While Europe increasingly questions the practice of circumcising boys, US paediatricians are about to say that the medical case for it is getting stronger. Most US adult men are circumcised, but the number of newborns having the op is falling, and is now below 50% in some states - intensifying the dilemma for parents.
Stephen Box - like most American men - is circumcised.
Seven months ago, as a new father, he had to decide whether to circumcise his newborn son. It was not a straightforward decision.
"I was uncomfortable he would be different from me," he begins.
Stephen Box is part of a generation in the US for whom circumcision was almost universal - so much so that an uncircumcised boy would stand out in the locker room, his most private part an object of curiosity, perhaps even ridicule.
"Little boys can be ruthless on little boys who are different," he says.
But Stephen and his wife decided not to circumcise their son. They felt they could only justify the operation if they could find a good reason for doing it - and they didn't.
"Just because that's the way we were raised, doesn't make it correct," Stephen says.
"There was no strong argument for doing it, and there was room for hesitation.
"It's tools-in-hands on the special part of a little boy."
At the end of June, Germany was shaken by a court ruling that circumcision of minors was harmful, and a violation of a child's rights.
Jews and Muslims were outraged, seeing the ruling as an attack on one of the fundamental parts of their faith.
Editorials and opinion pieces in major US newspapers expressed similar outrage and 20 representatives in Congress wrote a letter to the German ambassador in Washington, expressing "deep concern".
Unlike in Europe - where rates are low, and circumcision is mostly confined to the Jewish and Muslim communities - circumcision is one of the most common operations in the US.
Three-quarters of American adult men are circumcised. There are over one million procedures each year, or around one every 30 seconds.
But rates are falling, as parents - like Stephen Box and his wife - are opting to break with tradition, and alongside this, an increasingly vocal anti-circumcision movement has emerged.
Figures from the Centers for Disease Control and Prevention (CDC) show that 55-57% of newborn boys in the US are now circumcised in hospital, and the numbers are dropping by around 1% each year.
Having your baby boy circumcised was, for many years, the "default position", says Dr Douglas Diekema, professor of paediatrics at the University of Washington.
Circumcision was thought to be as normal as a vaccination. Until the end of the 1970s doctors would say "When would you like your baby circumcised?", now they are more likely to say "Would you like your baby circumcised?" says Diekema.
-BBC