Circumcision rates: averages which deceive

By Razib Khan | July 30, 2013 2:40 am

Update 2: No longer accepting comments on this post. Please stop submitting. Thanks.

Update: Due to the vociferous and emotive nature of many comments, I am not publishing over half submitted on this post. Just so you know your chances…

One thing that I have read repeatedly is that circumcision rates in the United States have fallen over the past generation. For non-Americans in the readership, yes, American males are customarily circumcised even if they are not from a religious or cultural tradition where this is the norm (i.e., they are not Muslim, Jewish, or East or West African). For Americans, yes, circumcision has nothing to do with Christianity (something that would be obvious if more Americans actually read the New Testament, instead of just quoting selective passages from it). But looking more closely at the data it seems that the decline in circumcision is predominantly a function of its collapse as a normative practice in the western states!

One might think that this is due to demographic changes in the West, as Hispanics have lower rates of circumcision than non-Hispanics (black or white). But while California had circumcision rates of 22% in 2009, Washington state’s was 15%. It seems that Medicaid coverage has a strong effect, but this can’t explain all of the variation. In the late 1970s the western states had the same circumcision rates as the northeastern states. Today northeastern states have circumcision rates two to three times higher than in the west. And it doesn’t map onto politics either. Extremely conservative (and western) Utah has circumcision rates of 42%. Blue Rhode Island has rates of 76%.

Finally, I want to observe here that the males who were born during the era of diverging circumcision rates are now entering sexual maturity en masse. This is going to shape the expectations of both sexes, and perhaps result in some surprises for those who relocate to the other coast as they transition to adulthood….

MORE ABOUT: Circumcision
  • Robert Ford

    I have nothing to add other than that is really weird to me. I never would’ve guessed states differed that much.

  • Melissa

    An acquaintance of mine here in Chicago who was born in Washington and has lived in the Midwest for much of his adolescence and adult life told me he had his newborn son circumcised reluctantly because of discrimination he faced as an uncut man in the Midwest. Doesn’t surprise me. When I hear women talking about it in Chicago it’s almost always about how “gross” it is and they seem pretty ignorant about it. Based on the stuff they say it’s amazing anyone in Europe ever has sex because they must smell so bad, etc.

    • Rebecca Fine

      European women are free to prefer uncircumcised men, and American women are free to prefer circumcised men. There are different cultural preferences involved. There’s not necessarily a right or a wrong. The circumcised penis IS cleaner and more attractive in some ways, that’s why many women prefer it. Let’s not try to pretend otherwise.

      • razibkhan

        and more attractive in some ways, that’s why many women prefer it. Let’s not try to pretend otherwise.

        this sort of assertion of a subjective opinion as objective fact is going to result in angry follow up comments. thanks for that.

        • AG

          That is exactly mentioned in my above comment. Most people judge thing from their own perspective while refusing to understand or see from different perspective.
          Quite a lot of human conflicts are due to such cultural encapsulation.

      • Melissa

        Either can be the same amount of clean if they are cleaned, which I guess is an issue in pockets of American culture where being uncut is uncommon and men might not know how to clean themselves properly. It really shouldn’t be an issue if a man keeps himself clean.

      • LA

        I bet you (and most women) would be prettier down there with some of those meat flaps cut off. Maybe I should do that to my daughter! Enough parents start doing it, and in a few decades, men will start preferring it!

        • Sandgroper

          In the West, cosmetic surgery on female genitalia to make them more ‘neat’ has definitely become an issue, reportedly because men prefer it.

          I don’t know about that – the only thought I have is that it might make riding a bicycle more comfortable, but if I was a girl I think I’d want to experiment with seat width and configuration, riding angle and height above the pedals quite a bit before contemplating surgery on a very sensitive and private part of my anatomy. If the bike doesn’t fit right, it’s the wrong bike, not because your anatomy needs surgical ‘correction’.

  • AG

    Well, you can see how powerful brainwash can do for your judgement if you do not have analytic mind.
    Circumcision like foot binding or tatoo or body piecing can viewed as beauty or disgusting body disfigurement, depending on brainwashing effect.
    Also smell of parmigiano cheese is the same as human vomit in smell test. Like it or hate it depending on suggestion what you are smelling.

