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The Great Foreskin Debate: Why the Midwest leads the world in infant circumcision and what the hell that says about us

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"In the 19th century this was so common, the Jewish community referred to it as 'second circumcision,'" Van Howe says.

As for HIV and STDs, advocates can only point to studies done in Africa on consenting adult men who've been paid for their participation. The World Health Organization now advocates the procedure be done on adults because of these studies, even though regular condom usage gets the same results. In fact, even circumcised men must wear condoms to keep from contracting or spreading the disease.

Diekema says the WHO's stance on circumcision is much different than the AAP's for one big reason.

"The World Health Organization is a public health organization that is looking for implications for large groups rather than singular people," he says. "It's more complicated when you're looking at individuals."

Still, Diekema notes that circumcision helps reduce the spread of diseases like the human papillomavirus (HPV), which is known to cause cervical cancer in women and penile cancer in men.

"Most of the benefits are preventative," he says. "You don't know which kids will suffer either way."

Some critics have gone so far as to attempt to link circumcision to autism.

To that, Diekema almost chuckles. "It's difficult to know where to put all the little girls with autism, then," he says. "There is absolutely no data to support that."

Other arguments for circumcision include that women prefer circumcised men, that boys who aren't circumcised will be made fun of, and that it's harder to clean an uncut penis.

All of these points can be argued either way. Critics say that the foreskin provides a layer of lubrication during sex that is absent in a circumcised penis. That lubrication makes sex more comfortable for both the woman and uncircumcised man. Advocates say women like the look of a circumcised penis, and the increased penile-vaginal contact, stimulation, and marginally better staying power during sex make circumcision advantageous, according to literature by circumcision proponent Brian Morris, professor emeritus of molecular medical sciences at the University of Sydney, Australia.

Hygiene might be the biggest issue, though, as advocates assert that an uncut penis will be smegma-filled and odorous, while critics say nothing more than warm water is necessary to keep the organ clean. Critics say that even doctors are misinformed on this issue and that they often misadvise parents that the foreskin should be pushed back and cleaned at every diaper change and during every bath.

But the foreskin doesn't actually retract until the child hits puberty, and retracting it before it does so on its own is painful, can tear the skin, and lead to infection.

The First Cut Is the Deepest

Jennifer Rice is the mother of two sons. She had her oldest circumcised, but decided she didn't want to circumcise her second son.

"With my oldest, after he came back from the surgery he wouldn't take the binky, he wouldn't nurse, he was very irritable," says Rice. "With my second son, everything was very peaceful for him." She also notes that her second was also much easier to keep clean.

"With my first, you had to make sure his penis was Vaseline'd at every diaper change so that things wouldn't get stuck to it and it wouldn't get infected," she says. "You had to touch it a lot. With my second son, we don't touch it at all. We'd just give him a bath and he's fine. We don't even clean it with soap; I just dunk him in warm water. He doesn't smell at all."

Like many parents who choose to leave their sons uncircumcised, Rice experienced some backlash from her family, though she says that's all dissipated now. She even found that most doctors and nurses were receptive to her decision, and many of them congratulated her.

"I feel really proud of the decision that I made," she says. She'll likely have some questions to answer when her sons get older, about why she chose to circumcise one and not the other. She says it's important that both her husband, who is circumcised, and her oldest son know there isn't anything wrong with their penises.

A Mother's Choice

Lillian Cannon isn't a doctor, a nurse, or a psychologist. Much like Rice, she's a stay-at-home mom with a 10-year-old son. It was her pregnancy with her oldest boy that led her to explore reasons for circumcision. On a quest for information about the procedure, she fell down an Internet rabbit hole and stumbled across the image of an infant being circumcised.

"You couldn't see any blood, the body was covered up with a robe, but you can see that baby screaming in pain," she says. That image convinced her she wouldn't be circumcising her son, but she needed to convince her circumcised husband that the surgery wasn't necessary, an uphill battle for many women who don't want to circumcise their sons. So she gathered up some literature and left it in the bathroom for her husband to peruse at his leisure.

"A couple months later, he came out and said, 'We don't have to do it.'" she says. "Since then, he's become vehemently against it."

Not all women find it so easy to sway their mate. Cannon says many men need to feel that what was done to them as infants must be justifiable in some way, so they can have a hard time seeing why the procedure is pointless.

But what makes Cannon an expert? Well, since her son was born and left uncircumcised, Cannon has continued to educate herself. She followed Dr. Darcia Narvaez, a professor of psychology at Notre Dame and executive editor of the Journal of Moral Education, and when Narvaez came under fire for a post on circumcision, Cannon volunteered some of her own findings to be published on PsychologyToday.com. You can read her work on the website, where it's published under Dr. Narvaez's blog.

Cannon represents a growing number of parents who are educating themselves rather than waiting for information from their doctors. Oftentimes, parents now are more informed about how to care for an uncircumcised child than the health care provider is, a total reverse from decades past.

Marilyn Milos is the mother of three sons, all of whom are circumcised. She went to nursing school when her boys were older, only to experience the traumatic effects of the procedure first-hand.

"My doctor had told me that there was no pain for the baby, that it only took a minute, and that it would be helpful to the baby," she says.

But during clinicals, she was exposed to an infant circumcision first-hand. She says the baby was strapped down to a table, fighting against its bonds like any adult would, and screaming in protest. She attempted to soothe the baby, letting it suck on her finger, stroking his head, and speaking gently. She says the baby settled down, until the doctor performed the circumcision without anesthetic. After that, there was no calming the child.

"The doctor looked at me and said, 'There is no medical reason for doing this,'" Milos says.

Shortly after, in 1986, she founded NoCirc and since then she's spent her time as a nurse refuting claims made by doctors, health organizations, and circumcision proponents. When she speaks, it's with passion and intensity.

"It's a hoax," she says of the WHO's studies. "They'll never end circumcision here because doctors love money too much."

Norm Cohen, head of NoCirc Michigan, hopes that as Medicaid slowly stops paying for the procedure in order to curb budgets and save money, rates will drop dramatically. He feels that when uninformed, uneducated, poor mothers are presented with the idea that the surgery is free and will help the child, they're much more likely to have it done to their sons. As soon as they're told they'll be paying for the procedure, then they start doing some research.

It's a worthy point, considering how rates are dramatically dropping out west, a region where many states have stopped paying for circumcision through Medicaid in order to help curb costs.

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