History of male circumcision
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The origination of male circumcision is not known with certainty. It has been variously proposed that it began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility or fertility, as a means of enhancing sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of higher social status, as a means of humiliating enemies and slaves by symbolic castration, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, as a means of removing "excess" pleasure, as a means of increasing a man's attractiveness to women, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen, or to copy the rare natural occurrence of a missing foreskin of an important leader, and as a display of disgust of the smegma produced by the foreskin. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread. Darby describes these theories as "conflicting", and states that "the only point of agreement among proponents of the various theories is that promoting good health had nothing to do with it." Immerman et al. suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practising circumcision, leading to its spread. Wilson suggests that circumcision reduces insemination efficiency, reducing a man's capacity for extra-pair fertilizations by impairing sperm competition. Thus, men who display this signal of sexual obedience, may gain social benefits, if married men are selected to offer social trust and investment preferentially to peers who are less threatening to their paternity. It is possible that circumcision arose independently in different cultures for different reasons.
The oldest documentary evidence for circumcision comes from ancient Egypt. Circumcision was common, although not universal, among ancient Semitic peoples. In the aftermath of the conquests of Alexander the Great, however, Greek dislike of circumcision (they regarded a man as truly "naked" only if his prepuce was retracted) led to a decline in its incidence among many peoples that had previously practiced it.
Circumcision has ancient roots among several ethnic groups in sub-equatorial Africa, and is still performed on adolescent boys to symbolize their transition to warrior status or adulthood.
- 1 Circumcision in the Ancient world
- 2 Male circumcision in Africa
- 3 Male circumcision in the Greco-Roman world
- 4 Male circumcision in the Middle Ages
- 5 Male circumcision in the 18th century
- 6 Male circumcision in the 19th century and beyond
- 7 Male circumcision to prevent masturbation
- 8 Medical circumcision from 1870 to 1950 in English-speaking countries
- 9 Circumcision since 1950
- 10 Circumcision in the 21st century
- 11 References
- 12 Bibliography
- 13 External links
Circumcision in the Ancient world
Sixth Dynasty (2345–2181 BC) tomb artwork in Egypt has been thought to be the oldest documentary evidence of circumcision, the most ancient depiction being a bas-relief from the necropolis at Saqqara (c. 2400 BC) with the inscriptions reading: "The ointment is to make it acceptable." and "Hold him so that he does not fall". In the oldest written account, by an Egyptian named Uha, in the 23rd century BC, he describes a mass circumcision and boasts of his ability to stoically endure the pain: "When I was circumcised, together with one hundred and twenty men...there was none thereof who hit out, there was none thereof who was hit, and there was none thereof who scratched and there was none thereof who was scratched."
Herodotus, writing in the 5th century BC, wrote that the Egyptians "practise circumcision for the sake of cleanliness, considering it better to be cleanly than comely." Gollaher (2000) considered circumcision in ancient Egypt to be a mark of passage from childhood to adulthood. He mentions that the alteration of the body and ritual of circumcision were supposed to give access to ancient mysteries reserved solely for the initiated. (See also Clement of Alexandria, Stromateis 1.15) The content of those mysteries are unclear but are likely to be myths, prayers, and incantations central to Egyptian religion. The Egyptian Book of the Dead, for example, tells of the sun god Ra cutting himself, the blood creating two minor guardian deities. The Egyptologist Emmanuel vicomte de Rougé interpreted this as an act of circumcision. Circumcisions were performed by priests in a public ceremony, using a stone blade. It is thought to have been more popular among the upper echelons of the society, although it was not universal and those lower down the social order are known to have had the procedure done. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ.
Circumcision was also adopted by some Semitic peoples living in or around Egypt. Herodotus reported that circumcision is only practiced by the Egyptians, Colchians, Ethiopians, Phoenicians, the 'Syrians of Palestine', and "the Syrians who dwell about the rivers Thermodon and Parthenius, as well as their neighbours the Macronians and Macrones". He also reports, however, that "the Phoenicians, when they come to have commerce with the Greeks, cease to follow the Egyptians in this custom, and allow their children to remain uncircumcised."
