What is a foreskin anyway? In a heavily circumcised country like the United States, many people simply don’t know. Basically, the foreskin is an open "sock” covering the glans of the penis and maintaining it as a sensitive, moist membrane. It starts off adhering to the glans but becomes fully retractable as a child gets older. A foreskin has an abundance of nerve endings, and winds up being erogenous tissue, much like the various parts of the female genitalia. Some men resent having lost their foreskins as babies, but some don’t miss them in the least.

Of course, foreskins aren’t merely lost or shed; they’re cut off. Thanks to a video provided by Stanford University Medical School, you can see a state-of-the-art circumcision ( 2gVRQsj) before deciding whether to choose the procedure for your child. The procedure demonstrated is used by the majority of circumcisers in the United States (67 percent) according to a 1998 survey (see Stang and Snellman in the Bibliography). The baby is first strapped down and then receives two injections of lidocaine anesthetic at the base of his penis. Next, he is draped with two sterile sheets, the little penis sticking up between them. Two instruments are used to stretch the foreskin up beyond the glans and to open it at the tip. A sharp third instrument is inserted in the opening and used to separate the foreskin from the glans. Next, a scissors-like clamp is inserted and used to make a vertical, one-inch "crush injury” in the foreskin. Then a scissors is used to cut to the base of the crush injury. The foreskin is retracted—peeled downwards. Remaining adhesions are cleaned off with gauze. The foreskin is pulled back up so it extends a few inches beyond the glans. Then a “Gomco clamp” is used to make the final cut in such a way that the glans is protected (watch the video if you want to know exactly how it works), and to insure that the cut is an even circle. There is some bleeding, but not a lot. The whole procedure takes about ten minutes, and afterwards the circumcised penis is covered with Vaseline-treated gauze and the child’s diaper is put back on.

The majority of newborn boys in the United States are circumcised, though regional variation is striking: the rate is 80.1 percent in the Midwest; 69.6 percent in the Northeast; 64.7 percent in the South; and 34 percent in the West. Outside of the United States, only religion-linked circumcision is common. Of the 30 percent of males who are circumcised around the world, two-thirds are Muslim. In

Israel the vast majority of boys are circumcised. In Europe the vast majority of parents don’t circumcise their sons.

How, then, did nonreligious circumcision become so common in the United States? According to Leonard Glick, author of Marked in Your Flesh: Circumcision from Ancient Judea to Modern America, American circumcision has its roots in Jewish circumcision, so the story begins long ago. In chapter 17 of the biblical Book of Genesis, God is described as establishing a covenant with Abram, promising to make him "exceedingly numerous” and to give him the land of Canaan. God promises constancy: "I will maintain My covenant between Me and you, and your offspring to come, as an everlasting covenant throughout the ages ..—but God makes demands in return. Abram is now to be called "Abraham,” and his descendants must keep the covenant, sealing it through circumcision. "[E]very 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.” It’s also stipulated when circumcision shall take place: "And throughout the generations, every male among you shall be circumcised at the age of eight days.” Even non-Jewish members of the household must be circumcised: "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.” Circumcision is meant to function much like the signature at the bottom of a contract: "Thus shall my covenant be marked in your flesh as an everlasting pact.” If you don’t sign, you’re left out of the contract: "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.” In the next two paragraphs of chapter 17, Abraham is described as circumcising himself, his son Ishmael, and all the slaves in his house.

Throughout the centuries, rahhis and Jewish philosophers have offered numerous interpretations of the practice of circumcision. According to one account, the point of it is only superficially to make a newborn baby a member of the community. In the twelfth century, the Jewish philosopher Maimonides suggested that the significance of circumcision is to serve as a test of the father’s membership in the community of Jews. You won’t circumcise your son "unless it be in consequence of a genuine belief. For it is not like an incision in the leg or a burn in the arm, but is a very, very hard thing" The modern ritual, known as brit milah (covenant of circumcision) does seem to be a challenge for many parents—both fathers and mothers.

It’s certainly puzzling that the Jewish ritual gave rise to a secular procedure, which became the norm in the United States, especially considering that Jews have always been a tiny minority ofAmericans and Christians have always been a sizable majority. The apostle Paul established the unimportance of circumcision to Christians in the New Testament, saying that the procedure has no religious importance (Galatians 6:15-17). Furthermore, for centuries Jews were reviled for the practice. According to Glick, the tide turned starting in the nineteenth century in Germany and England, but especially in the latter. The idea was born that Jews had stumbled upon, or somehow anticipated, a procedure with significant benefits. Circumcising was touted as reducing masturbation, partly because boys without foreskins could more easily keep themselves clean without touching themselves. Circumcision was also thought to reduce sexual pleasure (an alleged plus, not a minus!). With respect to more strictly medical benefits, some doctors began studying Jewish communities that circumcised and comparing them to the general population. Some concluded that circumcision prevented syphilis and a host of other diseases.

Circumcision became popular in the United States for many reasons. Glick speculates that the many Jewish physicians writing about the issue were not prejudiced against the procedure in the manner of some of their European colleagues. In fact, some of them were beyond not-prejudiced; they were positively eager to defend a practice that had attracted the hostility of anti-Semites through the ages. In addition, circumcision became a favorite of creative physicians who saw it as a cure for everything under the sun. At the turn of the century, births started to take place in hospitals rather than at home, with a resulting medicalization of everything associated with childbirth: that was the beginning of a surge in popularity. By 1910, 30 percent of American infant boys were already being circumcised. In 1940 it was 60 percent. Over the course of a few decades, a practice that was once seen as peculiarly Jewish and in fact distasteful to most non-Jews had come to seem modern, medical, and mandatory.

As time passed, initial rationales were forgotten. Since circumcision was performed on infants, and in fact on most of them, men might grow up never seeing anything else. And women too. Because of the ubiquity of the practice in the United States, to many the circumcised penis started to seem normal and natural, and the uncircumcised penis started to seem deviant. In the United States (but not in most other countries), foreskin-docking became part of the aesthetic norm for the male human. And then there started to be skeptics who asked why newborn boys were being subjected to surgery on the first days of life. Was there really any good reason to continue the practice?

One thing that makes these questions hard is the difficulty of disentangling the various considerations. Do any of the main rationales—health, conformity, religion—withstand scrutiny?

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