Circumcision in America - The Objective Standard

Every year throughout sub-Saharan Africa and the Middle East, between four and five million girls suffer gruesome genital mutilation at the hands of tribal “cutters” or circumcisers.1 Far from being regarded as barbaric criminals from whom children should be hidden, these wielders of sharpened rocks, broken glass, rusty metal, and (only sometimes) scalpels occupy a special position of power and influence in their communities.2 Parents voluntarily, sometimes enthusiastically, bring their young and infant daughters to be mutilated. Though methods vary in severity, in as many as 10 percent of cases, a cutter shears a girl’s labia for “beauty,” excises her clitoris to deprive her of sexual pleasure later in life, and sews closed her vagina to ensure virginity until marriage.3

To the Western mind, such practices are shocking and revolting. How could parents do such a thing to their children? With rare exception, Americans recognize female genital mutilation as a form of assault, and the United States outlaws even the least severe version of this ritual, a prick on the clitoris performed as a symbolic gesture to satisfy parents who demand genital cutting. But Americans’ righteous opposition to genital mutilation does not typically extend to males.

Whereas in the United States girls are protected from even a genital pinprick, boys can legally be circumcised for nontherapeutic reasons, and frequently are. Nontherapeutic circumcision of the infant penis is among the most commonly performed surgical procedures in America today, and the practice is widely supported by Americans. Although many support the practice, however, few understand its medical details.

Like female circumcision, male circumcision can be more or less severe in form. The most conservative or minimally invasive circumcision involves the removal of only the tip of the foreskin of the penis. But circumcision as American doctors typically practice it is a far more radical procedure. American doctors typically remove the entire foreskin, the specialized tissue that covers and protects the glans penis and urinary meatus. In most cases, doctors perform circumcision on an infant in his first days of life, when, unlike an adult’s foreskin, which easily retracts down and away from the glans, the infant’s foreskin is still fused to the glans. So during infant circumcision a doctor “bluntly dissects”—that is, rips away—the foreskin from the glans. The doctor then covers the glans with a protective device and cuts away the foreskin completely.

Unlike female genital mutilation in Africa and the Middle East, which has been a widespread practice since ancient times, the widespread practice of penile circumcision in America is a relatively recent phenomenon.

Until the late 1800s, penile circumcision in America was practically unheard of outside of Jewish communities. How did this infant-mutilating procedure become so common and so uncritically accepted in America? Although penile circumcision has been practiced in various forms by many cultures, the radical procedure commonly used in the United States is rooted ultimately in just one of these cultures: ancient Judea.4 How this procedure was adopted in 19th-century America and then grew in popularity to where it is today is a disturbing story of religious history, quack science, and social conformity.

The Roots of Circumcision in America

The roots of the tradition of Americans circumcising infant boys are traceable to ancient Canaan, a geographical area now consisting of Israel, Lebanon, Syria, and Jordan. In this region, male circumcision is a tribal custom that goes back thousands of years and is not exclusive to Judaism. However, historians believe that prior to its scriptural formalization in Judaism, circumcision was rarely performed on infants and was not taken to be part of a covenant with God.5

The circumcision narrative in the first book of the Hebrew Bible, in Genesis 17, may seem to indicate that the circumcision of infants began with the founding of the Jewish faith in the 17th century BC. But the circumcision story was not originally included in the Bible, and Judaism existed for around a thousand years without mandatory circumcision. Modern scholarship shows that the Bible was not written in chronological order; rather, it was composed by multiple authors over several centuries and was not finalized until circa 500 BC.6 It was around this time that Jewish priests revised scriptural text and added the passages about circumcision. Why did they do so?

In 586 BC, the Babylonians conquered the Jewish Kingdom of Judea, destroyed the First Temple in Jerusalem, and exiled many Jews, including priests, to Babylon. Decades later, Cyrus the Great of Persia conquered Babylon and permitted the Jews to return to their home.7 Among those returning were priests who believed the exile had been God’s punishment for religious laxity. They set out to end certain practices that they believed angered God. To this end, they wrote the final part of the Hebrew Bible and interjected various passages into parts of Genesis, Exodus, Numbers, and Leviticus. Among these passages was the text of Genesis 17 regarding circumcision:

God further said to Abraham, “As for you, you and your offspring to come throughout the ages shall keep My covenant. Such shall be the covenant between Me and you and your offspring to follow which you shall keep: every male among you shall be circumcised. You shall circumcise the flesh of your foreskin, and that shall be the sign of the covenant between Me and you. And throughout the generations, every male among you shall be circumcised at the age of eight days. As for the homeborn slave and the one bought from an outsider who is not of your offspring, they must be circumcised, homeborn and purchased alike. Thus shall My covenant be marked in your flesh as an everlasting pact. And if any male who is uncircumcised fails to circumcise the flesh of his foreskin, that person shall be cut off from his kin; he has broken My Covenant.”8

Previously, the story of Abraham’s covenant with God was told in Genesis 15, but with a crucial difference: The covenant was sealed with the sacrificial cutting of animals.9 In the newly added verses, the priests remade the covenant; instead of sacrificially cutting animals, Jewish men would sacrificially cut their infant sons.

