the subject. Fortunately, our son is fine, no complications, but it still strikes me as having been unnecessary.
      Stephanie’s last post … Top 10 Reasons to RecycleMy Profile

    8. My parents helped me out on this one; they opted not to circumcise my brother, so it seemed foreign to me to consider it. My hubs wanted to entertain the idea, although he wasn’t committed either way. In the end we couldn’t afford the $300+ price tag so discussing it was kind of moot so I “won” by default. When our son was about 3 weeks old my hubs told me he was very glad we didn’t, now that he had grown a deeper bond with our son and felt that he didn’t want him to be in pain for any procedure that wasn’t absolutely necessary.

      With one of our sons uncircumcised, it followed that the next two sons weren’t either =) Good topic!
      Melissa Vose’s last post … On Being an Adopted MomMy Profile

      • Truthfully, my husband was leaning towards circumcising when we were expecting our first child, having been circumcised himself (like pretty much all boys born in the 1970s). The price tag changed his mind, too. I think it’s one thing when it happens more or less automatically in the hospital for free. It’s another when you have to find a doctor and make an appointment and shell out. That’s why I think rates fell so much faster in the UK, although I’m glad they did.

      • Mine didn’t feel that strongly either way, but knew that I did, and that I had done the research. He has also since said he’s very glad we didn’t.
        Andrea’s last post … That’s My BoyMy Profile

    9. I’m against genital mutilation on boys or girls & that’s what I consider circumcision to be. When it’s medically indicated, like with appendectomies or mastectomies, then fine. But when it is required for some health reason, that’s pretty much never at birth. Circumcising at birth to prevent some slight possibility of infection or other issues later in life makes as much sense to me as prophylactic tonsillectomy on infants. There was never a debate between me & my husband on it when we had a son because his parents are European–he wasn’t circumcised, why would we do that to our son?

      I’m always happy to hear of people like Dana above who are bucking their religious/cultural traditions & NOT circumcising their children. Just as many religious practices have changed over time, so can circumcision.

      Great post, Amber. The stats & history were really interesting. :)
      Lisa C’s last post … Wordless Wednesday: VIP EditionMy Profile

    10. Great post! I’m very anti-circ. My brother was uncut as well, as is my husband (who was born in South Korea – He’s the first/only uncut man I’ve been with), so it was easy for us. I understand that it’s harder if you’re not used to the idea, but I am very frustrated with the reluctance to change in this (and maybe your?) country. Whether it’s ideas about nutrition, chemicals, car seats… Americans would rather do what they’ve always done than make a change. I guess because that means admitting they didn’t know everything before?

      Performing unnecessary surgery on an infant is barbaric. It hurts enough that it can interfere with breastfeeding.

      Later on, studies (including my own *ahem*) show that the foreskin makes sex better for everyone.
      Janine’s last post … #Revlon Expression ExperimentMy Profile

      • I think that reluctance to change is pretty much universal. Like you say, it means admitting you might have been wrong.

      • concerned cynic says:

        I trust that you all know of Marilyn Milos. When she tours continental Europe giving lectures, women approach her afterwards asking, “if American men do not have foreskins, how can their wives do foreplay?” For educated people in intact societies, circumcision makes men sexually lame.

        Doctors who advocate routine infant circumcision (e.g., Brian Morris, Edgar Schoen, Neil Pollock, the AAP Task Force members) never talk to women who’ve been in committed relationships with both kinds of men. They never talk to gay men, who are well represented in the intactivist community.

    11. Hi

      An excellent well researched post! There was no way my husband and I were going to do an unnecessary medical procedure on our baby boy without his consent.

      However as most of our husbands and brothers were circumsized, there is little knowledge about the uncircumsized penis for mommies of boys (in South Africa anyway.) Just last week I dashed my son off to a urologist who informed me that a “smegma pearl” is a totally normal and common thing for a uncircumsized penis to have at my son’s age (2 years.) I was referred to the specialist by another doctor who thought it was something that might need surgery.

      I do think that more education about uncircumsized baby boys should be passed to moms and dad.
      I had NO idea that the foreskin was actually physically attached to the tip of the penis at birth and that it would separate from the tip over time.

      I found this article to be very helpful.
      http://www.drmomma.org/2010/01/common-questions-regarding-normal.html

      • It sounds like not only parents need education, but so do doctors, if one of them thought your son required surgery. My hope is that as not circumcising becomes more common, everyone will become better-informed about it, just as we’ve become better informed about the normal course of breastfeeding.

    12. I have six boys, so I am no stranger to this debate. I would like to add that while masturbation insanity seems like an unlikely reason to circumcised, there are medical reasons to do it. Recent comprehension studies have shown that HIV/ AIDs transmission rates are FAR lower in circumcised men than non. That reason alone is a valid one to circumcise. So, while I will not judge anyone’s choice for her son, I would love to hear the words mutilation taken out of the conversation. The fact is there is no one right choice and at the end of the day, people need to make informed decisions and not be condemned for them.

      • I agree that the word mutilation is not helpful.

        On the HIV front, there are studies that suggest that the incidence rate among heterosexual men is about 50% lower for those who are circumcised, vs. those who are not (see http://www.scientificamerican.com/article.cfm?id=circumcision-penis-microbiome-hiv-infection & http://www.cdc.gov/hiv/malecircumcision/). However, this protective effect does not extend to their partners (i.e. – a woman is just as likely to contract HIV from a circumcised partner and an uncircumcised partner, if that partner is infected), there’s no good evidence on male-to-male transmission and it obviously does not impact HIV transmission in other ways, such as intravenous drug use.