According to Genesis, God told Abraham to circumcise himself, his household and his slaves as an everlasting covenant in their flesh, see also Abrahamic Covenant. Those who were not circumcised were to be "cut off" from their people (Genesis 17:10–14). Covenants in biblical times were often sealed by severing an animal, with the implication that the party who breaks the covenant will suffer a similar fate. In Hebrew, the verb meaning to seal a covenant translates literally as "to cut". It is presumed by Jewish scholars that the removal of the foreskin symbolically represents such a sealing of the covenant. Moses might not have been circumcised; his sons were not, nor were some of his followers (Joshua 5: 4–7). Moses's wife Zipporah may have circumcised their son when God threatened to kill Moses (...kill Moses son - considering Gen 17:14) (Exodus 4: 24–26).
Male circumcision in Africa
"The distribution of circumcision and initiation rites throughout Africa, and the frequent resemblance between details of ceremonial procedure in areas thousands of miles apart, indicate that the circumcision ritual has an old tradition behind it and in its present form is the result of a long process of development." 
African cultural history is conveniently spoken of in terms of language group. The Niger–Congo speakers of today extend from Senegal to Kenya to South Africa and all points between. In the historic period, the Niger–Congo speaking peoples predominantly have and have had male circumcision which occurred in young warrior initiation schools, the schools of Senegal and Gambia being not so very different from those of the Kenyan Gikuyu and South African Zulu. Their common ancestor was a horticultural group five, perhaps seven, thousand years ago from an area of the Cross River in modern Nigeria. From that area a horticultural frontier moved outward into West Africa and the Congo Basin. Certainly the warrior schools with male circumcision were a part of the ancestral society's cultural repertoire.
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Male circumcision in East Africa is a rite of passage from childhood to adulthood, but is only practiced in some nations (tribes). Some peoples in East Africa do not practice male circumcision (for example the Luo of western Kenya).
Amongst the Gikuyu (Kikuyu) people of Kenya and the Maasai people of Kenya and Tanzania, male circumcision has historically been the graduation element of an educational program which taught tribal beliefs, practices, culture, religion and history to youth who were on the verge of becoming full-fledged members of society. The circumcision ceremony was very public, and required a display of courage under the knife in order to maintain the honor and prestige of the young man and his family. The only form of anesthesia was a bath in the cold morning waters of a river, which tended to numb the senses to a minor degree. The youths being circumcised were required to maintain a stoic expression and not to flinch from the pain.
After circumcision, young men became members of the warrior class, and were free to date and marry. The graduants became a fraternity which served together, and continued to have mutual obligation to each other for life.
In the modern context in East Africa, the physical element of male circumcision remains (in the societies that have historically practiced it) but without most of the other accompanying rites, context and programs. For many, the operation is now performed in private on one individual, in a hospital or doctor's office. Anesthesia is often used in such settings. There are tribes however, that do not accept this modernized practice. They insist on circumcision in a group ceremony, and a test of courage at the banks of a river. This more traditional approach is common amongst the Meru and the Kisii tribes of Kenya.
Despite the loss of the rites and ceremonies that accompanied male circumcision in the past, the physical operation remains crucial to personal identity and pride, and acceptance in society. Uncircumcised men in these communities risk being "outed", and subjected to ridicule as "boys". There have been many cases of forced circumcision of men from such communities who are discovered to have escaped the ritual.
Male circumcision in the Greco-Roman world
According to Hodges, ancient Greek aesthetics of the human form considered circumcision a mutilation of a previously perfectly shaped organ. Greek artwork of the period portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians. This dislike of the appearance of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it throughout Hellenistic times. In Egypt, only the priestly caste retained circumcision, and by the 2nd century, the only circumcising groups in the Roman Empire were Jews, Jewish Christians, Egyptian priests, and the Nabatean Arabs. Circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism (or Early Christianity and others derogatorily called Judaizers) in Roman courts—Suetonius in Domitian 12.2 described a court proceeding in which a ninety-year-old man was stripped naked before the court to determine whether he was evading the head tax placed on Jews and Judaizers.
Cultural pressures to circumcise operated throughout the Hellenistic world: when the Judean king John Hyrcanus conquered the Idumeans, he forced them to become circumcised and convert to Judaism, but their ancestors the Edomites had practiced circumcision in pre-Hellenistic times.