Historians are not certain why the priests chose infant sons or the foreskin in their refashioning of the covenant story. But some sense can be made of the change when considered in the context of ancient Judean society, a deeply patriarchal culture obsessed with tribal loyalty and fidelity on the part of both men and women. What better way for a man to show loyalty to the group than to sacrifice part of his infant son’s penis as a mark of inclusion and commitment? A man willing to do that for the tribe is willing to do anything for the tribe. As for female fidelity, penile circumcision clearly marked for Jewish women those men with whom they were permitted to have sex: Jewish men. The Hebrew word for uncircumcised, arel,10 means “forbidden.”11 For any Jewish woman who might consider breaking this taboo, the price of straying and sleeping with an arel (i.e., forbidden man) is told clearly in Genesis 34, in which Jacob’s sons slay an entire village of uncircumcised men after one of its citizens “defiled” their sister Dinah.12 Likewise, Jewish men were not to have sex outside the tribe, and the punishment for doing so was severe.13 In Numbers 25, a circumcised Israelite is slain during the act of intercourse with a non-Jewish woman because he thereby desecrated his circumcised penis.14

The choice of the foreskin as the object of sacrifice might also have rested in primitive ideas about reproductive fecundity in which a man was thought to be the crucial partner in procreation, planting his active “seed” in a woman’s passive womb. This model of reproduction likely originated from an analogy. Howard Eilberg-Schwartz, a rabbi and anthropologist, has demonstrated that the ancient Israelite idea of “fruitfulness” was derived from experience with fruit trees, especially fig, date, and olive trees common in the Mediterranean region.15 These trees require pruning in their early years so that they may bear fruit in maturity. A passage in Leviticus 19 suggests that Jewish priests analogized circumcision to the care of fruit trees:

When you enter the land and plant any tree for food, you shall regard its fruit as forbidden [literal Hebrew translation, “uncircumcised”]. Three years it shall be forbidden [uncircumcised] for you, not to be eaten. In the fourth year all its fruit shall be set aside for jubilation before the LORD; and only in the fifth year may you use its fruit—that its yield to you may be increased. . . .16

Another plausible explanation for the Jewish adoption of circumcision is that it served to replace the practice of full-fledged child sacrifice. Anthropological evidence shows that the practice of killing children for God was common among the ancient people of Canaan, and several passages of the Torah suggest that child sacrifice, specifically of the firstborn son, may have been practiced in early Judaism.17 In Genesis 22, one of the most well-known chapters of the Torah, God tests Abraham by commanding that he sacrifice his firstborn son, Isaac, as a burnt offering, sparing the boy only at the last second when Abraham was clearly about to go through with it.18 In the story, Abraham did not protest. Was his faith in God so great that he would do the unthinkable? Or is it possible that this kind of thing was relatively common and thus didn’t seem outrageous or unacceptable?

God appears to demand child sacrifice in several passages of Exodus as well. For instance, in Exodus 22 God commands, “You shall not put off the skimming of the first yield of your vats. You shall give Me the first-born among your sons. You shall do the same with your cattle and your flocks: seven days it [the firstborn male] shall remain with its mother; on the eighth day you shall give it to Me.”19 Not only does God openly command child sacrifice of a male, he explicitly commands that it be done on the eighth day. Could it be only a coincidence that the traditional circumcision ritual, brit milah, also occurs on the eighth day?

A passage in the book of Jeremiah further suggests that the priests may have started the traditional brit milah to curb the practice of child sacrifice:

For the people of Judah have done what displeases Me—declares the LORD. They have set up their abominations in the House which is called by My name, and they have defiled it. And they have built the shrines of Topheth in the Valley of Ben-hinnom to burn their sons and daughters in fire—which I never commanded, which never came to My mind.20

The priests’ motivations for fashioning the circumcision mandate as they did were likely multiple, but the result was a singular new Jewish mandate, a religious rite that would become a defining feature of Jewish faith, the practice of circumcising an infant son on his eighth day of life: the brit milah.

