Why is Circumcision so Popular in America?
Recent years have raised questions about the ethics and effectiveness of male circumcision
I was taking my father to the airport this morning to see him off when I got a surprise text from a friendly face I hadn’t seen in a while.
It was Julia, my former partner-in-crime and Editor-in-Chief at Sexography, who’s since stepped down and gone to college for psychology with me taking over the sole editing duties. She was curious about a question I didn’t know the answer to.
Why is male circumcision so popular in America?
I told her I don’t know, but assumed it might have something to do with religion. Perhaps America or Northern Europe’s flavor of protestantism led to a surge in circumcision after the Protestant Reformation? I wasn’t sure.
But I decided to investigate because it’s a topic on a lot of people’s minds, as young parents are now wondering what’s right for them and their children. Young people are radically questioning—and often repudiating—the traditions of old that we’ve since learned were based on bad science, flawed reasoning, or senseless moral policing.
Does circumcision belong in this category? That’s up to you to decide.
Turns out, the history and significance of circumcision is much more labyrinthine than I’d thought. To understand why it’s gained such prevalence in America, we must explore its linguistic, ethical, historical, cultural, and medical dimensions.
Boundless ink has been spilled arguing in favor of or against circumcision. I’m not here to reinvent the wheel and repeat history. Here are some rather unique frameworks for thinking about it that might help you understand circumcision (and ethics generally) a bit better.
Meditationes de historia obscurationis linguae
First, I can’t help but notice that “circumcision”—which is Latin for “cutting around” if memory serves me right—is a polite euphemism for “chopping off the skin around the penis” in the same way “pork” (short for the Latin porcus, meaning “pig”) is a euphemism for “a chunk of dead pig.” The word “beef” is short for βοδινό (bovino), the Greek word for “beef,” which is also where we get the word “bovine” from.
Don’t worry, I’m not here to lecture anybody on the ethics of meat-eating. But I think it’s related to circumcision because both are sexed and tucked behind obscurantist language. What’s important here is understanding that it’s hard to think clearly about things using indirect language.
Carol J. Adams argued convincingly in her excellent book The Sexual Politics of Meat, that meat-eating has been sexualized as predominantly (or exclusively) male in cultures across the globe. Both circumcision and the idea of the male meat-eater come down to us from at least the Bronze Age, and probably pre-history.
Adams showed we tend to Latinize or Graecize (make Greek) words that make us uncomfortable, like our names for various meats. We apply archaic terms as symbolic representations, called referents, thereby dancing around the real name of the activity in question.
The word “organs” (heart, lungs, entrails) comes from the Greek όργανα (organa), which just means “instruments”—your organs are the instruments of your body. We don’t do this with “skin” (δέρμα or derma), “hair” (μαλλιά or mallia), or “eyes” (μάτια or matia), or their Latin counterparts (pellis, capilli, oculi).
Our insides make us very uncomfortable, just as our sex organs do. Humans have blushed when they’ve had to discuss sex since as long as we’ve had written language.
Penis, vagina, fellatio and anus are Latin words and vulva is Greek. Their English equivalents (dick, pussy, and asshole) are considered more vulgar in English than their Greco-Roman counterparts.
Cunnilingus is a nominalized combination of the Latin cunnis (meaning both vagina and slit) and lingere (meaning lick). Anilingus is a portmanteau of “anus” and “cunnilingus” that blends each word into a new word—cunnilingus of the ass.
This transcends English. Vagina is Latin for sheath (as in, a sword) and Scheide is German for both sheath and separation (as well as divorce)—and it’s the traditional German word for vagina as well.
We also use referents when we want something to sound more important than it is. Shakespeare’s English just sounds more romantic to our modern ears the same way the King James Bible sounds more ethereal. “Thy shalt not steal” sounds more foreboding and official than “don’t steal” does.
An absent referent is when the alternative word adds nothing to the language, but separates us from the activity in question through a lack of accessibility.
Using “pork” instead of “pig” makes us think of a neatly-packaged and ready-to-cook cutlet rather than a living pig. When you say “pork” you probably picture a product, not an animal—and that’s the point. It’s part of how we normalize our (oftentimes bizarre and violent) cultural rituals.
This allows us to unquestioningly participate in such rituals, often without even realizing what we’re doing because the reality is obscured.
