Changes

The '''sexual effects of circumcision''' are now well documented. Studies have been conducted to investigate the effect of [[circumcision ]] ([[amputation]] of the [[foreskin]]) on sexual drive, erectile function, premature and delayed [[ejaculation]], sexual satisfaction, sexual sensation and penile sensitivity. Studies have also assessed whether [[circumcision]] affects [[masturbation]] or other sexual practices, and the degree to which a heterosexual woman's experience of sex is affected by her partner's [[circumcision ]] status. Cold & Taylor (1999) stated:

The [[prepuce ]] is primary, erogenous tissue necessary for normal sexual function.<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref>

Masters & Johnson (1966) in their book, ''Human Sexual Response'',<ref name="masters-johnson1966" /> showed little interest or understanding of the human foreskin. One illustration, labelled normal [[penis]] anatomy, showed a drawing of a [[penis ]] without a [[foreskin]]. A listing of penile pathology in their book included “[[uncircumcised]] penis”[[penis]]”! Their work was done in St. Louis, located in the highly [[circumcised]] Midwest, and almost all of their subjects were [[circumcised]]. Their testing was quite limited. With regard to the [[foreskin]], they said only:

Routine neurologic testing for both exteroceptive and light tactile discrimination were conducted on the ventral and dorsal surfaces of the penile body, with particular attention directed toward the [[glans]].</blockquote>

Routine neurologic testing for both exteroceptive and light tactile discrimination were conducted on the ventral and dorsal surfaces of the penile body, with particular attention directed toward the [[glans]]. No clinically significant difference could be established between the [[circumcised]] and the [[uncircumcised]] [[glans ]] during these examinations.<ref name="masters-johnson1966">{{REFbook

Therefore, it appears that Masters & Johnson (1966) performed little or no testing on the [[foreskin| foreskins ]] of their few [[intact]] subjects and provided no useful information.<ref name="sorrells2007">{{Sorrells etal 2007}}</ref>

There were, however, some other little noticed papers overlooked by Masters & Johnson, that told a different story. Winklemann (1956) investigated the innervation of the [[prepuce ]] and found it to be highly innervated.<ref name="winkleman1956">{{REFjournal

}}</ref> Winkleman (1959) later identified the [[prepuce ]] as "specific erogenous tissue".<ref name="winkleman1959">{{REFjournal |last=Winkelmann |init=RK |title=The erogenous zones: their nerve supply and significance |journal=Proceedings of the Staff Meetings of the Mayo Clinic |volume=34 |issue=2 |pages=39-47 |url=http://www.cirp.org/library/anatomy/winkelmann/ |quote= |pubmedID=13645790 |pubmedCID= |DOI= |date=WinkelmannRK 1959-01 |accessdate=2019-12-21}}</ref>

[[William Keith Campbell Morgan| William Keith C. Morgan]], {{MD}} (1965), a Canadian physician practicing in the [[United States]], had a comment critical of the then American practice of non-therapeutic (routine) [[circumcision]] of infants. With regard to sexual function, he identified the ease of penetration and said:

|author-link=William Keith Campbell Morgan

|author-link=William Keith Campbell Morgan

The sensory pleasure induced by tactile stimulation of the [[foreskin]] is almost totally lost after its surgical removal. The surface of the exposed [[glans]], as we know, has no capacity to receive and transmit any fine sensations of touch, heat, etc. Consequently, the fundamental biological sexual act becomes, for the [[circumcised]] male, simply a satisfaction of an urge and not the refined sensory experience that it was meant to be.<ref name= "falliers1970">{{REFjournal

<!--Only medical trade associations, such as the [[American Academy of Pediatrics]] (AAP), a [[medical trade association]] which represents doctors who profit from carrying out circumcisions, still contend that [[circumcision ]] does not harm sexual function. The American Academy of Pediatrics points to a survey (self-report) finding [[circumcised ]] adult men had less sexual dysfunction and more varied sexual practices, but also noted anecdotal reports that penile sensation and sexual satisfaction are decreased for [[circumcised ]] males.<ref name="AAP1999">{{REFjournal

}}</ref> In January 2007, The [[American Academy of Family Physicians]] (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a [[circumcised ]] [[glans ]] becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a [[circumcised ]] [[penis ]] is less sensitive. [...] No valid evidence to date, however, supports the notion that being [[circumcised]] affects sexual sensation or satisfaction."<ref name="AAFP2007"/> Conversely, a 2002 review by Boyle et al. stated that "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to [[circumcision]], with an inevitable reduction in sexual sensation experienced by circumcised males." They concluded, "intercourse is less satisfying for both partners when the man is [[circumcised]]".<ref>{{BoyleGJ GoldmanR SvobodaJS FernandezE 2002}}</ref>-->