The modern brit milah is a three-step procedure performed by a mohel, which is Hebrew for “circumciser.” First, he makes an incision in the foreskin of the infant’s penis; this step is called milah, which is Hebrew for “circumcision.” Second, he tears the adhered foreskin from the delicate underlying mucosal tissue of the glans; this step is called peri’ah, which is Hebrew for “opening” or “uncovering.” Third, the mohel sucks blood from the wound with his mouth; this step is called metsitsah, which is Hebrew for “sucking.”21 These last two steps, peri’ah and metsitsah, have not always been part of the tradition. They were incorporated into the ritual in response to developments during the Hellenistic period, when Jewish culture became entangled with Greek culture.

In 332 BC, Alexander the Great conquered Judea, which became part of the Hellenistic Seleucid empire. In the Hellenistic states, men would regularly see other men nude, and the circumcised penis, odd looking as it was, became a social liability for Jews as they interacted more with Gentiles. The Greeks, and later the Romans, regarded Jewish circumcision as ridiculous and barbarous. Although Hellenistic rulers sometimes permitted the practice, at other times they meted out severe punishments for it.22 As an example of the latter, Antiochus IV outlawed circumcision and subjected transgressors to horrific punishment: The circumcised infant was hung from his mother’s neck, then the mother and her child were paraded through the streets before they both were executed.23

Some Jewish men sought to assimilate by disguising all traces of circumcision, either to gain social acceptance or to avoid persecution. Between the 2nd century BC and the 2nd century AD, there emerged a growing practice of meshikhat orlah, the stretching of the foreskin to conceal the condition of circumcision.24 Taking advantage of a portion of remaining foreskin on his circumcised penis, a Jewish man would stretch the foreskin via various methods of prolonged tension and thus make his penis appear uncircumcised. This practice persisted for several centuries before Jewish authorities instituted new practices to stop it.

In the decades following the destruction of Jerusalem and the Temple by the Romans in 70 AD, many Jews fled or were captured and sold into slavery. Without the Temple, the newly scattered population of Jews living outside Judea, known as the Diaspora community, adapted to practice Judaism without the hereditary authority of the priests. In the past, the Hebrew term “rabbi” had denoted a teacher or a person highly educated in Judaism, but rabbis wielded little authority. Following the destruction of Jerusalem, however, the rabbis stepped in as the new source of authority and spiritual guidance. They took up leadership not in temples but in assemblies, “synagogue” in Greek, and from these positions of influence, they reinterpreted the entire religion and adapted it to the new challenges of the Diaspora.

The rabbis’ efforts culminated in a set of texts: the Talmud and the Midrash.25 Among the many problems addressed in these texts was the widespread practice of meshikhat orlah. The rabbis realized that the remnants of a foreskin cannot be stretched if there are no remnants. Rabbinic Judaism therefore specified the new practice of peri’ah, the tearing off of the entire foreskin from the penis. The practice of metsitsah, the sucking of blood from the wounded penis, likely followed as a means of dealing with the profuse bleeding that ensued. To emphasize the need for complete removal of the foreskin, the new texts explicitly forbade leaving even a shred (“tzintzin” in Hebrew).26 This new, comprehensive procedure made foreskin stretching impossible and returned circumcision to its prior status, the unmistakable and now unconcealable mark of a Jewish man.

Around the same time these rabbis began instituting the rules for comprehensive circumcision, another group of Jews, the fathers of the Christian faith, began calling the practice into question.

At this time, Christianity was a sect of Judaism, and many of the apostles saw conversion to Judaism, including the embrace of circumcision, as a precondition for conversion to Christianity. But Paul, the self-proclaimed “missionary to the Gentiles,” took exception to this approach. Paul held that the new, Christian covenant was the will of God, as revealed by faith, and that it rendered the worldly concerns of traditional Judaic law moot. No doubt Paul also realized that, on a practical level, Jewish law represented an insuperable barrier to the conversion of Gentiles. Kosher dietary restrictions and animal sacrifices aside, what adult man of a Hellenistic background would willingly submit to circumcision? Paul set himself firmly against the other apostles. He articulated an argument against circumcision in a series of letters to the Galatians, a gentile Christian congregation that had accepted circumcision in accordance with Jewish law. Here’s a relevant excerpt:

O foolish Galatians! Who has bewitched you? It was before your eyes that Jesus Christ was publicly portrayed as crucified. Let me ask you only this: Did you receive the Spirit by works of the [Jewish] law or by hearing with faith? Are you so foolish? Having begun by the Spirit, are you now being perfected by the flesh? Did you suffer so many things in vain— if indeed it was in vain? Does he who supplies the Spirit to you and works miracles among you do so by works of the law, or by hearing with faith . . . ? I, Paul, say to you that if you accept circumcision, Christ will be of no advantage to you. . . . You are severed from Christ, you who would be justified by the law; you have fallen away from grace.27