Some Jews tried to hide their circumcision status, as told in 1 Maccabees. This was mainly for social and economic benefits and also so that they could exercise in gymnasiums and compete in sporting events. Techniques for restoring the appearance of an uncircumcised penis were known by the 2nd century BC. In one such technique, a copper weight (called the Judeum pondum) was hung from the remnants of the circumcised foreskin until, in time, they became sufficiently stretched to cover the glans. The 1st-century writer Celsus described two surgical techniques for foreskin restoration in his medical treatise De Medicina. In one of these, the skin of the penile shaft was loosened by cutting in around the base of the glans. The skin was then stretched over the glans and allowed to heal, giving the appearance of an uncircumcised penis. This was possible because the Abrahamic covenant of circumcision defined in the Bible was a relatively minor circumcision; named milah, this involved cutting off the foreskin that extended beyond the glans. Jewish religious writers denounced such practices as abrogating the covenant of Abraham in 1 Maccabees and the Talmud. Because of these attempts, and for other reasons, a second more radical step was added to the circumcision procedure. This was added around 140 AD, and was named Brit Peri'ah. In this step, the foreskin was cut further back, to the ridge behind the glans penis, called the coronal sulcus. The inner mucosal tissue was removed by use of a sharp finger nail or implement, including the excising and removal of the frenulum from the underside of the glans. Later during the Talmudic period (500–625 AD) a third step, known as Metzitzah, began to be practiced. In this step the mohel would suck the blood from the circumcision wound with his mouth to remove what was believed to be bad excess blood. As it actually increases the likelihood of infections such as tuberculosis and venereal diseases, modern day mohels use a glass tube placed over the infant's penis for suction of the blood. In many Jewish ritual circumcisions this step of Metzitzah has been eliminated.
First Maccabees tells us that the Seleucids forbade the practice of brit milah, and punished those who performed it–as well as the infants who underwent it–with death.
The 1st-century Jewish author Philo Judaeus (20 BC - 50 AD) defended Jewish circumcision on several grounds, including health, cleanliness and fertility. He also thought that circumcision should be done as early as possible as it would not be as likely to be done by someone's own free will. He claimed that the foreskin prevented semen from reaching the vagina and so should be done as a way to increase the nation's population. He also noted that circumcision should be performed as an effective means to reduce sexual pleasure: "The legislators thought good to dock the organ which ministers to such intercourse thus making circumcision the symbol of excision of excessive and superfluous pleasure."
The Jewish philosopher Maimonides (1135–1204) insisted that faith should be the only reason for circumcision. He recognised that it was "a very hard thing" to have done to oneself but that it was done to "quell all the impulses of matter" and "perfect what is defective morally." Sages at the time had recognised that the foreskin heightened sexual pleasure. Maimonides reasoned that the bleeding and loss of protective covering rendered the penis weakened and in so doing had the effect of reducing a man's lustful thoughts and making sex less pleasurable. He also warned that it is "hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him."
A 13th-century French disciple of Maimonides, Isaac ben Yediah claimed that circumcision was an effective way of reducing a woman's sexual desire. With a non-circumcised man, he said, she always orgasms first and so her sexual appetite is never fulfilled, but with a circumcised man she receives no pleasure and hardly ever orgasms "because of the great heat and fire burning in her."
Flavius Josephus in Jewish Antiquities book 20, chapter 2 records the story of King Izates who having been persuaded by a Jewish merchant named Ananias (claimed by Robert Eisenman in James the Brother of Jesus to be Paul of Tarsus) to embrace the Jewish religion, decided to get circumcised so as to follow Jewish law. Despite being reticent for fear of reprisals from his non-Jewish subjects he was eventually persuaded to do it by a Galileean Jew named Eleazar on the grounds that it was one thing to read the Law and another thing to practice it. Despite his mother Helen and Ananias's fear of the consequences, Josephus said that God looked after Izates and his reign was peaceful and blessed.