  • Gianluca Interlandi

    That a circumcised penis is cleaner than an intact one is just a myth. The foreskin has a self-cleaning mechanism. It contains muscles that contract the foreskin and expel anything that gets into the foreskin. An intact penis is more hygienic and cleaner that a cut one. A circumcised penis is always in contact with underwear and any dirt, sweat or urine trapped in there. If you are concerned about hygiene you should not circumcise. Americans circumcise out of ignorance, shallowness and gullibility.

  • Roger

    First, I am not a doctor. My opinion is based only on my own experience, and my opinion is that removing the foreskin is just good preventive medicine.
    My first son was born in the mid 1980’s in Vermont. My wife had a female ob-gyn and we had female teachers for all the birthing classes we went to before my son was born. They were unanimous in their opinion that circumcision was cosmetic only and there was no medical reason to perform one. They were very strongly anti-circumcision. So we did not have our first son circumcised.

    While he was still an infant, he started developing some problems around the tip and our mail pediatrician said that his penis needed better cleaning at bath time and showed my wife how to do it. During a bath the foreskin apparently was retracted a little too far and became tight around the tip of the penis. I got a frantic phone call at work from my wife while my baby was screaming in the background.

    I met her at the pediatrician’s office where he thought it was a simple problem he could fix until he saw it. My infant son’s penis was swollen and purple. The doctor and I both jumped back at the site of it. He sent us directly to the emergency room and told me “It’s still warm, I don’t think he’ll lose it”. LOSE IT????!!!!!

    My son had an emergency circumcision and was fine. The biggest concern of the surgeon was that he had already eaten and if he had a reaction to the anesthetic, food in his stomach could be a problem.

    Later, the urologist told me that he often saw problems in uncircumcised males that required emergency circumcisions. Sometimes when they were much older, almost adults. His opinion was that circumcisions should be done normally to prevent the possibility of problems later on.

    The problem seemed to me to be that circumcision was something typically done by the ob-gyn, and the female ob-gyn doctors were reluctant to do it right after birth because it was done without anesthetic. They never saw the emergency problems that can happen later. The urologists see those.

    When we had my second son and the birthing class teachers and doctors began telling people not to have their sons circumcised I would stand up and tell them what happened in no uncertain terms. If the rate of circumcision is much higher in the northeast U.S., I may be a small part of the reason.

    Some pain for your infant, that they won’t even remember later, can prevent much more serious problems in the future. How likely are those problems? I don’t know, but in my opinion keeping the foreskin is not worth the risk.

    • John Aguirre

      OK, to be fair here, you were given some very incorrect information on how to properly wash your son. A foreskin should never ever be forcibly retracted before it does so on its own. Children’s foreskins are physically attached to the glans and retracting it can cause damage. In time, they retract on their own. If nothing is forced, then there is little that can go wrong. Arguing that circumcisions must be done in order to prevent injury from incorrect care is like arguing that pinky toes should be removed because it hurts when you stub them.

  • disqus_BNbEfrPmXP

    Circumcision should be a personal choice when the person is
    old enough to decide for themselves. I was circumcised as a infant and wish I
    wasn’t. Just let it be your son’s decision.

    • razibkhan

      fwiw, that’s my position, since it is not easy to reverse.

  • Rebecca Fine

    A valid point. The decrease in the national circumcision rate comes predominantly from the low rates in the West. In the Midwest, South and Northeast, they remain very high, and the majority of boys continue to be circumcised in most states. Thus circumcision for boys remains the normative practice in most states and will continue to be a common practice for many years to come.

    • Gianluca Interlandi

      My previous response to this seems to have not passed moderation :( Briefly, I believe that Americans should be smarter than that. And Americans have been able to change things that needed to be changed. For example, here in Seattle there is a strong green movement towards environmental awareness. Once people will more openly talk about circumcision, things will change.

  • Rebecca Fine

    I think you misunderstood the point of the article. What Khan is saying is that circumcision remains the norm for boys in most parts of the U.S. and that the practice has not become much less common except in the Western states.

    • razibkhan


      • Rebecca Fine

        The other key point I would mention is the most recent AAP report on the issue. A year ago the new 2012 policy statement from the AAP stated that the benefits of male circumcision outweigh the risks. Perhaps a reference to it above or a link could provide further information.