Paul’s argument boiled down to this: Jewish law is earthly and manmade, the new Christian covenant is spiritual and divine, and to physically sever your foreskin is to spiritually sever yourself from God. This argument appealed to many Gentiles, who flocked to the fledgling Christian faith in such droves that gentile Christians soon far outnumbered Jews.28 Paul’s writings on circumcision became Catholic dogma. A few hundred years later, when the Emperor Constantine declared himself Christian, Christianity effectively became the official religion of the Roman Empire. And for the next fourteen hundred years, in Christian Europe, circumcision, by and large, was rejected and reviled as a form of barbaric mutilation. Christian contempt for the practice of circumcision fueled anti-Jewish bigotry and violence in Europe well into the 20th century.29

The Rise of Circumcision in Modern America

In the United States during the 19th century, the social status of circumcision underwent an astonishing change from the long-vilified and distinctively Jewish practice to a widely embraced surgical procedure. How did this happen?

A key event in the transformation was the annual meeting of the American Medical Association in 1870, in which Dr. Lewis Sayre, an orthopedic surgeon, presented the case report of a five-year-old boy who was paralyzed in both legs.30 In front of the most distinguished physicians of the time, Sayre claimed to have cured the boy by excising part of his foreskin, which the boy’s nurse had noticed was irritated. Today his account sounds fantastic, even ridiculous; however, it was consistent with a then-popular theory of medical illness called “reflex neurosis,” which held that any affliction in one body part can produce dysfunction in another body part via the nervous system. According to this theory, it was possible for an inflamed foreskin to produce any number of ailments and that excision of the foreskin might cure them. Sayre’s case report, and his further claims that he cured other conditions through circumcision, garnered widespread attention and lent credibility to the notion that circumcision could cure disease. Sayre did not recommend removal of the entire foreskin, but only enough to “cure” a given ailment. He even made special mention in one case that “the [remaining] prepuce was sufficiently long to cover the glans, and could be readily glided over it without any irritation whatever.”31

Unfortunately, the physicians who followed Sayre in adopting this alleged medical practice did not show such restraint. In the ensuing medical literature, physicians expressed a growing admiration for the Jewish practice of removing the entire foreskin—not only to cure an existing disease, but also to prevent disease—and not only to prevent disease, but also to prevent sin.

In 1871, Dr. Moses Montefiore published an article titled “The Value of Circumcision as a Hygienic and Therapeutic Measure” in which he advocated circumcision as a preventative therapy for both medical ailments and moral vices such as masturbation.32 In 1882, Norman Chapman, a neurologist, claimed circumcision to be a cure for all kinds of “nervous affections” and speculated that the Biblical “Moses was a good sanitarian.”33 In 1889, Dr. A. U. Williams claimed to have cured four hundred men of penile infections by circumcision and, in an article to that effect, stated, “I would follow in the footsteps of [the Biblical] Moses and circumcise all male children.”34 Dr. J. Henry C. Simes, a urologist, went a step further, recasting Moses as a medical genius ahead of his time:

The hygienic advantages, which are the result of the operation of circumcision, none can doubt. Leaving aside the religious significance of the operation when performed by the Jews, there is no doubt that it was commanded to be done for its hygienic effect, and that the first and great teacher of hygienic medicine, Moses, certainly had this view in his mind when he gave forth the order, that all male children of Israel must be circumcised.35

In the wild imaginations of these prominent physicians, circumcision was a preventative medical panacea discovered by the Jews. It is no coincidence that the particular circumcision procedure that became most popular in America was essentially that of the Jewish brit milah, a complete removal of the entire foreskin in the first days of infancy.

By 1910, more than one-third of American infant boys were undergoing radical penile circumcision. At this same time, hospital births were becoming more common.36 Infants who previously would have been born at home and thus likely spared genital mutilation increasingly fell victim to physicians’ newfound enthusiasm for circumcision. In 1934, Aaron Goldstein (an inventor) and Dr. Hiram Yellen (an obstetrician) created a clamp device called the Gomco clamp, which reduced bleeding during the circumcision procedure and which soon became widely used. In 1954, a rabbi, Harry Bronstein, invented another clamp, the Mogen (Hebrew for “shield”), which did essentially the same thing.37 The convenience afforded by these devices further facilitated the adoption of infant circumcision as a routine aspect of hospital birth. By the 1960s, more than 90 percent of births in America occurred in a hospital, and more than 80 percent of infant boys underwent radical circumcision using a clamp device during the same hospitalization.38 In less than a century, infant circumcision had gone from a highly reviled and distinctively Jewish ritual to a standard surgical procedure performed on the vast majority of American boys.