The Council of Jerusalem in Acts of the Apostles 15 addressed the issue of whether circumcision was required of new converts to Christianity. Both Simon Peter and James the Just spoke against requiring circumcision in Gentile converts and the Council ruled that circumcision was not necessary. However, Acts 16 and many references in the Letters of Paul show that the practice was not immediately eliminated. Paul of Tarsus, who was said to be directly responsible for one man's circumcision in Acts 16:1–3 and who appeared to praise Jewish circumcision in Romans 3:2, said that circumcision didn't matter in 1 Corinthians 7:19 and then increasingly turned against the practice, accusing those who promoted circumcision of wanting to make a good showing in the flesh and boasting or glorying in the flesh in Galatians 6:11–13. In a later letter, Philippians 3:2, he is reported as warning Christians to beware the "mutilation" (Strong's G2699). Circumcision was so closely associated with Jewish men that Jewish Christians were referred to as "those of the circumcision" (e.g. Colossians 3:20)  or conversely Christians who were circumcised were referred to as Jewish Christians or Judaizers. These terms (circumcised/uncircumcised) are generally interpreted to mean Jews and Greeks, who were predominate, however it is an oversimplification as 1st-century Iudaea Province also had some Jews who no longer circumcised, and some Greeks (called Proselytes or Judaizers) and others such as Egyptians, Ethiopians, and Arabs who did. According to the Gospel of Thomas saying 53, Jesus says:
- "His disciples said to him, "is circumcision useful or not?" He said to them, "If it were useful, their father would produce children already circumcised from their mother. Rather, the true circumcision in spirit has become profitable in every respect."" SV 
In John's Gospel 7:23 Jesus is reported as giving this response to those who criticized him for healing on the Sabbath:
- Now if a man can be circumcised on the sabbath so that the Law of Moses is not broken, why are you angry with me for making a man whole and complete on a sabbath? ( Jerusalem Bible)
This passage has been seen as a comment on the Rabbinic belief that circumcision heals the penis (Jerusalem Bible, note to John 7:23) or as a criticism of circumcision.
Male circumcision in the Middle Ages
Europeans, with the exception of the Jews, did not practice male circumcision. A rare exception occurred in Visigothic Spain, where during the armed campaign king Wamba ordered to circumcise everyone who committed atrocities against civilian population.
The Catholic Church condemned the observance of circumcision as a mortal sin and ordered against its practice in the Council of Basel-Florence in 1442. According to UNAIDS, it stated that circumcision was unnecessary for Christians; El-Hout and Khauli, however, regard it as condemnation of the procedure.
Male circumcision in the 18th century
Circumcision was not practiced amongst Christians in Europe in the 18th century.
- Edward Gibbon had referred to it as a "singular mutilation" practised only by Jews and Turks and as "a painful and often dangerous rite" ... (R. Darby)
In 1753 in London there was a proposal for Jewish emancipation. It was furiously opposed by the pamphleteers of the time, who spread the fear that Jewish emancipation meant universal circumcision. Men were urged to protect:
- "the best of Your property" and guard their threatened foreskins. It was an extraordinary outpouring of popular beliefs about sex, fears about masculinity and misconceptions about Jews, but also a striking indication of how central to their sexual identity men considered their foreskins at that time. (R.Darby)
Male circumcision in the 19th century and beyond
Until well into the 19th century, the same sentiments prevailed.
The English explorer Sir Richard Burton observed that "Christendom practically holds circumcision in horror". This attitude is reflected in the ninth edition of the Encyclopædia Britannica (1876) which discusses the practice as a religious rite among Jews, Muslims, the ancient Egyptians and tribal peoples in various parts of the world. The author of the entry rejected sanitary explanations of the procedure in favour of a religious one: "like other body mutilations ... [it is] of the nature of a representative sacrifice". (R. Darby)
Then, a change of attitude began, something that was reflected in successive editions of the Encyclopædia Britannica:
By 1910 the entry had been turned on its head: "This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Muslims": now it was primarily a medical procedure and only after that a religious ritual. The entry explained that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health" (11th edition, Vol. 6). By 1929 the entry is much reduced in size and consists merely of a brief description of the operation, which is "done as a preventive measure in the infant" and "performed chiefly for purposes of cleanliness". Ironically, readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context (14th edition, 1929, Vol. 5). (R. Darby)
Historically, neonatal circumcision was promoted during late Victorian times in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom and was widely practiced during the first part of the 20th century in these countries. However, the practice declined sharply in the United Kingdom after the Second World War, and somewhat later in Canada, Australia and New Zealand. It has been argued (e.g., Goldman 1997) that the practice did not spread to other European countries because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case.