  • Rebecca Fine

    The new 2012 American Academy of Pediatrics statement said that it is up to parents to decide whether their boys should be circumcised.

    • Hugh7

      The AAP may say that, but more and more unhappily circumcise men disagree with it.

    • LA

      For years, Egyptian doctors believed parents should decide what to do with their daughters’ clitorises. Your thoughts on that, Rebecca?

  • cbjones06

    1. …there are data in the scientific mainstream demonstrating that HIV infection is more likely when a male is uncircumcised…
    2. …i’m not certain that #1 can be generalized to all parasites in all men…
    3. …as a female, I prefer a partner who is circumcised…primarily, but, not exclusively, for aesthetic reasons…granted, this is a learned response…
    4. …re: permitting the male to decide for himself when older, circumcision is a very unpleasant operation that most males would not want to endure…

    • razibkhan

      it’s commonly endured in many cultures. have you studied this to make that assertion, or is that your intuition?

    • Gianluca Interlandi

      I find #3 and #4 insulting to manhood. Just because you have a preference it does not mean that it has to be enforced onto infants.

    • Gianluca Interlandi

      I will try again: the evidence that circumcision reduces the risk of HIV infection or other STDs has been deemed too weak, at least in a “Western context” by a recent review co-authored by European, Canadian and Australian pediatrics. Search for “cultural bias circumcision” on pubmed if interested.

  • razibkhan

    But I don’t see how choosing your partner based on their genitals can lead to a lasting relationship.

    to be fair i long ago eliminated ~50 percent of the human population based on their genital state.

    • Sandgroper


  • Melissa

    I wonder if it becomes a problem in a culture where it’s uncommon because maybe mothers and fathers, who might be cut, don’t know how to educate their sons about washing properly.

  • lemmycaution

    This is super interesting. I live in CA and none of my boys got circumcised. I thought this was a national trend.

  • Neuroconservative

    According to the chart you linked, South Carolina is 81% circ but North Carolina is only 52% — what could explain that discrepancy? If correct, that is fascinating.
    There is clearly some correlation with Hispanic demography (e.g., West Virginia has lowest Hisp rate and highest circ rate), but so many other factors are clearly at work. Western states are considered to be more libertarian, and I suspect there is some correlation with attitudes on marijuana and euthanasia, for which Washington state is at the forefront.

  • Neuroconservative

    On a separate note: Many people argue in favor of leaving the choice to the individual once he becomes an adult. But the effects of brain plasticity in neurodevelopment is rarely considered in this line of argument. Thus, it is often argued that the foreskin contains X number of nerve endings that are lost. But this is only directly relevant in the case of adult circumcision, which I would imagine would be a big loss of sensation. However, in the case of infant circumcision, it is likely that the potential sensory pathways are remapped to remaining tissue (ie, the glans). This hypothesis is difficult to test, but consistent with other things we know about neurodevelopment. If true, this would constitute an argument against adult circ.

    • prometheus

      Your argument assumes the premise that circumcision must necessarily be done as an adult if not as a child. That’s clearly not the case when over 80% of the world’s males never choose to be circumcised. As you say, sensitivity loss is extremely hard to measure, but that is only tangential to the main issue. It is clearly unethical to cut off a healthy body part from someone without their express consent. There’s no good reason not to simply postpone the “decision” until the child is an adult.

      • Neuroconservative

        1) My argument does not assume that premise. You need to work on your reading skills.
        2) “It is clearly unethical…” “There’s no good reason…” – Really? Glad you cleared that up. I guess when you are so certain of your own positions, it is not necessary to be able to read and accurately interpret someone else’s argument.

  • TLCTugger

    Circumcision alters sex dramatically. His body, his decision.

    Most of the world (95% of non-Muslims) does not circumcise.

  • Robert Ford
  • Barefoot Intactivist

    Extend the data past 1999 and you will see declines in all regions. Your data is almost 15 years old!


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About Razib Khan

I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. In relation to nationality I'm a American Northwesterner, in politics I'm a reactionary, and as for religion I have none (I'm an atheist). If you want to know more, see the links at


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