5 Things You Didn't Know About Circumcision

A new policy statement from the American Academy of Pediatrics (AAP) is likely to throw fuel on the fiery controversy surrounding male infant circumcision.

The AAP's statement touts the medical benefits of circumcision while stopping short of recommending the procedure, which opponents decry as painful and unnecessary. For instance, new research has found that circumcision lowers the risk of acquiring sexually transmitted infections, including HIV, genital herpes, human papillomavirus and syphilis.

Circumcision seems to be on the decline in the United States (a 2005 Agency for Healthcare Research and Quality study put the rate at about 56 percent), but the practice has long religious and cultural roots. Here are five circumcision facts that may come as a surprise.

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1. It was once touted as a cure for paralysis

In the late 1800s, doctors turned to circumcision to "cure" an array of ailments, from childhood fevers to brass poisoning to paralysis. This era was a boom time for genital surgery — women were losing their ovaries to the knife in the name of curing hysteria — but it was an 1870 case that shone the spotlight on circumcision.

Writing in the journal Transactions of the American Medical Association, Lewis Sayre, a professor of orthopedic surgery at Bellevue Hospital Medical College, told the tale of being called to the bedside of a 5-year-old boy whose knees were flexed and paralyzed, preventing him from walking.

During his examination, Sayre discovered that the boy's foreskin had contracted, causing the child great pain. Speculating that the foreskin problem could be the source of the boy's "physical prostration and nervous exhaustion," Sayre conducted a circumcision the next day. In less than two weeks, Sayre reported, the boy was walking again.

Whatever the cause of the boy's paralysis and miraculous cure, the foreskin can occasionally become trapped over the head of the penis, a condition called phimosis. Modern cures include circumcision, manual stretching of the foreskin, or preputioplasty, an operation to widen the foreskin. [Macho Man: 10 Wild Facts About His Body]

2. The foreskin is more complex than you might think

The foreskin isn't just skin. Think of it as more like an eyelid for male genitals. On the inside, the foreskin is made up of mucous membrane, analogous to the inside of the eyelid or the inside of the mouth. It's this moist environment that seems to be responsible for the foreskin's association with sexually transmitted infections. The foreskin also contains a large number of Langerhans cells, a type of immune cell targeted by HIV infection.

Women have a foreskin equivalent, too: the clitoral hood, which protects the clitoris much as the foreskin covers the glans. The foreskin and the clitoral hood, known in gender-neutral terms as the prepuce, evolve from the same tissue in the womb. [10 Odd Facts About the Female Body]

3. The first-recorded circumcision happened in Egypt

As far as we know from the historical record, the land of the pharaohs pioneered circumcision. The earliest reference to the procedure dates back to around 2400 B.C. A bas-relief in the ancient burial ground of Saqqara depicts a series of medical scenes, including a flint-knife circumcision and a surgeon explaining, "The ointment is to make it acceptable," likely referring to some form of topical anaseptic.

Ancient Egyptian circumcisions were not done in infancy, but instead marked the transition from boyhood to adulthood. The Greeks saw their Mediterranean neighbors' tradition as rather bizarre. In the fifth century, Herodotus made his opinion known in his work "The History of Herodotus."

"They practice circumcision for the sake of cleanliness," he wrote of the Egyptians, "considering it better to be cleanly than comely."

4. It may have caught on as a status symbol

An increase in hospital births and a perception of circumcision as promoting cleanliness certainly contributed to the rise of the procedure in the United States. But the procedure may have been a status symbol as well.

Writing in the University of Cincinnati Law Review in 2003, Seton Hall University law professor Sarah Waldeck points out that Sayre and his circumcision-promoting colleagues came onto the scene just as hospital births were becoming more common. The wealthy were more likely to go to the hospital and have a physician-attended birth; thus, circumcision became a marker of class. The need to circumcise essentially became a social norm, Waldeck writes. It was what "good" parents chose. As more and more parents made the choice, it became odder and odder not to, which then put more pressure on parents to choose circumcision so their child would be "normal."

5. Circumcisions leave unique marks           

Most circumcisions in the United States are done with one of three devices: the Mogen Clamp, the Plastibell and the Gomco clamp. The Mogen clamp is a scissorlike device consisting of two flat blades used that are clamped over the foreskin, cutting off blood flow. A scalpel is then used to slice away the tip of the foreskin.

The Plastibell is a plastic device that is placed over the head of the penis, under the foreskin. The doctor or nurse then ties a string around the foreskin, cutting off circulation. The string may be used as a guide for the surgical removal of the foreskin, or the Plastibell may be left on for a week or so, after which the dead foreskin will fall off on its own.

The Gomco clamp is also inserted between the head of the penis and the foreskin. Again, the surgeon clamps the device over the foreskin, cutting off circulation. After about five minutes, the blood around the clamp will begin to clot, and the surgeon uses a scalpel to cut away the foreskin. This method sometimes leaves a distinctive light brown scar on the head of the penis.

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