The Alleged Benefits of Neonatal Circumcision

With the birth of modern medicine as an experimental science in the early 20th century, “reflex neurosis” was quickly discredited. But the refutation of the medical theory underpinning circumcision did little to deter the practice in America.39

By this time, many doctors passively accepted as fact that circumcision prevents venereal disease, decreases masturbation, and promotes personal hygiene. Then, in 1926, Abraham Wolbarst, a urologist and an outspoken supporter of circumcision as a means to prevent infectious disease, published an article titled “Is Circumcision a Prophylactic Against Penis Cancer?” He claimed that “the prepuce is an ideal cancer grower” and that elderly Jewish and Muslim men demonstrate much lower rates of penile cancer because they are circumcised as children. Although he was aware that penile cancer is a disease of adults and not infants, he advocated infant circumcision, opining that it is “the greater part of wisdom to remove [the prepuce] in the infant and thereby secure to every male all the sanitary and prophylactic advantages which are conceded to the circumcised.”40

In 1950, another urologist, Abraham Ravich, took Wolbart’s claims several steps further, asserting that circumcision prevents not just penile cancer but also cancer of the prostate and uterine cervix. Accordingly, Ravich wrote, “the best prophylactic measure would be a more universal practice of circumcising male infants.”41

In the 1980s, the AIDS crisis inspired still further speculation about the role of the foreskin in the transmission of sexually transmitted infections. In 1986, Aaron Fink, another urologist, published a letter in the New England Journal of Medicine titled “A Possible Explanation for Heterosexual Male Infection with AIDS.” He hypothesized “that the presence of a foreskin predisposes both heterosexual and homosexual men to the acquisition of AIDS.”42

All of these alleged benefits of circumcision were advanced as speculation, and none of them, even if true, provides any justification for neonatal circumcision. Prevention of sexually transmitted infection is relevant only to sexually active people, adolescents at the youngest. Penile cancer, prostate cancer, and cervical cancer are diseases of adulthood, most often elderly adults. Still, those who proclaim the alleged benefits of circumcision unanimously recommend that the practice be performed on newborn boys.

Despite widespread adoption of neonatal circumcision in the 20th century, many in the medical community justifiably questioned the practice. In 1975, the American Academy of Pediatrics (AAP), the preeminent professional organization representing pediatricians in the United States, created a Task Force on Circumcision that concluded there is “no absolute medical indication for routine circumcision of the newborn.”43 The task force reconvened in 1989 and 1999 and essentially restated its earlier position, though less strongly, stating (in 1989) “Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks”44 and (in 1999) “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.”45 In a 2001 statement, the American College of Obstetricians and Gynecologists agreed with the AAP.46 And in 2012, on the premise that circumcision might prevent urinary tract infection in newborns, the AAP’s task force reversed its previous position and endorsed infant circumcision, stating:

Evaluation of current evidence indicates that the health benefits of new-born male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits for male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer.47

The only new evidence on which the AAP based its change in position pertains to urinary tract infections in the first two years of life. But invoking the alleged benefits of circumcision for reducing urinary tract infections amounts to a post hoc rationalization for the practice, not a valid reason to continue it. Notably, the issue of urinary tract infections is a recent “justification” for circumcision, not the reason the practice began or became so widespread. Further, circumcision as a medical strategy for reducing urinary tract infections has not been subjected to randomized testing or weighed against alternative treatments, as are most other medical procedures. As the AAP acknowledges, the possibility that proper care of the penis might be as effective at reducing the incidence of urinary tract infections has not even been studied.48 Also worth noting is that boys and girls suffer similar rates of urinary tract infections, and no one in America advocates any preventive therapy in this area for girls, certainly not an irreversible and disfiguring surgical one.49 In reality, most urinary tract infections are easily treated noninvasively with antibiotics.

Only one randomized, controlled trial on the subject has been attempted, and it considered not routine neonatal circumcision, but circumcision after the first documented urinary tract infection.50 The body of literature supporting the claim that routine infant circumcision prevents urinary tract infection relies solely on nonexperimental observation.51 Such observation can demonstrate correlation but is inadequate for confirming causation.

