For decades, American parents were on circumcision autopilot. Conventional wisdom held that the foreskin-free penis was healthier and cleaner. Everyone was doing it, so everyone had it done.
Not so today. Rates of infant circumcision have declined overall since the 1960s, and almost half of baby boys in the U.S. now go uncircumcised.
The Centers for Disease Control and Prevention and the American Academy of Pediatrics, currently neutral on whether to circumcise, are drafting new policies in light of recent studies suggesting circumcision helps prevent transmission of HIV and other sexually transmitted diseases.
Both agencies say they plan to publish their new recommendations this year, though they've been saying that for the last two years.
Anti-circumcision activists -- dubbed "intactivists" because they advocate leaving penises intact -- fear official endorsement could encourage more parents to subject their sons to what they consider an unethical and purely cosmetic procedure.
"That would be a disaster," said John Geisheker, executive director and general counsel for the advocacy group Doctors Opposing Circumcision. "We hope they waffle again."
Since 1999, the American Academy of Pediatrics' policy has stated that the potential medical benefits of circumcision are not enough to recommend it as a routine procedure, and parents should decide according to what's in the best interest of the child. The AAP's new policy isn't expected to recommend circumcision outright, but it's likely to give more credence to health benefits, said Dr. Doug Diekema, a member of the AAP's circumcision task force.
The CDC has not yet determined whether it will recommend circumcision as an STD-prevention strategy. The recommendations will go through a period of public comment, and parents wouldn't have to abide by them, said spokeswoman Elizabeth-Ann Chandler.
The studies driving the new recommendations, based on clinical trials in sub-Saharan Africa and published in recent years in the Lancet medical journal, found that circumcised men had a 60 percent lower incidence of contracting HIV from heterosexual sex than their uncircumcised peers.
Another study, published in January in the Lancet, found that women with circumcised partners were 28 percent less likely to contract the human papillomavirus (HPV), a common STD that can cause cervical cancer, than women with uncircumcised partners.
Critics say the HIV study results are of limited relevance to the U.S. because they don't address the most-frequently infected population in the U.S.: men who have sex with men. In addition, studies show that circumcision doesn't reduce HIV transmission to women. Besides, opponents say, adults should be preventing STDs through condom use.
"We're talking about amputating tissue from a child in order to prevent disease that adult behavior can prevent," Geisheker said.
Though circumcision has been linked to fewer urinary tract infections in infants and a lower risk of penile cancer in men, plus STD prevention, opponents say those purported benefits don't outweigh the risk of pain, complications or loss of sexual sensitivity.
Culture: Both sides agree that most parents circumcise their sons not for health but to conform to cultural norms, which raises ethical questions about whether parents should be able to irrevocably alter their kid's appearance.
"You're removing healthy, erogenous, highly nerve-supplied tissue from a human being who has not given his or her consent, and you're doing it for nontherapeutic reasons," Geisheker said.
It's a boy: Are you having him circumcised?
Circumcision at University of Chicago Hospital (Terrence Antonio James/Chicago Tribune)