Results of studies of the effect on penile sensitivity have been mixed. In a British study of 150 men [[circumcised ]] as adults for penile problems, Masood et al. (2005) found that 38% reported improved penile sensation (p=0.01), 18% reported worse penile sensation, while the remainder (44%) reported no change.<ref name= "masood2005">{{REFjournal

}}</ref> In a survey of men circumcised as adults for medical (93%) or elective (7%) reasons, Fink et al. (2002) found an association between [[adult circumcision ]] and decreased penile sensitivity that "bordered on statistical significance" (p=0.08).<ref name="fink2002">{{REFjournal

A number of studies have looked at the question of whether sensitivity of the [[glans ]] is affected by [[circumcision]].

Yang et al. (1998) concluded in their study into the innervation of the penile shaft and [[glans penis ]] that: "The distinct pattern of innervation of the glans emphasizes the role of the glans as a sensory structure."<ref name="yang1998">{{REFjournal

Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 [[circumcised]] and 68 [[uncircumcised]], adult male volunteers, They reported "the [the[glans]] glans of the [[uncircumcised]] men had significantly lower mean (sem) pressure thresholds than that of the [[circumcised ]] men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity."<ref name="sorrells2007"/>

=== [[Foreskin sensitivity ]] ===

[[Circumcision ]] removes the [[Ridged band|ridged band]] at the end of the [[foreskin]].<ref name="taylor1996" /> Taylor (1996) observed that the [[ridged band ]] had more [[Meissner's corpuscles]] — a kind of nerve ending that is concentrated in areas of greatest sensitivity — than the areas of the foreskin with smooth mucus membranes and a rich blood supply to serve the neurological tissue. Taylor (2000) postulated that the ridged band is sexually sensitive and plays a role in normal sexual function. He also suggested that the [[gliding action]], possible only when there was enough loose [[shaft skin|skin on the shaft]] of the penis, serves to stimulate the ridged band through contact with the corona of the [[glans penis]] during vaginal intercourse.<ref name="taylor2000">{{REFjournal

[[Morris L. Sorrells | Sorrells]] et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the [[uncircumcised]] penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." According to Sorrells et al., the five penile areas most sensitive to fine-touch are located on the foreskin.<ref name= "sorrells2007" />

In 2009, Schober et al. reported on self-assessed sexual sensitivity in 81 men, 11 of whom were [[uncircumcised]]. When assessing areas producing sexual pleasure, the [[foreskin ]] was ranked 7th, after the [[glans]], lower and upper shaft, and the left and right sides of the [[penis]], but above the area between scrotum and anus, the scrotum itself, and the anus.<ref name= "schober2008">{{REFjournal

Reports detailing the effect of [[circumcision]] on [[erectile dysfunction]] have been mixed. Studies have variously found a statistically significant increase,<ref name=fink2002/><ref name= "shen2004">{{REFjournal

}}</ref><ref name="kimpang2006kimpang2007"/>

Kim & Pang (2007) reported no significant difference in [[erection]].<ref name="kimpang2006kimpang2007">{{REFjournal |last=DaiSik |first=Kim |init=K |last2=Pang |first2=Myung-Geol |init2=MG |title=The effect of male circumcision on sexuality |journal=BJU Int |volume=99 |issue=3 |pages=619-622 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2006.06646.x |quote= |pubmedID=17155977 |pubmedCID= |DOI=10.1111/j.1464-410X.2006.06646.x |date=KimDS PangMG 2007-03 |accessdate=2019-12-19}}</ref>

Waldinger et al. (2005) recruited 500 men (98 [[circumcised]] and 261 not-circumcised) from five countries: the Netherlands, [[United Kingdom]], Spain, Turkey, and the [[United States]] and studied their ejaculation times during [[sexual intercourse]]. They found that the [[circumcised]] men in the study took on average 6.7 minutes to ejaculate, compared with 6.0 minutes for the [[uncircumcised]] men. This difference was not statistically significant. The comparison excluded Turkey, which was significantly different from the other countries studied.<ref name="Waldinger2005">{{REFjournal

}}</ref> Commenting on the study, Sorrells et al. (2007) said "Turkish men, the vast majority of whom are [[circumcised]], had the shortest IELT [Intravaginal ejaculation latency time]."<ref name= "sorrells2007"/>

Collins et al. (2002) conducted a prospective study of 15 [[Adolescent and adult circumcision| adult circumcision]] patients, using the Brief Male Sexual Function Inventory (BMSFI). The authors did not find a statistically significant effect on [[ejaculation ]] scores.<ref name="Collins2002"/>