As Adams says:
Because the structure of overlapping absent referents is so deeply rooted in Western culture, it inevitably implicates individuals. Our participation evolves as part of our general socialization to cultural patterns and viewpoints, thus we fail to see anything disturbing in the violence and domination that are an inextricable part of this structure.
In other words, it would be much harder to convince children to eat the cute cows and pigs if we called them cows and pigs. Most people don’t want to see how the sausage is made, literally.
A similar process appears afoot with circumcision. It’s harder to convince parents to cut their newborn baby’s penis without the use of a referent. The entire sentence “circumcise a penis” is a referent.
Referents often blind us to the true severity of our actions, right or wrong, for better or worse, so it’s smart to be on the lookout for them when asking yourself what you believe is right.
The Ancient History of Circumcision
Rooted in cultural and religious tradition, circumcision has evolved over millennia. The Ancient Egyptians practiced circumcision for both religious and medical reasons. They believed it was a rite of passage into adulthood and a religious rite. It’s hard to argue that it was a means of promoting cleanliness in the modern sense considering the ancients had no conception of microbes and viruses.
Boys were circumcised between ages six and twelve in Ancient Egypt.
Historically, it was believed that circumcision was invented by the Ancient Israelites, something modern-day Christians still believe, and the practice “fell by the wayside” when the Ancient Israelites were taken into captivity. Though it’s quite possible—even likely—that the opposite is true and that the Ancient Israelites appropriated the practice from the Ancient Egyptians, possibly during captivity.
Known as "Brit Milah" in Hebrew, circumcision is a central religious ritual for Jewish males, typically performed on the eighth day after birth. It commemorates the covenant between God and Abraham, as recounted in the Hebrew Bible. This tradition has persisted for thousands of years and remains a fundamental element of Jewish identity.
The problem with the idea that circumcision is originally Jewish is that it assumes that the Pentateuch is much older than it actually is. The Pentateuch was assembled long after Israel had made contact with the Egyptians. It’s also telling that circumcision comes about in Exodus as the Jews are leaving Egypt. While it appears in Genesis, too, all the books of the Pentateuch were written and assembled at the same time.
The Pentateuch is the Bible’s “first” books of Genesis, Exodus, Leviticus, Numbers, and Deuteronomy. The word itself means “five laws” in Ancient Greek. I say “first” in quotes because we now know the Bible was written out of order and assembled later.
Robert Wright’s book The Evolution of God does an excellent job of piecing things back together in chronological order, along with other religions besides Judaism and Christianity.
Islam also includes circumcision in its religious practices, though it is not as universally practiced as in Judaism. In Islam, circumcision is known as "Khitan" and is seen as an act of cleanliness and obedience to the teachings of the Prophet Muhammad.
But the practice isn’t limited to the Abrahamic religions.
Circumcision has deep roots in various African cultures. Many ethnic groups in Africa practice male circumcision as a rite of passage into adulthood. These traditions are diverse, with different tribes having unique rituals and cultural significance attached to the practice. For example, the Xhosa people of South Africa have a ceremony called "Ulwaluko," which includes circumcision as a crucial element.
This is important. In the West, we’ve created such strong associations between circumcision and Judaism that we regularly forget that other cultures who never encountered Western or Asian traditions also practiced it.
It’s possible the practice began long, long before humans started writing things down.
Modern Medical Circumcision
To be clear, while I used the word “circumcision” above, there’s a difference between circumcision, a medical practice, and religious or customary rites of passion like Brit Milah—and the difference is crucial to understanding it. Most people in America think there’s a long, unbroken chain tracing circumcision from the Ancient Israelites of the Bible to modern-day-baby-penis-chopping. Not quite true.
As a medical practice, circumcision was developed and popularized independently from the religious practice, beginning in the late 1800s. You see a shift in definitions about circumcision starting in at least 1876, when the Encyclopedia definition of circumcision defined it as a religious practice among the aforementioned groups.
This must’ve been thanks to anthropological discoveries that found the practice in more and more Native tribes around the world.
Two quotes from J. Henry C. Simes in his 1890 work titled Circumcision are relevant.
The mutilation of the genitals among the various savage tribes of the world presents a strange and unaccountable practice of human ideas, which one is not able to reconcile with any reasoning power. Why such customs should be in vogue none can tell at the present time; but we must suppose that at some period they had their significance, which in the course of ages has been lost, and the practice has been handed down from generation to generation.
