Like everything else in science and medicine, there is modern controversy about circumcision. In the United States the rate of circumcision is around 81%.

A paper in Mayo Clinic Proceedings finds that the benefits of infant male circumcision to health exceed the risks by over 100 to 1. Brian Morris, Professor Emeritus in the School of Medical Sciences at the University of Sydney and his colleagues in Florida and Minnesota found that over their lifetime half of uncircumcised males will contract an adverse medical condition caused by their foreskin. The findings add considerable weight to the latest American Academy of Pediatrics policy that supports education and access for infant male circumcision.

In infancy the strongest immediate benefit is protection against urinary tract infections (UTIs) that can damage the kidney in half of babies who get a UTI. Morris and co-investigator Tom Wiswell, MD, Center for Neonatal Care, Orlando, showed last year that over the lifetime UTIs affect 1 in 3 uncircumcised males. In a systematic review, Morris, with John Krieger, MD, Department of Urology, University of Washington, Seattle, showed that there is no adverse effect of circumcision on sexual function, sensitivity, or pleasure, which dispelled one myth perpetuated by opponents of the procedure.

Whereas circumcision rates have risen in white men to 91%, in black men to 76%, and in Hispanic men to 44%, the study authors found an alarming decrease in infants. To get the true figures they had to correct hospital discharge data for underreporting. This showed that circumcision had declined from a high of 83% in the 1960s to 77% today.

There seemed to be two major reasons for the fall.

• One is a result of demographic changes, with the rise in the Hispanic population. Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys.

• The other is the current absence of Medicaid coverage for the poor in 18 US states. In those states circumcision is 24% lower.

Professor Morris stated, "The new findings now show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child's health at risk and will usually mean it will never happen."

Taken together, the new findings should send a strong message to medical practitioners, professional bodies, educators, policy makers, governments, and insurers to promote this safe, simple procedure, best done in infancy under local anesthesia and to increase access and third party coverage, especially for poor families, who tend to suffer most from foreskin-related diseases. Infant circumcision has, moreover, been shown to be cost saving.