by Hugh O'Donnell, April 2001

America began the 20th century as the land of promise:

Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me.

and ended it as an economic powerhouse, creating unimaginable wealth for a few and sybaritic affluence for a great many.

It was a century of extraordinary progress for America and the world, driven by astonishing American scientific and technological achievements, including the harnessing of the power of the atom, and sending Earthlings to the Moon.

For all that, America's greatest achievement in the 20th century -- the one that benefited mankind the most -- was to defeat an ideology that threatened to engulf and enslave the world.

Despite these great achievements, America's record was imperfect. Nor should one seek perfection; perfection is akin to sterility. However, that does not preclude striving to eradicate the most egregious of blemishes. And one of the most egregious blemishes on America's record in the 20th century was its embrace and integration into its culture of the practice of male genital mutilation; moreover, the most meaningless and useless and indefensible form of that practice.

Male genital mutilation has been practised by many unrelated cultures over many thousands of years, so it was by no means a novel idea for America to adopt it. However, it was certainly an incongruous development. America was clearly the world's leader in science in the 20th century. Mutilation of the genitals, male or female, is always rooted in superstitious beliefs. Superstition is the antithesis of science. America's embrace of circumcision represents a triumph for superstition over science.

America cherishes the rights of individual citizens perhaps more than any other nation on Earth. Removing any part of a newborn's body (or the body of a child of any age) without compelling medical justification is a clear and gross breach of that individual's rights. It is extraordinary that America, while bearing the torch of freedom for the world, while ensuring the survival of human rights in the world, should turn a blind eye to this crime.

During 20th century, more than 120 million foreskins were severed from American penises, more than in any other country in the world. At the height of the circumcision frenzy, a foreskin was being sundered, and a penis crippled, every 17 seconds. Whatever other name one might give the 20th century in respect of America, the appellation "The Circumcision Century" is particularly fitting. Although male circumcision was not made compulsory by law, parents who wanted their sons to grow up complete were browbeaten until they relented and gave their sons up for mutilation, and doctors hunted down and amputated surviving foreskins with demonic determination. The history of newborn circumcision in America is quite well documented; while the equally unsavoury history of later circumcision has received much less attention.

One the eve of Genital Integrity Awareness Week 2001, it is appropriate to reflect on the experience of the century recently ended and to look at what the new century might bring.

On the ABC's Good Morning America program on March 12, 2001, Charles Gibson remarked, "It may be surprising to learn that 60% of men in America have been circumcised!"

It is difficult to interpret this remark. On the surface, it appears to mean that it may be surprising to learn that such a high percentage of men have been circumcised because, had Gibson intended to convey that the figure was surprisingly low, it is likely that he would have inserted the word "only". However, since "almost everyone" knows that "almost everyone" (and certainly every "real" American male) gets circumcised routinely, it is likely that the reaction of many viewers was, "What!!!??? You mean to say that 40% of men in America have NOT been circumcised??!!"

Where Gibson obtained his figure from is unknown, but it is more than likely that he simply confused the newborn circumcision rate with the completely different statistic of what percentage of living males have been circumcised. And the two figures /are/ completely different; for example, the newborn circumcision rate in Australia is about 10%, but close to 50% of all living males in Australia have been circumcised.

The question as to what percentage of living males in the US have been circumcised is an interesting one which is answered in the analysis below, using data in Wallerstein's book, Circumcision: An American Health Fallacy (New York 1981). The data are included in the Appendix to this essay.

Wallerstein himself states that, "If anything, [the data] errs on the side of caution, using lower percentages." Indeed it is much easier to make a case that the newborn circumcision rates presented by Wallerstein underestimate the true rates than that they overestimate them. With that in mind, the results below may also be underestimates.

Table 1:  Intact and Circumcised Male Populations of the USA by Year, 1900 to 2000

Sources: Population data:  U.S. Bureau of the Census;  Circumcision data:  Wallerstein

Notes

1. 70% of the current male population of the US have been circumcised.

2. 110 of the 166 million males (66%) born during the century underwent circumcision in the newborn period.

3. The annual number of circumcisions was highest between 1955 and 1965. During that decade, 1.8 million males were circumcised every year -- almost 5,000 every day.

4. Between 1915 and 1995 the intact male population remained in a very narrow band between 36 and 38 million, while the circumcised male population soared from 12 million to 90 million.

5. A male born during the century who remained intact in the newborn period had on average about a one in five chance of being circumcised after the newborn period, or a four in five probability of dying intact. That probability fell steadily during the course of the century so that, if the current post-newborn circumcision rate remains constant in the future, a male born at the end of the century who escaped circumcision in the newborn period nevertheless has less than a two in three chance of dying intact.

6. The model used to produce these figures takes into account non-newborn circumcision rates, the rate of immigration and the circumcision status of immigrants, and the circumcision status of deaths and emigrants, all important factors in arriving at the percentage of living males who have been circumcised.

