Lewis Albert Sayre was an orthopedic surgeon who practiced medicine in New York City, New York, during the second half of the nineteenth century and held a number of leadership positions in his profession. Over the course of his nearly fifty-year career, Sayre developed a number of surgical and nonsurgical treatments of bone problems including scoliosis and other forms of spinal curvature, club foot, and hip-joint disease resulting from tuberculosis infection. He also helped popularize circumcision, or surgical removal of the foreskin of the penis, as a treatment for a variety of medical conditions, including muscle paralysis and epilepsy, based on the theory, discredited as of 2025, that a chronically irritated foreskin could lead to diseases in other parts of the body. By providing a medical justification for circumcision, Sayre helped to embed the surgical procedure within US medicine, even as the medical rationales for its use would change periodically in the decades that followed.

In 1949, Douglas Gairdner, a pediatrician in Cambridge, England, published “Fate of the Foreskin: A Study of Circumcision,” hereafter, “Fate of the Foreskin,” in the British Medical Journal. In the article, Gairdner highlights what he saw as a seriously understudied topic, the natural development of the foreskin in males. Although physicians were then circumcising tens of thousands of male infants annually in England, data on the normal anatomy and function of the foreskin were scarce. In “Fate of the Foreskin,” Gairdner assembles those data and uses them to argue against performing circumcision to treat conditions like phimosis. Phimosis is when the foreskin tightly encases the glans, or head, of the penis and cannot retract. Gairdner finds that an unretractable foreskin is actually the normal state for newborn males, and that the foreskin will become retractable on its own over a period of months to years. By showing that phimosis is not a pathological condition, “Fate of the Foreskin” questioned the legitimacy of routine circumcision, and ultimately led to a steep decline of the practice in England.

The Gomco circumcision clamp is a metal device that medical practitioners use to perform circumcision, or the removal of the foreskin of the penis. Created in 1934 by Hiram S. Yellen, a physician who studied obstetrics and gynecology, and inventor Aaron A. Goldstein, the Gomco clamp was one of the first and, as of 2025, is the most commonly used circumcision clamp in the United States. To use the Gomco clamp, the medical practitioner first separates the foreskin from the glans, or head, of the penis, then places the foreskin into the clamp. The practitioner tightens the clamp, which crushes a thin, circular ribbon of foreskin, and then cuts off the remaining foreskin above the crushed portion. The Gomco clamp reduces the risk of blood loss, controls the amount of foreskin removed, protects the glans of the penis during circumcision, and allows for a clean surgical cut. By simplifying the surgical procedure of circumcision and reducing the risk of complications, the Gomco clamp helped to institutionalize routine, non-therapeutic infantile circumcision as part of the childbirth process in US hospitals.

Non-therapeutic infant circumcision is the surgical removal of healthy foreskin from a male infant, often shortly after birth, for the purpose of achieving potential future medical benefits. Today, in 2025, the practice is common the United States but not as common in other Western industrialized countries. Though circumcision itself is an ancient cultural practice, doctors began performing circumcision for medical purposes only in the nineteenth century, and primarily in English-speaking countries. Orthopedic surgeon Lewis Sayre, who practiced medicine in New York City, New York, in the late nineteenth century popularized circumcision as a treatment for conditions such as muscle paralysis. Sayre’s ideas eventually fell out of favor, but doctors increasingly identified other reasons to perform the procedure, including the prevention of sexually transmitted diseases, urinary tract infections, and cancer. As of 2025, doctors, parents, ethicists, and others continue to debate the medical value of circumcision as well as the ethics of operating on the healthy genitals of people who cannot consent.