In a study of 255 [[circumcised]] men and 118 [[intact]] men, Kim & Pang (2006) reported no statistically significant difference in [[ejaculation ]] or ejaculation latency time between [[circumcised ]] and [[intact ]] participants.<ref name="kimpang2006kimpang2007"/>

In a study of men [[circumcised]] for benign disease, Masood et al. (2005) reported that of those who stated they had prior premature ejaculation, 13% reported improvement after [[adult circumcision| circumcision]], 33% reported that it became worse, and 53% reported no change.<ref name="masood2005"/>

In a study of 22 men [[circumcised]] as adults, Cortés-González et al. reported that 31.8% suffered from premature ejaculation before the procedure; this diminished to 13.6% afterwards.<ref>{{REFjournal |last=Cortés-González |first= |init=JR |author-link= |last2=Arratia-Maqueo |first2= |init2=JA |author2-link= |last3=Martínez-Montelongo |first3= |init3=R |author3-link= |last4=Gómez-Guerra |first4= |init4=LS |author4-link= |etal=no |title=[Does circumcision affect male's perception of sexual satisfaction?] |trans-title= |language=Spanish |journal=Arch Esp Urol |location= |date=2009-11 |volume=62 |issue=9 |pages=733-6 |url=https://www.aeurologia.com/EN/10.4321/S0004-06142009000900008 |archived= |quote= |pubmedID=19955598 |pubmedCID= |DOI=10.4321/s0004-06142009000900008 |accessdate=2024-08-19}}</ref>

In a study by Korean researchers of 255 men [[circumcised]] after the age of 20 and 18 who were [[Intact| not circumcised]], Kim & Pang (2007) reported that masturbatory pleasure decreased in 48% of the respondents and increased in 8%. [[Masturbation|Masturbatory]] difficulty increased in 63% but was easier in 37%. They concluded that there was a decrease in masturbatory pleasure after [[Adolescent and adult circumcision| circumcision]].<ref name="kimpang2006kimpang2007"/>

}}</ref> For example, among whites the "estimated ratio of the odds of masturbating at least once a month for [[circumcised]] men was 1.76 that for [[uncircumcised]] men." Dr. Laumann provides two explanations for the difference in sexual practices. "One is that [[uncircumcised]] men, a minority in this country, may feel a stigma that inhibits them. Another is that [[circumcision ]] reduces sensitivity in the [[penis]], leading [[circumcised]] men to try a range of sexual activities."<ref>Study Is Adding to Doubts About Circumcision

Several studies have investigated the effect of [[circumcision ]] on sexual drive. Studies that did not find a statistically significant difference include Kim & Pang,<ref name="kimpang2006kimpang2007"/> Collins et al.,<ref name="Collins2002"/> and Senkul et al.<ref name="senkul2004"/>

Kim & Pang (2007) found that 20% reported that their sex life was worse after [[circumcision ]] and 6% reported that it had improved. They concluded that "there was a decrease ... sexual enjoyment after [[circumcision]], indicating that [[adult circumcision ]] adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings."<ref name="kimpang2006kimpang2007"/>

Masood et al., in their study mentioned earlier of men [[circumcised ]] for benign disease, found that 61% reported satisfaction with the results, while 17% felt it made things worse, and 22% expressed neutral sentiments. 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. The authors of the study concluded that the satisfaction rate was a 'poor outcome,' given the pre-procedure penile disease state and recommended discussing with prospective patients the results of this study during the [[informed consent]] process.<ref name=masood2005/>

Shen et al. reported that [[Adolescent and adult circumcision | adult circumcision]] appeared to result in improved satisfaction in 34 cases (of 95 adults being [[circumcised]]), the association was statistically significant.<ref name="shen2004"/>

Collins et al. reported on a study of 15 [[adult circumcision ]] patients. No statistically significant difference in BMSFI scores was observed.<ref name="Collins2002"/>

