In North American medicine, the trend is to offer circumcision only as an elective procedure, rather than a standard practice as was the tradition. The primary debates revolve around issues of cleanliness, health benefits, social inclusion, infliction of pain on infants, mutilation, and cultural or religious identity. The widespread continued support for male circumcision in the United States relies on the potential health benefits of the surgery. The stance of the American Academy of Pediatrics is to give parents information about the advantages and disadvantages so that they may make an informed decision (1999). The traditional medical benefits are not as significant as physicians once thought, although well-documented studies do show some prophylactic benefit from the procedure. In the face of a decline in circumcisions, a greater emphasis is being placed on good hygiene for those who are uncircumcised.
A debate continues concerning whether routine circumcision is cost-effective. To achieve a statistically significant drop in cases of urinary tract infection or penile cancer, a large number of males must be circumcised; the rates of both diseases are low. For instance, the rate of penile cancer increases from 0.00001 percent to 0.00009 percent for uncircumcised males (American Academy of Pediatrics 1999). Although this is a statistically significant increase, penile cancer is still rare in the uncircumcised population. The percentage of risk as well as the actual rarity of occurrence should be weighed when evaluating the importance of the procedure.
The final issues center on a worldview of fundamental rights, a natural state as good, and social inclusion. Anticircumcision groups use the descriptors of mutilation and amputation for male circumcision. They label it as abuse. The language invokes rights and autonomy, as well as the constitution of a valued body. Using this language, the unaltered and natural state is the one that should be highly prized, and circumcision moves the male away from that. Further, the child has a right to make decisions about long-term health care. By performing the operation before the child reaches an age of assent or consent, we remove this possibility.
The flip side to this debate is that parents have the right to decide what is best for their children. Even if the health benefits may be slight, religious ceremony and social inclusion weigh importantly when the risks are relatively low. Also, geriatric health care issues arise when considering the implications of keeping the penis clean for an uncircumcised elderly male who can no longer carry out basic self-cleaning tasks (Frank et al. 2000).