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In "Circumcision: A History of the World's Most Controversial Surgery," medical historian David L. Gollaher rounds up thousands of years' worth of religious, cultural and medical arguments for and against circumcision. While he is civil toward the operation's proponents, he's firmly against it, and in the course of his elegant, sometimes dauntingly academic discussion he prompts many crotch-clutching winces with tales of aboriginal stone knives, accidental amputations resulting in impromptu infant sex-reassignment surgery and the howls of babies circumcised without anesthesia. It's the crossed-legs read of the year.

How did we come to be so gung-ho about lopping off foreskins? Disparate tribal cultures require boys (and often girls) to undergo some form of genital surgery -- some that make the average American circumcision seem as invasive as a haircut -- though the social and spiritual significance of the act varies from place to place. Both Jews and Muslims do it on scriptural authority. That slick rhetorician Paul saw that it would hinder converts to Christianity, and so he told Gentiles that they needed to undergo only a metaphorical "circumcision of the heart."

Sixty or so generations of uncut Christians later, in the 19th century, a few influential American and British doctors began touting circumcision as a prophylactic against everything from venereal disease and masturbation to epilepsy and paralysis. In the Victorian climate of squeamishness about hygiene, moralistic prurience and across-the-board self-improvement, the upper classes went along with it, and, willy-nilly, the rabble followed: "Out of the complicated social milieu at the turn of the 20th century -- when eugenics was another popular public health measure -- grew an ideal of the normal healthy body: nature's product improved by modern surgery."

The crux of Gollaher's argument is that neonatal circumcision directly flouts the Hippocratic oath: First, do no harm. Why perform surgery when the statistical risks -- from scarring to those nightmarish knife slips to the occasional death -- are greater than any proven benefits? Except in the case of disorders resulting from attached or too-tight foreskins, which can't ordinarily be diagnosed until puberty anyway, the medical evidence is fuzzy. Penile cancer virtually never strikes circumcised men, but it's a rare disease in any event, and its incidence among the almost unanimously uncut men of Finland and Denmark is significantly lower than that in the United States. Gollaher notes pithily that "circumcision prevents penile cancer just as mastectomy prevents breast cancer." Studies linking foreskins and venereal-disease transmission have been, he shows, "stunningly contradictory."

And it's for purely social reasons that most American parents have their sons circumcised: Junior should look like Dad, and like the other kids in the locker room. Anti-cutting activists claim that circumcision drastically reduces male sexual pleasure -- the same claim made, with opposite intent, by puritanical authorities of the past 150 years, including one Dr. C.W. Cockshut -- and Gollaher cites anatomical evidence that the foreskin is full of hypersensitive nerves. I'd point out here what Gollaher doesn't: Cut men, like uncut men, generally have a pretty excellent time with their penises, and they don't generally point to their maimed organs, or to buried memories of the trauma of circumcision, as a reason for sexual dysfunction. But Gollaher's lucid essay ought to inspire parents to consider whether paying a doctor to surgically modify their newborn's weenie is a choice motivated by real social benefit, ancient ritual or merely easy medical habit.
salon.com | Feb. 22, 2000

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