Infant circumcision has been abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). The decline in circumcision in the United Kingdom followed the decision by the National Health Service (NHS) in 1948 not to cover the procedure following an influential article by Douglas Gairdner which claimed that circumcision resulted in the deaths of about 16 children under 5 each year in the United Kingdom.
Male circumcision to prevent masturbation
Non-religious circumcision in English-speaking countries arose in a climate of negative attitudes towards sex, especially concerning masturbation. In her 1978 article The Ritual of Circumcision, Karen Erickson Paige writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' – the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"
"Self-abuse" was a term commonly used to describe masturbation in the 19th century. According to Paige, "treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended covering the penis with plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration." Paige details how circumcision became popular as a masturbation remedy:
In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons of England published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the "vestigial" prepuce. Evidently the foreskin could cause "nocturnal incontinence," hysteria, epilepsy, and irritation that might "give rise to erotic stimulation and, consequently, masturbation." Another physician, P.C. Remondino, added that "circumcision is like a substantial and well-secured life annuity ... it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills." No wonder it became a popular remedy.
At the same time circumcisions were advocated on men, clitoridectomies (removal of the clitoris) were also performed for the same reason (to treat female masturbators). The US "Orificial Surgery Society" for female "circumcision" operated until 1925, and clitoridectomies and infibulations would continue to be advocated by some through the 1930s. As late as 1936, L. E. Holt, an author of pediatric textbooks, advocated male and female circumcision as a treatment for masturbation.
One of the leading advocates of circumcision was John Harvey Kellogg. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.
Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice.
Robert Darby, writing in the Australian Medical Journal, noted that some 19th-century circumcision advocates—and their opponents—believed that the foreskin was sexually sensitive:
In the 19th century the role of the foreskin in erotic sensation was well understood by physicians who wanted to cut it off precisely because they considered it the major factor leading boys to masturbation. The Victorian physician and venereologist William Acton (1814–1875) damned it as "a source of serious mischief", and most of his contemporaries concurred. Both opponents and supporters of circumcision agreed that the significant role the foreskin played in sexual response was the main reason why it should be either left in place or removed. William Hammond, a Professor of Mind in New York in the late 19th century, commented that "circumcision, when performed in early life, generally lessens the voluptuous sensations of sexual intercourse", and both he and Acton considered the foreskin necessary for optimal sexual function, especially in old age. Jonathan Hutchinson, English surgeon and pathologist (1828–1913), and many others, thought this was the main reason why it should be excised.
Mainstream pediatric manuals continued to recommend circumcision as a deterrent against masturbation until the 1950s.
Medical circumcision from 1870 to 1950 in English-speaking countries
Until 1870, medical circumcisions were performed to treat conditions local to the penis: phimosis, balanitis, and penile cancer. In that year, Lewis Sayre, a prominent New York orthopedic surgeon and vice president of the newly formed American Medical Association, examined a five-year-old boy who was unable to straighten his legs, and whose condition had so far defied treatment. Upon noting that the boy's genitals were inflamed, Sayre hypothesized that chronic irritation of the boy's foreskin had paralyzed his knees via reflex neurosis. Sayre circumcised the boy, and within a few weeks, he recovered from his paralysis. After several additional incidents in which circumcision also appeared effective in treating paralyzed joints, Sayre began to promote circumcision as a powerful orthopedic remedy.
Sayre's prominence within the medical profession allowed him to reach a wide audience. He lectured widely in the United States and the United Kingdom, and his ideas influenced physicians throughout the English-speaking world. As more practitioners tried circumcision as a treatment for otherwise intractable medical conditions, sometimes achieving positive results, the list of ailments reputed to be treatable through circumcision grew. By the 1890s, hernia, bladder infections, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, Bright's disease, erectile dysfunction, syphilis, insanity, and skin cancer had all been linked to the foreskin, and many physicians advocated universal circumcision as a preventive health measure. In 1855, the Quaker surgeon, Jonathan Hutchinson, observed that circumcision appeared to protect against syphilis. Although this observation was challenged (the protection that Jews appear to have are more likely due to cultural factors), a 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk ... syphilis."