Table 2: Number and Percentage of Living Males in USA in 2000 who have been Circumcised, by Age and Place of Birth

	Native Born					Foreign Born					Total
Age	Pop (x1,000)	NC (%)	LC (%)	Circ'd (%)	Circ'd (x1,000)	Pop (x1,000)	AC (%)	PC (%)	Circ'd (%)	Circ'd (x1,000)	Pop (x1,000)	Circ'd (x1,000)	Circ'd (%)
0- 4	9,600	63	1	64	6,100	82	5	1	6	5	9,683	6,105	63
5- 9	9,975	68	1	69	6,915	233	15	2	17	39	10,208	6,954	68
10-14	9,548	74	2	76	7,225	464	25	3	28	128	10,012	7,354	73
15-19	9,395	80	2	82	7,674	756	25	4	29	216	10,151	7,890	78
20-24	8,176	85	2	87	7,073	1007	20	5	25	249	9,183	7,322	80
25-29	7,881	82	2	84	6,625	1174	15	6	21	246	9,055	6,871	76
30-34	8,316	80	3	83	6,865	1455	15	7	22	317	9,771	7,181	73
35-39	9,676	78	3	81	7,844	1539	15	8	23	347	11,216	8,191	73
40-44	9,677	75	4	79	7,624	1362	15	8	23	316	11,039	7,940	72
45-49	8,405	72	5	77	6,433	1096	15	9	24	262	9,501	6,695	70
50-54	7,129	70	5	75	5,360	869	15	9	24	213	7,998	5,572	70
55-59	5,537	65	6	71	3,953	646	15	10	25	162	6,183	4,115	67
60-64	4,443	60	8	68	3,007	525	15	11	26	134	4,968	3,141	63
65-69	3,926	58	8	66	2,608	410	15	11	26	107	4,337	2,715	63
70-74	3,543	55	9	64	2,282	318	15	12	27	85	3,862	2,367	61
80-84	1,680	50	11	61	1,029	134	15	13	28	37	1,814	1,066	59
85-89	759	42	13	55	421	88	15	13	28	25	847	445	53
90-94	264	35	15	50	133	43	15	14	29	12	307	146	47
95-99	61	30	17	47	29	15	15	14	29	4	76	33	44
100+	8	25	19	44	3	3	15	14	29	1	11	4	40
	120,802	72	4	75	90,955	12,473	16	8	24	2,968	133,279	93,923	70

Sources: Population data:  U.S. Bureau of the Census; Circumcision data:  Wallerstein

Notes

NC = Circumcised in the newborn period (neonatal circumcision)
LC = Circumcised after the newborn period (later circumcision)
AC = Circumcised prior to arrival in the USA
PC = Circumcised after arrival in the USA

1. Table 2 also shows that 70% of the current male population of the US have been circumcised.

2. The figure for every age group below the age of 90 is over 50%. Only the (very small and rapidly diminishing number of) males born before 1910 have a better than even chance of having retained their foreskins.

3. 87% of all 20-24yo males born in US have been circumcised. From the differences in circumcision rates by race, one can infer that over 90% of all 20-24yo white males born in US have been circumcised.

Table 3:  Changes in Male Population by Circumcision Status between 1900 and 2000

Notes

(a) Newborn circumcisions
(b) Immigrants who arrived already having been circumcised
(c) Non-newborn circumcisions

Table 1 showed that the percentage of the male population which has been circumcised has stabilised at 70%. The factors which affect the figure, namely the newborn circumcision rate, the non-newborn circumcision rate, the percentage of immigrant arrivals who have been circumcised, and the percentage of deaths and emigrants who have been circumcised are in balance. This is further illustrated by Table 4.

Table 4:  Estimated Changes in Male Population by Circumcision Status between 2000 and 2001

 

Notes

1. Although the newborn circumcision rate has fallen, this has not resulted so far in a fallen in the percentage of living males who have been circumcised. Indeed, that percentage is at an all time high.

2. The percentage of living males who have been circumcised is a very sticky figure. Even if the newborn circumcision rate were to fall dramatically, it would take many decades for the generations of largely circumcised males to be flushed from the statistics.

If the 20th century was ugly, the 21st century will be uglier still unless Americans wake to the harm they are doing to their kind.

If the population of the US grows in line with projections by the US Census Bureau, and current rates of newborn and non-newborn circumcision do not change, there will be 166 million newborn circumcisions and 40 million non-newborn circumcisions in the US in the 21st century.

It is less upsetting to focus on a brighter scenario; a scenario in which the efforts of those campaigning to bring an end to the stupid, barbaric custom bear fruit.

In this highly optimistic scenario, the newborn circumcision rate begins immediately to fall to a similar level as pertains in almost all the free and prosperous countries in the world, reaching that level within a relatively short time span, while the non-newborn rate falls at the same speed, in tandem with the newborn rate.

