Circumcision became widespread in the United States for reasons that had little to do with religion or modern medicine. What started as a Victorian-era effort to curb masturbation evolved into a hospital routine so deeply embedded in American culture that, even today, about half of newborn boys are circumcised before leaving the hospital. At its peak in the 1960s, roughly 83% of American boys were circumcised. No other wealthy Western nation comes close: the U.S. rate of 71.2% among all living males dwarfs rates in the U.K. (20.7%), Canada (31.9%), Australia (26.6%), and most of Europe, where rates sit in the single digits.
Victorian Origins and Dr. Lewis Sayre
The story begins in 19th-century Britain, where the medical establishment believed masturbation caused blindness, mental illness, and a range of other ailments. Circumcision was promoted as a way to reduce sexual sensation and enforce chastity. Doctors even invented a diagnosis, “spermatorrhoea,” for men who emitted semen outside of marital intercourse. As Australian historian Robert Darby has written, “The deepest origins of routine circumcision lie in the extraordinary mental gymnastics by which normal male sexuality was categorized as a life-threatening disease.”
In the United States, the practice gained real traction through the work of Dr. Lewis Sayre, a prominent orthopedic surgeon in the late 1800s. Sayre claimed circumcision could cure paralysis and a host of other conditions. His influence helped establish the procedure as a standard part of newborn care in American hospitals, and by the early 20th century it had spread from the upper classes to the general population. Britain followed a similar path for a time: in the first half of the 1900s, 84% of boys from elite British boarding schools had been circumcised. But the two countries diverged sharply after World War II. Britain’s National Health Service, established in 1948, declined to cover routine circumcision, and rates plummeted. In the U.S., where private insurance and later Medicaid continued to pay for the procedure, the practice kept climbing.
How It Became a Hospital Default
By midcentury, circumcision in America had shed its anti-masturbation rationale and taken on a new medical veneer: hygiene, disease prevention, and conformity. Hospitals offered the procedure as part of the standard postnatal package, and most parents simply agreed without much deliberation. The procedure peaked around 1981, when 64.9% of newborns were circumcised during their birth hospitalization, according to CDC data. In the Midwest, rates climbed as high as 82.9% in 1998.
This normalization created a self-reinforcing cycle. Because most American men were circumcised, parents expected their sons to match. Research on parental decision-making confirms this: cultural and personal beliefs play an equal or greater role than medical information. Parents who chose circumcision were more likely to believe that fathers should “look like” their sons, that circumcised penises look better, and that the procedure helps with cleanliness. These beliefs clustered together in studies, forming a single cultural factor that predicted the decision more reliably than any medical argument.
The Medical Case: Real but Modest
Circumcision does carry genuine health benefits, which has helped sustain its popularity. Three large randomized trials found that circumcision reduces a man’s risk of acquiring HIV through heterosexual sex by 53% to 60%. It also lowers the risk of urinary tract infections in the first year of life and reduces transmission of several other sexually transmitted infections. Some evidence suggests a protective effect against penile cancer and HPV, though not all studies agree.
The American Academy of Pediatrics reviewed the literature through 2010 and concluded that “the health benefits of newborn male circumcision outweigh the risks.” Complications are infrequent and mostly minor when the procedure is performed by trained professionals with appropriate pain management. But the AAP stopped short of recommending circumcision for every newborn, stating that the benefits “are not great enough to recommend routine circumcision for all male newborns.” Instead, the organization said families should have access to the procedure and that insurers should cover it for those who choose it.
This measured position is worth noting because it distinguishes the U.S. from other English-speaking countries. Medical associations in Britain, Australia, and Canada have generally taken a more skeptical stance, concluding that the benefits don’t justify routine recommendation. The American medical establishment’s relatively favorable framing has helped keep the practice mainstream.
Insurance and Medicaid Shape the Map
Money plays a surprisingly large role in who gets circumcised. When states drop Medicaid coverage for the procedure, circumcision rates among Medicaid beneficiaries fall by an average of 21.4 percentage points. Among families with private insurance in those same states, rates drop only 3.2 points. A 2004 cross-sectional study found that hospitals in states covering circumcision through Medicaid had a 24% higher circumcision rate than hospitals in states that didn’t.
This financial dimension helps explain the sharp regional and racial disparities in the data. In the Western U.S., where several states stopped covering circumcision through Medicaid and where larger immigrant populations from non-circumcising cultures settled, the rate dropped 37% between 1979 and 2010, falling from 63.9% to 40.2%. The Midwest, by contrast, maintained rates above 68% throughout the same period. Hispanic newborns are circumcised at a rate of about 21%, far below the roughly 60% to 66% rates for white and Black newborns.
Religion Plays a Smaller Role Than You’d Think
Judaism and Islam both prescribe circumcision, and it’s natural to assume religion drives American rates. But Jewish Americans make up roughly 2% of the U.S. population, and Muslim Americans about 1%. Even if every boy in those communities were circumcised, religious obligation would account for only a small fraction of the national total. The vast majority of American circumcisions happen in secular, non-religious hospital settings where the decision is driven by cultural expectation, parental preference, and the convenience of a procedure offered right after birth.
A Slow Decline Is Underway
American circumcision rates have been falling for decades, though the trend is gradual and uneven. Nationally, the newborn circumcision rate dropped from 64.5% in 1979 to 58.3% in 2010. More recent data from a Johns Hopkins study of over 1.5 million hospitalizations found a further decline from 54.1% in 2012 to 49.3% in 2022, marking the first time the rate dipped below 50%.
The decline is concentrated among certain groups. White newborns saw circumcision rates fall from 65.3% to 60.0% over that decade. Rates among Black newborns held steady near 65%, while Hispanic rates remained flat around 21%. Asian and Pacific Islander rates dropped modestly, from 39.7% to 37.5%.
Several forces are pushing rates down. Growing immigration from Latin America and Asia has brought families from cultures where circumcision isn’t routine. The internet has made information about the procedure’s risks and contested benefits more accessible. And as fewer boys are circumcised, the “looking like dad” argument loses some of its force for the next generation of parents. The Midwest still circumcises at the highest rate in the country, while the West has become the region least likely to perform the procedure, with rates that dipped as low as 31.4% in 2003.