If neonatal circumcision does reduce the incidence of urinary tract infection, the effect is small. A common statistic for estimating the benefit of a medical or surgical intervention is the number-needed-to-treat (NNT) to prevent one bad outcome. In the best available studies of routine neonatal circumcision and urinary tract infection, the NNTs range from 57 to 195.52 This means that to potentially prevent a single hospitalization due to a urinary tract infection, doctors irreversibly disfigure the genitals of upwards of two hundred boys—all to “treat” a condition for which far less invasive treatments are known to be effective.

Advocates of circumcision never have been motivated by a genuine concern regarding infant urinary tract infection, nor are they so motivated today. This is simply the most recent in a long line of pseudoscientific rationalizations seeking to legitimize an illegitimate procedure.

The Immorality of Routine Infant Circumcision

Neonatal circumcision—a practice that evolved from barbaric religious rituals—carries the potential harms of profuse bleeding, infection, accidental amputation of the penis, decreased sexual sensation, and, in rare cases, death. Yet doctors and parents in the United States force the procedure on countless infant boys—who are incapable of objecting or consenting to the procedure—for “benefits” that either do not exist or do not accrue until adulthood, or that can be gained through far less intrusive means. Doctors who perform such circumcisions as a routine procedure thus violate their professional obligation to “first do no harm.” Doctors and parents have no moral right—and should have no legal right—to disfigure children without sound scientific reason. Such disfigurement properly is regarded as mutilation, not medicine, and it should be illegal.

Nor does the claim that infant boys might someday consent to circumcision—or might not consent, as the AAP Taskforce on Circumcision observes53—justify mutilating them when they are incapable of consent. By comparison, doctors do not force nonconsenting adults to undergo medical procedures on the grounds that they might consent, if only they knew better.

Is the choice to circumcise an infant properly up to the parents or guardians? No, it is not. Just as parents in America have no legal right to cut out a girl’s clitoris or amputate a child’s arm without objective medical cause, so they should have no legal right to cut off the foreskin of a boy’s penis without objective medical cause. Children are not the property or the playthings of their parents: They are individuals with rights that government properly protects.

Yet various organizations of medical professionals have claimed that parents have some sort of “right” to mutilate their infant sons. For example, in 1975 the AAP claimed that parents may circumcise their infant boys out of “traditional, cultural, and religious” considerations—even if they maintain not even the pretense that the practice is for medical reasons.54 The organization has repeated this claim (or variants of it) in subsequent years, as recently as 2012.55

Notably, most parents do not actually cite medical concerns as their reason for subjecting their infant sons to circumcision, or they cite it as a minor concern. In a 1987 survey, 18 percent of fathers and 13 percent of mothers listed “I just don’t want him to look different” as their most important reason. Nine percent of both fathers and mothers selected “His brothers are circumcised,” and 9 percent of fathers and 5 percent of mothers chose “I just think so.” Only 9 percent of fathers and 14 percent of mothers chose “There will be less chance of infection or cancer.” The authors who reported the survey results observed that “even though parents were concerned about medical issues, concern that the child’s penis look like his father’s, siblings[’], and friends’ seemed to be more important.” The authors concluded, “The circumcision decision in the United States is emerging as a cultural ritual rather than the result of medical misunderstanding among parents.”56

Another study in 1999 showed that, although 41 percent of parents cited “Medically, it’s better to be circumcised” as a reason for their choice, still greater numbers cited superficial reasons, with 63 percent citing “It’s easier to do it now than when he’s older,” 37 percent citing “The baby’s father is circumcised,” and 11 percent citing “My son should be like other boys.”57 The study further observed that 80 percent of parents made their decision before discussing it with their physician. Another study on the effect of medical education on parental viewpoints found, “Overall, most respondents maintained their original views on circumcision despite the information presented.”58

On examination, the evidence reveals that, for decades, various organizations of medical professionals have condoned, and countless doctors have performed medically unnecessary surgery on—that is, they have mutilated—the genitals of male infants for cultural and cosmetic “reasons.” When doctors do the same to female infants, government properly prosecutes them under criminal law. Yet, although “the AAP is totally opposed to all forms of female genital mutilation”59 (a recent reversal of its earlier endorsement of “ritual nicks” of female genitals),60 it continues to sanction male genital mutilation.


Female genital mutilation is a horrifying, barbaric, and evil practice. The routine circumcision of infant boys in the United States is in principle and in practice no different. Far from a legitimate medical procedure conceived of to treat or prevent an actual illness, infant male circumcision emerged in the United States in the late 19th century as a blatant resurrection of Jewish circumcision in its most barbaric form.

Although there may be in certain circumstances legitimate medical reasons for a teenage or adult male to consent to some form of circumcision, the choice should be his to make. Neither his parents nor his doctors have a moral right to rob him of that choice by mutilating him in infancy.

