Circumcision

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Overview

Circumcision in males involves the removal of the foreskin (also called the prepuce) from the head (or glans) of the penis. Circumcision is most often performed on infants, but is sometimes performed on older boys and men.

Circumcision is one of the earliest known forms of elective surgery. It is believed to have originated in Egypt approximately 15,000 years ago and to have spread to nearby regions through population migration.

Circumcision has been a commandment in Jewish law for over 3000 years and is one of the rules of cleanliness in Islamic law. But circumcision has also been known in other cultures; for example, when Columbus landed in North America, he discovered that males were circumcised.

Historically, circumcision may have been used as a rite of passage to manhood, as a form of cultural identity, or as a sacrifice to the gods. In the 19th century, circumcision was believed to be effective in curing or preventing a variety of illnesses, including epilepsy, insanity, hernias, club foot, and gout.

Current reasons for circumcision include religious or cultural beliefs, concerns about hygiene, a desire to have a child look like his circumcised father, or to treat a medical problem.

Circumcision of Infants

Statistics/Trends
Infant (neonatal) circumcision is more common in the United States, Canada, and the Middle East. It is much less common in Asia, South America, Central America, and Europe.

According to the 2003 National Hospital Discharge Survey, 55.9% of all newborn males in the United States were circumcised. This is down from 64.7% in 1980. However, circumcision rates vary by race and geographic distribution.

Caucasians have the highest circumcision rate, followed by African Americans and Hispanics. Geographically, the highest rates are found in the Midwest, followed by the Northeast, the South, and the West.

Healthcare coverage also has an effect on circumcision rates. Most insurance plans continue to pay for infant circumcision. However, as of 2005, 16 states no longer fund routine neonatal circumcisions through Medicaid, causing a decrease in the number of procedures performed.

Medical Recommendations
Over the last two decades, opinions have changed regarding the necessity or benefits of infant circumcision. None of the major medical societies in the United States recommends infant circumcision as a routine procedure. However, none of these organizations advise against it, either. In all cases, parents are urged to seek information from their doctor and to weigh the benefits and risks.

The American Association of Pediatricians (AAP) issued a statement in 1999 saying that the benefits of circumcision are not significant, that it is not medically necessary, and that the AAP no longer recommends it as a routine procedure.

The American Academy of Family Physicians has described the medical literature on infant circumcision as "controversial and conflicting." It advises parents to discuss the procedure with their doctor before making a decision. The American Medical Association supports the findings of the AAP.

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