Fink et al. reported improved satisfaction (p=0.04). Half of the [[circumcised ]] men reported benefits, while 38% reported harm. "Overall, 62% of men were satisfied with having been circumcised." Fink attributes the improved satisfaction to the respondee's aesthetic considerations and to a resolution of previous painful conditions.<ref name="fink2002"/> Uberoi et al. (2022) surveyed reports from [[circumcised]] men on social media. The authors reported:<blockquote>The qualitative review of social media posts clearly demonstrates that some men are experiencing a complex constellation of negative psychological, physical, and sexual associations that lead to significant emotional distress directed both internally and externally.<ref name ="uberoi2022">{{REFjournal |last=Uberoi |first= |init=M |author-link= |last2=Abdulcadir |first2= |init2=J |author2-link= |last3=Ohi |first3= |init3=DA |author3-link= |last4=Santiago |first4= |init4=JE |author4-link= |last5= |first5= |init5= |author5-link= |last6= |first6= |init6= |author6-link= |last7= |first7= |init7= |author7-link= |last8= |first8= |init8= |author8-link= |last9= |first9= |init9= |author9-link= |etal=yes |title=Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum |trans-title= |language= |journal=Int J Impot Res |location= |date=2022-10-23 |volume= |issue= |article= |page= |pages= |url=https://www.nature.com/articles/s41443-022-00619-8 |archived= |quote= |pubmedID=36274189 |pubmedCID= |DOI=10.1038/s41443-022-00619-8 |accessdate=2023-02-19}}</ref></blockquote>

Wildman & Wildman (1976) surveyed 55 young women in Georgia, US, reporting that 47 (89%) of respondents preferred the [[circumcised ]] [[penis ]] (the remainder preferred the [[intact]] penis).<ref>{{REFjournal

}}</ref> (There were very few [[intact ]] males in Georgia in 1976 because of the prevalence of non-therapeutic infant [[circumcision]] so it is quite likely that few of the subjects tested had any experience with an [[intact]] male.)

Williamson et al. (1988) studied randomly selected young mothers in Iowa, where most men are [[circumcised]], and found that 76% would prefer a [[circumcised ]] penis for achieving sexual arousal through viewing it.<ref>[http://www.circs.org/library/williamson/index.html Williamson ML, Williamson PS. Women's Preferences for Penile Circumcision in Sexual Partners.] J Sex Educ Ther 1988; 14: 8</ref> There were very few [[intact ]] males in Iowa in 1988 because of the prevalence of non-therapeutic infant circumcision so it is quite likely that few of the subjects tested had any experience with an intact male.)

O'Hara & O'Hara (1999) argue that [[foreskin]] is a natural gliding stimulator of the [[Vagina| vagina walls]] during intercourse, increasing a woman's overall clitoral stimulation and helping her achieve orgasm more quickly and more often. Without the [[foreskin]]'s [[gliding action]], they suggest, it can be more difficult for a woman to achieve orgasm during intercourse.<ref name= "OHara1999">{{REFjournal

Boyle & Bensley (2003) reported that the lack of a [[foreskin]] in the male partner produces symptoms similar to those of [[Vagina#Female_Sexual_Arousal_Disorder| female arousal disorder]].<ref name="bensley2003">{{REFjournal

A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is [[circumcised]].<ref name="bensley2003" />

As previously reported, the [[foreskin ]] reduces the force required for penetration of the female partner's [[vagina ]] by as much as ninety percent,<ref name="taves2002">{{REFjournal

}}</ref>, so the lack of the [[foreskin ]] makes penetration more difficult. The [[gliding action]] of the foreskin reduces friction and abrasion, while conserving vaginal lubrication,<ref name="warren-bigelow1994">{{REFjournal

}}</ref> so the lack of the foreskin in the [[circumcised ]] partner renders the female experience less satisfactory.

In a first of its kind, O'Hara & O'Hara (1999) carried out a retrospective survey of 138 women with experience of both [[intact ]] and [[circumcised ]] partners. The women overwhelmingly concurred that the mechanics of coitus was different for the two groups of men. Of the women, 73% reported that [[circumcised ]] men tend to thrust harder and deeper, using elongated strokes, while unaltered men by comparison tended to thrust more gently, to have shorter thrusts, and tended to be in contact with the mons pubis and [[clitoris]] more, according to 71% of the respondents. Women with intact partners had a higher rate of orgasms than women with [[circumcised ]] partners. O'Hara & O'Hara concluded:<blockquote>Clearly, the anatomically complete [[penis ]] offers a more rewarding experience for the female partner during coitus. While this study has some obvious methodological flaws, all the differences cannot be attributed to them. It is important that these findings be confirmed by a prospective study of a randomly selected population of women with experience with both types of men. It would be useful to examine the role of the [[foreskin ]] in other sexual activities. Because these findings are of interest, the negative effect of [[circumcision ]] on the sexual enjoyment of the female partner needs to be part of any discussions providing '[[informed consent]]' before circumcision.<ref name="ohara1998">{{REFjournal

Solinis & Yiannaki (2007) concluded; "[t]here was a decrease in couple’s sexual life after [[circumcision ]] indicating that [[adult circumcision ]] adversely affects sexual function in many men or/and their partners, possibly because of complications of surgery and loss of nerve endings."<ref name="solinis-yiannaki2005">{{REFjournal