        In Canada the HIV infection rate is 0.30% of the population (http://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate). It’s 0.20% in the UK, where circumcision is not routinely performed. It’s 0.60% in the US, with almost twice the circumcision rate of Canada. In Canada, the primary mode of HIV transmission is male-to-male sexual contact, accounting for more than twice as many cases as heterosexual sex. Intravenous drug use and combined male-to-male sex and intravenous drug use, about tie with heterosexual sex (http://www.avert.org/canada-hiv.htm). In sub-Saharan Africa there are countries where HIV infection rates are 15, 20, or 25% or higher, and the predominant mode of transmission, by far, is heterosexual sex. This is why some health bodies recommend circumcision as a way to control HIV transmission at the population level, especially in countries where the HIV rate is high. The different circumstances in North America are why it’s still not considered medically necessary by groups like the Canadian Pediatric Society.

        Of course, as I said, as a parent you need to make the best choice for your children. There are a number of factors to weigh. But I think it’s important to be clear on what we’re talking about here – a reduced risk, not a protection. As a parent, I would still want my children to be safe, and that means that whether they’re circumcised or not, they need to be aware that they could contract HIV or other STIs.

        • concerned cynic says:

          Among advanced societies, the USA has the highest rate of HIV positivity, and Israel has an above average rate. These are the two advanced societies with the highest proportion of circumcised adult men. For me, these facts are determining: in the USA and Canada, circumcision is irrelevant to the struggle against AIDS.
          American investigators have never looked into the possibility that circumcised men are more likely to resist condom use, on the grounds that condoms make sex boring for such men. If this is so, circumcision could perversely make AIDS more likely.
          It also cannot be emphasized enough that circumcision has no effect on male-to-male or dirty needle transmission, and does not protect women who sleep with infected men. Weirder yet, FGM makes it less likely that a clean woman will catch AIDS from infected men.
          Circumcision is at best an odds changer. Who cares about odds changers, when there exists a game changer, called the condom??

          • That’s something I meant to say, but didn’t. In the case of my own son, even if his odds of infection could be cut in half, that’s still not enough for me to say, “Well, then, don’t worry about safe sex.” Either way, I would want him wearing a condom.

    13. concerned cynic says:

      The authority on the rise of routine circumcision in the UK is Robert Darby, the author of .
      http://www.press.uchicago.edu/ucp/books/book/chicago/S/bo3534612.html

      Gollaher published in 2000 a scholarly book on routine circumcision in the USA, but that book leaves me dissatisfied. I don’t deny that Sayre, Kellogg, Remondino et al wrote and lectured as they did. But Gollaher does not explain why their message caught on. That era also demonized the clitoris and clitoral hood (cf. the very weird “Journal of Orificial Surgery”, that stopped publishing in 1923), but removing those parts did not catch on.

      I have gone through a number of 20th century medical school textbooks, and can confirm that they say little about circumcision. This is an aspect of American medicine that is promulgated almost entirely by the oral teaching of clinical professors. Hence the rise of routine infant circumcision in the USA did not leave much of a paper trail. Everyone involved in the clinical training of doctors before 1950 is now dead.

      In my youth, I worked in dirty factories where we had to shower on company time at the end of every shift. Thus I discovered that only one man born before WWII was cut, and I was one of only two men born after WWII who was intact. The 1940s was the time when medical insurance became a standard fringe benefit. USA maternity wards very quickly began to circumcise every baby boy, not infrequently without the mother’s consent, and billing the insurance company, which paid without question. Parents meekly went along with this, because in those days doctors were seen as a scientific aristocracy, whose wishes were grounded in impeccable science.

      Thus baby boomers like myself grew up knowing nothing about the foreskin and its removal. The boys of my youth were a bawdy lot, but they never mentioned circumcision. I now believe that the vast majority of parents said nothing to their sons, because they simply did not know what to say.

      YouTube includes a 1942 US Navy documentary made to warn sailors of the perils of STDs caught from prostitutes. The film assumed that all viewers had foreskins.

      When routine circumcision began, local anesthesia did not exist, and general anesthesia was more dangerous than now. So doctors cut babies without anesthesia, and callously ignored the screaming. When lidocaine was available after 1950, but doctors simply could not be bothered to use it. American doctors were so convinced of the ample benefits of having a bald penis that last century, about 100 million infant circumcisions were performed without anesthesia. This was barbaric.

      Circumcision damages or removes the most sexually sensitive parts of the male body. The foreskin comes in direct contact with the walls of the vagina during intercourse. During intercourse, the foreskin moves back and forth, in a way that thrills one or both genders. Wnen intact boys and men masturbate, foreskin motion stands at centre stage. One would think that by now, American medicine would have researched the sexual consequences of infant circumcision, but that is simply not the case. I have it on good authority that a fair part of the caseload of USA pediatric urologists stems from infant circumcision damage and repair, a fact that goes unmentioned in the medical literature. What I write in this paragraph is inconsistent with RIC being a legitimate medical procedure, and consistent with its being grounded in a psycho-sexual obsession.

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    1. [...] Such balderdash being bandied about. Just read up on the history of the procedure. History of male circumcision – Wikipedia, the free encyclopedia 5 Things You Didn't Know About Circumcision : Discovery News History of Circumcision, Stop the Cut! Strocel.com | The History of Circumcision in North America [...]

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