Circumcision, long in decline in the U.S., may get a boost from a doctors’ group

When Tamar Jacobs became pregnant, she found herself hoping for a girl, mainly because she was dreading a difficult rite of passage that often comes with the birth of a boy — circumcision.

Growing up Jewish in Baltimore, “I never really questioned it,” she said, but the more she read and thought about it, the more “unnecessary and even cruel” circumcision seemed. By the time the grainy 20-week sonogram showed the outward sign of an XY chromosome, she knew she could not go through with it.

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“It seemed like such a severe, out-of-this-time thing to do,” she said.

The 32-year-old fiction writer and community college professor is part of a new wave of parents who are questioning not just an ancient Jewish tradition but a long-entrenched American one.

More than 1.2 million infant boys undergo the surgery each year, making the United States one of the industrialized world’s leading producers of circumcised men. But the once ubiquitous practice, in which the foreskin is removed from the penis, is waning.

From a high of about 80 percent in the 1960s, the portion of baby boys leaving hospitals with petroleum-jelly-covered wounds in their diapers dropped to 56 percent in 2008, according to the Centers for Disease Control and Prevention. (The figures do not include those circumcised in outside clinics or by religious providers.)

The downward trend is probably fueled by Medicaid laws in many states that have stopped paying for the surgery, increased immigration from Latin America and other areas were circumcision is less common, and a growingly vocal cadre of so-called “intactivists” who argue that the practice is a human rights violation.

It also reflects a generation that’s more likely to trust nature and second-guess their medical treatment. For these parents, circumcision has become less of an assumption and more of a choice, and not always an easy one.

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An expectant parent wading into the debate around circumcision is likely to discover a maze of medical research, white-hot rhetoric pitting children’s rights against religious freedom, and a choir of bathroom humor.

In interviews for this article, the untrimmed foreskin was alternately derided as an HIV-spreading “wrinkled elephant trunk” or heralded for its “elegant function” and thousands of pleasure-inducing nerve endings.

An uncircumcised California native described the embarrassed feeling of being the kid who looked different in the locker room, and an anti-circumcision activist explained how he spent the past decade trying to re-stretch his shorn foreskin and increase sensitivity in his penis by using a commercially available plastic cone that applies tension to the remaining skin.

Given the prevalence of circumcision, perhaps the most surprising perspective is one offered by American doctors, many of whom summarize the procedure as a “cosmetic” or “aesthetic” choice.

The American Academy of Pediatrics, which advises children’s doctors on research-based practices, has been officially neutral on the issue for more than a decade.