It is time for all Americans—circumcised and not circumcised—to see the practice of routine infant circumcision for what it is: a barbaric, uncivilized, rights-violating ritual that should be prohibited by law.

Of course, the fact that most American men were circumcised in infancy, and the fact that their parents approved of the procedure, may make many people feel awkward about taking a public stand against neonatal circumcision. A similar obstacle stands in the way of outlawing female genital mutilation in other parts of the world. Yet the fact remains that the practice is barbaric and immoral—even if most parents innocently erred in approving the procedure for their children based on the unprofessional and frankly cowardly advice of their physicians. Until Americans are willing to admit that many of them and many of their parents made a mistake, the practice of male genital mutilation in the United States is unlikely to end.

Parents should arm themselves with the facts and proudly refuse to circumcise their sons, just as they would refuse to mutilate their daughters. And physicians should end their nonsensical and immoral deference to barbaric cultural and religious practices, stop promoting the quack science used to rationalize the practice, properly educate parents about circumcision, and righteously refuse to perform routine infant circumcisions.

Genital mutilation is wrong. It is as wrong for boys as it is for girls. And everyone who cares about the rights of American boys must take a stand against it.


1. Committee on Bioethics, “Ritual Genital Cutting of Female Minors,” Pediatrics, vol. 125, 2010, pp. 1088–93,

2. Leonard J. Kouba and Judith Muasher, “Female Circumcision in Africa: An Overview,” African Studies Review, vol. 28, 1985, p. 100,

3. P. Stanley Yoder and Shane Khan, Numbers of Women Circumcised in Africa: The Production of a Total, (Calverton, MD: ORC Macro, March 2008), p. 14,; United Nations Children’s Fund, Female Genital Mutilation/Cutting: A Statistical Overview of the Dynamics of Change (New York: UNICEF, 2013),

4. Leonard B. Glick, Marked in Your Flesh: Circumcision from Ancient Judea to Modern America (New York: Oxford University Press, 2005), p. 5.

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5. Glick, Marked, p. 16.

6. Glick, Marked, p. 14. Modern biblical scholars group the text of the Torah into four sections composed at different times and labeled J, E, D, and P. The first two, J and E, were likely written in the 9th and 10th centuries BC and make up parts of Genesis, Exodus, and Numbers. At this time, Judaism included sects of polytheistic cult worship (the E stands for Elohim, literally meaning “Gods” plural). In D, written in the 7th century BC and making up much of Deuteronomy, reformers began striving toward monotheism and the worship of the One God “Yahweh” (or “Jehovah”). In P, written in the 6th century BC, priests reacted to the Babylonian captivity.

7. Bernard Reich, A Brief History of Israel, 2nd ed. (Facts on File, 2008), pp. 6–7.

8. JPS TANAKH: The Holy Scriptures, 1st ed. (Philadelphia: Jewish Publication Society, 2011), pp. 23–24.

9. Glick, Marked, pp. 15–16.

10. Note that all Hebrew words are written as commonly accepted English transliterations using the Roman alphabet.

11. Glick, Marked, p. 287.

12. Jewish Publication Society Inc., JPS TANAKH, p. 53.

13. Jewish Publication Society Inc., JPS TANAKH, p. 251.

14. Glick, Marked, pp. 15–16.

15. Glick, Marked, pp. 18–19.

16. Jewish Publication Society Inc., JPS TANAKH, p. 186.

17. Glick, Marked, pp. 21–24.

18. Jewish Publication Society Inc., JPS TANAKH, pp. 31–32.

19. Jewish Publication Society Inc., JPS TANAKH, p. 119.

20. Jewish Publication Society Inc., JPS TANAKH, p. 784 (italics added).

21. Glick, Marked, pp. 44–45. Metsitsah has been abandoned by most Jewish denominations out of concern that the practice spreads infectious diseases.

22. Will Durant, The Life of Greece: The Story of Civilization, Vol. II (New York: Simon & Schuster, 2011), pp. 580–84.

23. Nissan Rubin, “Brit Milah: A Study of Change in Custom” in The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite, ed. Elizabeth Wyner Mark (city: UPNE, 2003), p. 89.