Simes was trying to understand why this practice showed up all over the world wherever European colonists traveled. Unlike now, it wasn’t perceived as predominantly Jewish. And then, as now, circumcision is unpopular in Europe, meaning the Americans didn’t bring it from Europe as a practice.
According to the CDC, about 65% of Americans were circumcised in 1999. In early decades, some studies revealed rates as high as between 77% and 98%.
Compare that with the United Kingdom, where approximately 15.8% of men and boys are circumcised.
Simes also shows us that by the 19th century, circumcision was fully a medical practice divorced from any religious or cultural meaning:
The operation of circumcision is one which may be performed for moral reasons; one which is demanded for hygienic purposes; one which is frequently necessary for pathological conditions; and, finally, one which is of unquestionably prophylactic importance.
Notice the absence of religious justification.
By 1910, the Encyclopedia definition included medical and religious:
This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Muslims.
Circumcision has a bizarre history as a medical practice.
A man named Dr. Sayre, who eventually became the head of the American Medical Association, believed that circumcision could cure paralysis. It was the early days of the germ theory of disease and people were throwing stuff at the wall to see what stuck. One idea that cropped up was the idea that men and boys became paralyzed because they had foreskin.
What Simes’ quotes reveal is a budding modern medical industry in its infancy trying to figure out why people all over performed this practice. Early medical practitioners would go on to believe that circumcision was an effective treatment for epilepsy, bedwetting, and other disconnected conditions that in no way relate to the penis.
Not only was germ theory brand spankin’ new in the mid-to-late 1800s, reliable anesthesia and antiseptics were too. In those days, doctors were using narcotics and surgery to treat pretty much everything under the sun. Opium, alcohol, ether, and later, morphine and heroin, combined with the ability to wash a wound led to the perception that surgery was the solution for everything.
Since then, modern medicine has been trying to rationalize cock-chopping by linking it with an increasingly shrinking number of health conditions.
Circumcision and Sexual Health
By the 1900s, we understood STIs and even though we developed antibiotics to treat many STIs, major medical institutions continued to recommend circumcision. For nearly 200 years, doctors have pressured new parents to have their babies circumcised for a variety of reasons.
Since the mid-1900s, those reasons were limited to the prevention of infections from viruses, bacteria, and fungi. As recently as 2015, the CDC recommended circumcision for the prevention of HIV, HPV, and herpes, saying it could reduce rates from anywhere between 30% and 60%.
For many people, this is good enough. They’re ready to sign up. They’ll take the recommendation from public health officials, including the American Academy of Pediatrics and go home. The AAP says:
Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.
But others are skeptical. Any problems that might occur from bacteria and fungi are easily solved with soap and water, two things which are abundant in first-world countries like America. And if things get really bad, there’s antiseptics and antibiotics. To the skeptics, circumcision as a prevention of infections sounds like cutting off your toenails to avoid potential infections from foot fungus.
As far as STIs are concerned, not only do we have antibiotics that can treat most STIs, we have condoms and a plethora of other prophylactics. Not to mention, we have rapid STI testing in most cities around the country. Is circumcision really the best or even a necessary method to curb the spread of STIs?
Here, we encounter the conflict between public health officials and the individual.
When public health officials recommended wearing masks for the prevention of COVID-19, they were thinking in terms of whole populations. If everyone wearing masks can save the, say, 1% of Americans who would otherwise die, that’s 3.4 million people. If your job is to save lives through public health, it’s a no-brainer.
But from the perspective of the individual, wearing an uncomfortable device over your face becomes burdensome, especially if you’re in the category of young, healthy people unlikely to die from COVID-19. There’s a trade-off at work here, no matter where you fall on this spectrum.
The same is true for the skeptics of circumcision, only it’s less justified. But HIV and COVID-19 aren’t an apples to apples comparison. HIV is much, much less deadly than COVID-19 is and far fewer people get it.
Only about 1 million Americans have HIV and it only kills about 15,000 people per year. Wearing a mask is nowhere near as intrusive as removing a part of your child’s body.
Skeptics wonder if it’s really their unfettered right to permanently alter their child’s body—without consent—to protect against a virus that infects far less than 1% of the population and kills 0.004412% of Americans thanks to the advent of antiretroviral drugs and public awareness?
Mixed Research & Solutions
Further complicating things is the fact that the scientific research into the proposed health benefits of circumcision is both mixed and very weak.