Specific medical arguments aside, several hypotheses have been raised in explaining the public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene. Secondly, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation. All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. (However, a survey of 1410 men in the United States in 1992, Laumann found that circumcised men were more likely to report masturbating at least once a month.) As hospitals proliferated in urban areas, childbirth, at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with midwives in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.
During the same time period, circumcision was becoming easier to perform. William Halstead's 1885 discovery of hypodermic cocaine as a local anaesthetic made it easier for doctors without expertise in the use of chloroform and other general anaesthetics to perform minor surgeries. Also, several mechanically aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully.
By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygiene and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.
Infant circumcision was taken up in the United States, Australia, New Zealand and the English-speaking parts of Canada and to a lesser extent in the United Kingdom. The British Royal Family had a long tradition requiring that all male children be circumcised”[clarification needed]. Although it is difficult to determine historical circumcision rates, one estimate  of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
Circumcision since 1950
In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly formed National Health Service to remove infant circumcision from its list of covered services. One reason may have been Douglas Gairdner’s famous study, The fate of the foreskin, which revealed that for the years 1942–1947, about 16 children per year in England and Wales had died because of circumcision, a rate of about 1 per 6000 circumcisions. Since then, circumcision has been an out-of-pocket cost to parents, and the proportion of newborns circumcised in the hospital has fallen to less than one percent.
Similar trends have operated in Canada, (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse) individual provincial health insurance plans began delisting non-therapeutic circumcision in the 1980s. Manitoba was the final province to delist non-therapeutic circumcision which occurred in 2005.
In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945 and the spread of American influence. More than 90% of South Korean high school boys are now circumcised, which makes South Korea a unique case. The average age of circumcision is 12 years.
In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys:
The young men in the eastern Cape belong to the Xhosa ethnic group for whom circumcision is considered part of the passage into manhood. ... A law was recently introduced requiring initiation schools to be licensed and only allowing circumcisions to be performed on youths aged 18 and older. But Eastern Cape provincial Health Department spokesman Sizwe Kupelo told Reuters news agency that boys as young as 11 had died. Each year thousands of young men go into the bush alone, without water, to attend initiation schools. Many do not survive the ordeal."South Africa circumcision deaths". BBC Online. 15 July 2003. Retrieved 2009-04-07.
Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection.  A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 study reported that "The most important reason to circumcise or not circumcise the child was health reasons." A 2005 study speculated that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000. In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".
In the United States, statistics (1999) collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision had remained near 65% since data collection began in 1979. However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West in 1999. This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise.
Circumcision in the 21st century
As of 2011 the American Medical Association (AMA) states that ""There is strong evidence documenting the health benefits of male circumcision, and it is a low-risk procedure, said Peter W. Carmel, M.D., AMA president. "Today the AMA again made it clear that it will oppose any attempts to intrude into legitimate medical practice and the informed choices of patients.".
In 2012, the American Academy of Pediatrics (AAP) stated that, in their view, "the health benefits of newborn male circumcision outweigh the risks" and that the procedure should be available to families who choose it. Their view was challenged by a group of mostly European physicians as resulting from "cultural bias".
Studies also indicate that male circumcision can reduce the chance of HIV infection in heterosexual men. As the CDC claims, "several types of research have documented that male circumcision significantly reduces the risk of men contracting HIV through penile-vaginal sex, as well as lowers the risk of other STDs , penile cancer, and infant urinary tract infection. For female partners, male circumcision reduces the risk of cervical cancer, genital ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has risks including pain, bleeding, and infection, more serious complications are rare."
Neonatal circumcision remains the most common pediatric operation carried out in the U.S. today.
The South African Children's Act (No. 38 of 2005) has made the mass circumcision of Zulu children unlawful except for medical or religious reasons.
On 7 May 2012 the Cologne, Germany Regional court (Köln Landgericht) ruled that parents could not grant consent for ritual (non-therapeutic) circumcision of children.
For current circumcision rates, please see prevalence of circumcision.
Some have voiced ethical concerns about the procedure. See Bioethics of neonatal circumcision for more information.
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- , Page last updated: April 15, 2013 | Content source:Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention
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