Table 5:  Projected Newborn Circumcision Rate and Percentage of Living Males in the USA who have been circumcised, 2000 to 2050

Assumptions:

(1)        US Census Bureau projections of population change
(2)        Newborn circumcision rate declines exponentially from 60% to 10% between 2000 and 2050
(3)        Non-newborn circumcision rate declines exponentially from 6 per 1,000 per annum to 1 per 1,000 per annum between 2000 and 2050

Notes

1. Table 5 shows how slowly the percentage of living males who have been circumcised will decline, even as the newborn circumcision rate plummets. It is really only from 2020 -- when the baby boomers start to get flushed out of the statistics -- that the rate begins to decline significantly. While, in this scenario, the ewborn circumcision rate falls to 50% by 2005 and continues to decline rapidly, it takes until 2043 for the percentage of living males who have been circumcised to fall to 50%.

2. The absolute number of circumcised living males reaches a high water mark of 100,000,000 in 2011 and remains at that level (rounded to the nearest million) until 2025 inclusive. In the same way that all the factors combined to keep the intact population more or less constant during the 20th century, they now all combine to keep the circumcised population constant (while the intact population increases).

Table 6: Projected Changes in U.S. Male Population by Circumcision Status between 2000 and 2050

To some intactivists, the realisation of such numbers would be a dream come true, despite the figures showing 30 million newborn circumcisions and 8 million non-newborn circumcisions;  whereas, to other intactivists, such high numbers would still be anathema. Good. They will continue to fight for the rights of all to a complete body. It should be noted, however, that in this scenario compared with the status quo, 46 million males would have been spared the loss of their foreskins by 2050, and 143 million by 2100.

Appendix: Wallerstein's  data

The analysis in this essay is based on data presented by Wallerstein in Appendix B of his book and elsewhere in his book.

Table B-2:  Estimated Male Circumcision Rates in the United States

Source: Wallerstein, p. 217.

Wallerstein states that, "If anything, [the data] errs on the side of caution, using lower percentages." (p. 216). Wallerstein appears to transfer the figures directly into another table in note 10 of his notes to Chapter 13, viz:

Table B-3: Estimated Pool of Uncircumcised Males in the United States

Wallerstein, p. 244.

Wallerstein neglects to state a year for this calculation, even though that is quite fundamental. One must assume that the figure is as at the time of writing, i.e., circa 1979. Apart from the fact that the figures in the "Estimated % Circumcised" column required some adjustment while being transferred from Table B-2, Wallerstein makes much more serious errors by ignoring the significant effects of non-newborn circumcision and immigration. While the figure he arrives at is very close to the figures in Table 1 (37 million in 1975, 36 million in 1980), that is mere chance. It just so happens that immigration (of mostly intact males) more or less cancels out non-newborn circumcision.

Actually, Wallerstein appears to misunderstand the prevalence of non-newborn circumcision. On p 128 he asks "If an American infant is not circumcised at birth, what are the risks that the surgery will be required later?" After calculating that the annual rate is less than 3 per 1,000, he proceeds to answer his own question thus: "Whether the true figure is 2, 3, or even 6 per 1,000 men, it is obvious that only a tiny fraction of potential patients undergo circumcision after infancy; more than 99% do not."

This is simply untrue. In so saying, Wallerstein appears to make the same error that is commonly made with regard to the probability of getting penile cancer. The annual rate of penile cancer in the US is about 1 in 100,000. Some people mistakenly take this to mean that only one male in 100,000 will get penile cancer in his entire life. This is far from the case. The annual risk is cumulative, so that over a lifetime the probability is about 70 in 100,000 or 1 in 1400. If it were true that penile cancer is extremely rare in males who have been circumcised then, taking into account the percentage of males aged over 60 in the US (when penile cancer strikes), the probability that an intact male in the US will get penile cancer might be as high as 1 in 600.

Returning to the risk of circumcision after infancy, one can make a rough approximation of the lifetime probability by simply multiplying the annual rate, say 3 per 1000, by life expectancy.

Hence: 3 / 1000 * 70 = 0.21, or 21%

Table 1 provides confirmation.  Over the course of the 20th century the population at risk of post-infant circumcision averaged about 36.6 million. There were 11.4 million post-infant circumcisions. If male life expectancy were 100 years, one could calculate the probability of post-infant circumcision simply by dividing the number of circumcisions by the number exposed to risk. However, since male life expectancy over the period was closer to 70 years, one must multiply by 70/100. Hence: 11.4 / 36.6 * 70 / 100 = 0.22, or 22%

The annual current rate is 6 per 1,000. That may sound like a low figure but the truth is: if you are lucky enough to still have your foreskin, you better keep it under lock and key because the forces of darkness are out to take it away from you.