Some studies found that male circumcision prevents HIV and other STIs in African nations where HIV is a crisis:
When the data were analyzed to take into account men who were actually circumcised in the control group or not circumcised in the intervention group, the protective benefit of circumcision was 76% (95% CI: 56%– 86%). Similar protection was demonstrated by the other 2 large trials, which were stopped early when results of an interim analysis showed that circumcision of adult men has protective efficacy of 53% (in the Kenya study) or 48% (in the Uganda study).
But these nations are unique countries with very specific challenges unrelated to the United States. America has easy access to everything from prophylactics to antiretroviral drugs. Here in the U.S., HIV is predominantly limited to MSM (gay and bisexual men) who make up 63% of cases. 70% of new infections are MSM.
The studies didn’t even analyze MSM and were limited to only heterosexual people. Study authors write:
It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse.
…and…
These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM.
Further complicating things is the fact that many of these studies have serious conflicts of interest, like this Australian study which was headed by a group of people who stand to benefit financially from the sale of circumcision equipment. It was also put on by the Circumcision Academy of Australia, hardly a biased source.
This study found:
Population-based studies in high-income countries have failed to find that male circumcision protects against sexually transmitted infections. Using evidence from several sources, we show that male circumcision does protect against HIV during insertive intercourse for men who have sex with men.
But, my dear friends, it was headed up by the same people from the Australian study above. Generally, I don’t believe that someone’s ties or financial benefit automatically invalidate study results. It’s a red flag, but it’s possible good research comes from people who receive a direct kickback from the research’s findings.
But when the research was conducted by a political institution (non-profits included) whose stated goal is the furthering of policies or ideologies, I write it off altogether.
Politics has no place in scientific investigation.
An investigation into HPV by Kangni You, Yue Huang, and Zhengyu Li found some positive benefits from circumcision in the prevention of HPV. In their review titled Prevention and treatment of human papilloma virus in men benefits both men and women the researchers concluded:
We draw the conclusion that MC should be included as a primary preventive measure for cervical cancer, penile cancer, and other HPV-related cancers within updated medical guidelines.
But it’s understandable that skeptics might shrug at this, too, as the very next section describes the efficacy of the HPV vaccine. It only takes 75% vaccination to eradicate the highly-cancerous HPV16 in a given population:
A growing number of studies on gender-neutral HPV vaccination have emerged, and investigators have suggested that HPV16 eradication in the general population is predicted when 75% coverage of early adolescents (both boys and girls) is achieved.
It seems that in regards to the science itself, every point the pro-circumcision crowd has (which are genuine) in terms of health, the anti-circumcision crowd has a bona fide counter-point. The research is mixed and not very robust with post-hoc assertions that seem tailored to support one pre-existing belief or another.
Conclusions
European countries have seen a dramatic decline in medical circumcision (though presumably religious ceremonies have remained unchanged) and pushes to outright ban the practice, while in America, it thrives. In the 1960s, it was the most popular in America, reaching its height of about 90% of children being circumcised at the behest of doctors pushing the practice (without much solid data on it).
Circumcision became popular in America because it was born out of the Industrial Age that saw massive changes in modern medicine alongside a ton of experimentation.
In modern times, circumcision remains a subject of debate and discussion. Medical opinions on the practice have evolved. Some studies have suggested potential benefits, such as a reduced risk of urinary tract infections (UTIs) and certain sexually transmitted infections (STIs), including HIV (only in heterosexual populations).
However, the magnitude of these benefits is a topic of ongoing research and debate, and the decision to circumcise is increasingly seen as a matter of personal choice.
The ethical aspects of circumcision have garnered attention in recent years. Critics argue that the practice violates a person's bodily autonomy, as it is often performed on infants who cannot provide informed consent. This has led to calls for delaying circumcision until individuals can make their own decisions about their bodies.
Great one, Joe! I think the thing I liked most about this article was learning how very few people are living with HIV now, and dying from it. We have come such a long way with education and means of prevention for this and it makes me very happy and proud. I had a cousin who died of AIDS in the early 90s after only know he was sick for a few years. The fact that people now can go on to live long, fulfilling lives while treating this disease is something we should be really proud of. 💚
My son was born in 1992. He’s intact because it’s HIS body. Why would I want to make the decision to remove the most sexually sensitive part of his body? My daughter elected to keep her son intact as well. Our baby boys were born perfect. No surgery at birth required!