Circumcision, Male

Who Gets Circumcised and Why?

Male circumcision dates back several thousand years. The earliest documentation comes from Egyptian tomb artwork dated to the Sixth Dynasty (2345–2181 BCE). The book of Genesis (17:11) speaks of circumcision as a rite of passage for Jews during the age of Abraham, who lived around 2000 BCE. Although its origin is unknown, male circumcision practice is widespread today, extending from Africa to the Middle East, the islands of the Pacific to the West.

Male circumcision practices differ greatly by culture. Its practice is often associated with rites of passage into adulthood, religious sacrifice, and hygiene promotion. Approximately 25% of males are circumcised globally. The age at time of circumcision also varies with culture, extending from infancy through puberty and into adulthood. Jews and Muslims mandate circumcision as a part of their religious practice and account for 100,000 and 10 million annual circumcisions, respectively. Pacific Islanders are traditionally circumcised as a rite of initiation, as are Australian aboriginals. In Africa, circumcision practice is disparate, dictated largely by influences ranging from colonization to tribal rituals.

In the United States, 65% to 90% of males are circumcised. This wide range is attributed to differences between the statistical reporting of birthing centers and the observed rate of practice that includes adult circumcision. From 1988 to 2000, the U.S. newborn circumcision rate increased by 12.8%. This increase is most prominent in states where immigration is low, because most immigrants to the United States, particularly Hispanics, are traditionally not circumcised.

Outside religious or medical influences, circumcision decisions are based most heavily on parental preference. For mothers, there is a strong correlation between their son's circumcision status and the woman's ideal male partner's circumcision status. Likewise, fathers make the decision based on personal experience.

Histological and Biological Effects of Male Circumcision

To fully comprehend the protective effects of male circumcision, one needs to have a general understanding of the histological and biological differences between a circumcised and uncircumcised penis.

Keratin is a protein found in skin cells that acts as a primary line of immunological defense against infection. According to a histological study conducted [Page 185]in 2006 by McCoombe and Short, different regions of the penis are keratinized to varying degrees. In an uncircumcised male, the outer surface of the foreskin is heavily keratinized while the inner surface is not and closely resembles the mucosal epithelia of the cervix and nasal passageways. When the penis is erect, this weak inner prepuce is exposed and stretched, thus putting it in direct contact with potentially infectious agents during unprotected sex.

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