24. Rubin, “Brit Milah,” p. 87.

25. Glick, Marked, pp. 43–49.

26. Rubin, “Brit Milah,” pp. 91–97.

27. Crossway Bibles, ESV Study Bible (city: Crossway Bibles, 2008), pp. 2249–54.

28. Glick, Marked, p. 39.

29. Glick, Marked, pp. 85–114.

30. Glick, Marked, p. 158.

31. Glick, Marked, p. 159.

32. Glick, Marked, p. 163.

33. Glick, Marked, p. 162.

34. Glick, Marked, p. 172.

35. Glick, Marked, p. 173.

36. Glick, Marked, pp. 179–81.

37. Glick, Marked, pp. 196–98.

38. Edward O. Laumann, Christopher M. Masi, and Ezra W. Zuckerman, “Circumcision in the United States. Prevalence, Prophylactic Effects, and Sexual Practice,” The Journal of the American Medical Association, vol. 277, 1997, pp. 1052–57,

39. Maria Owings, Sayeedha Uddin, and Sonja Williams, “Trends in Circumcision among Male Newborns Born in U.S. Hospitals: 1979–2010,” Centers for Disease Control and Prevention, August 2013,

40. Glick, Marked, pp. 183–87.

41. Glick, Marked, p. 191.

42. Glick, Marked, p. 206.

43. Hugh C. Thompson, Lowell R. King, and Sheldon B. Korones, “Report of the Ad Hoc Task Force on Circumcision,” Pediatrics, vol. 56, 1975, pp. 610–11,

44. American Academy of Pediatrics Task Force on Circumcision, “Report of the Task Force on Circumcision,” Pediatrics, vol. 84,1989, pp. 388–91,

45. American Academy of Pediatrics Task Force on Circumcision, “Circumcision Policy Statement,” Pediatrics, vol. 103, 1999, pp. 686–93,

46. American College of Obstetricians and Gynecologists Committee on Obstetric Practice, “ACOG Committee Opinion No. 260: Circumcision,” Obstetrics and Gynecology, vol. 98, 2001, pp. 707–8,

47. American Academy of Pediatrics Task Force on Circumcision, “Male Circumcision,” Pediatrics, vol. 130, 2012, p. e756–85, 10.1542/peds.2012-1990.

48. AAP, “Male Circumcision,” p. e763.

49. S. Mårild and U. Jodal, “Incidence Rate of First-Time Symptomatic Urinary Tract Infection in Children under 6 Years of Age,” Acta Paediatrica, vol. 87, 1998, pp. 549–52,; B. Jakobsson, E. Esbjörner, and S. Hansson, “Minimum Incidence and Diagnostic Rate of First Urinary Tract Infection,” Pediatrics, vol. 104, 1999, pp. 222–26,; Nader Shaikh, et al., “Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis,” The Pediatric Infectious Disease Journal, vol. 27, 2008, pp. 302–8,

50. A. Nayir, “Circumcision for the Prevention of Significant Bacteriuria in Boys,” Pediatric Nephrology (Berlin, Germany), vol. 16, 2001, pp. 1129–34,

51. Vanitha A. Jagannath, et al., “Routine Neonatal Circumcision for the Prevention of Urinary Tract Infections in Infancy,” The Cochrane Database of Systematic Reviews, vol. 11, 2012,

52. E. J. Schoen, C. J. Colby, and G. T. Ray, “Newborn Circumcision Decreases Incidence and Costs of Urinary Tract Infections during the First Year of Life,” Pediatrics, vol. 105, 2000, pp. 789–93,; D. Singh-Grewal, J. Macdessi, and J. Craig, “Circumcision for the Prevention of Urinary Tract Infection in Boys: A Systematic Review of Randomised Trials and Observational Studies,” Archives of Disease in Childhood, vol. 90, 2005, pp. 853–58,; T. To, et al., “Cohort Study on Circumcision of Newborn Boys and Subsequent Risk of Urinary-Tract Infection,” Lancet, vol. 352, 1998, pp. 1813–16,

53. AAP, “Male Circumcision,” p. e760. The AAP Taskforce on Circumcision lists the fact that “newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood” as a reason for performing the procedure in the newborn period.

54. Thompson et al., “Report of the Ad Hoc Task Force on Circumcision,” p. 610.

55. AAP, “Male Circumcision,” p. e759.

56. M. S. Brown and C. A. Brown, “Circumcision Decision: Prominence of Social Concerns,” Pediatrics, vol. 80, 1987, pp. 215–19,

57. J. D. Tiemstra, “Factors Affecting the Circumcision Decision,” The Journal of the American Board of Family Practice, vol. 12, 1999, pp. 16–20,

58. Marvin L. Wang, et al., “Updated Parental Viewpoints on Male Neonatal Circumcision in the United States,” Clinical Pediatrics, vol. 49, 2010, pp. 130–36,

59. Stephanie Chen, “Pediatricians Now Reject All Female Genital Cutting,” CNN, May 27, 2010,

60. Committee on Bioethics, “Ritual Genital Cutting of Female Minors,” p. 1092.


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