Sexual injury of circumcision: Difference between revisions
WikiModEn2 (talk | contribs) Relocate Masters & Johnson (1966) comment; Add Morgan (1967) |
WikiModEn2 (talk | contribs) And so began the investigation of the sexual effects of male circumcision. |
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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.</blockquote> | ||
With regard to the [[ | With regard to the [[glans penis]], Masters & Johnson stated: | ||
<blockquote> | <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 | 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 | ||
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}}</ref> | }}</ref> | ||
William Keith | William Keith C. Morgan, M.D. (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: | ||
<blockquote> | <blockquote> | ||
Now let us consider whether the operation is in any way harmful or contraindicated. The function of the prepuce is to protect the glans, the latter being almost insensitive to most ordinary tactile and thermal stimuli. It has, however, specific receptors for other pleasurable sensations. Removal of the prepuce exposes the glans to foreign stimuli which dull these special receptors. During the act of coitus the uncircumcised phallus penetrates smoothly and without friction, the prepuce gradually retracting as the organ advances. In contrast, when the circumcised organ is introduced during coitus, friction develops between the glans and vaginal mucosa. Penetration in the circumcised man has been compared to thrusting the foot into a sock held open at the top, while, on the other hand, in the intact counterpart it has been likened to slipping the foot into a sock that has been previously rolled up.<ref name="morgan1965">{{REFjournal | Now let us consider whether the operation is in any way harmful or contraindicated. The function of the prepuce is to protect the glans, the latter being almost insensitive to most ordinary tactile and thermal stimuli. It has, however, specific receptors for other pleasurable sensations. Removal of the prepuce exposes the glans to foreign stimuli which dull these special receptors. During the act of coitus the uncircumcised phallus penetrates smoothly and without friction, the prepuce gradually retracting as the organ advances. In contrast, when the circumcised organ is introduced during coitus, friction develops between the glans and vaginal mucosa. Penetration in the circumcised man has been compared to thrusting the foot into a sock held open at the top, while, on the other hand, in the intact counterpart it has been likened to slipping the foot into a sock that has been previously rolled up.<ref name="morgan1965">{{REFjournal | ||
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}}</ref> | }}</ref> | ||
</blockquote> | </blockquote> | ||
Falliers (1970) commented in a critical letter to the ''Journal of the American Mmedical Association'': | |||
<blockquote> | |||
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 | |||
|last=Falliers | |||
|first=CJ | |||
|author-link= | |||
|etal=no | |||
|title= Circumcision (letter) | |||
|trans-title= | |||
|language= | |||
|journal=JAMA | |||
|location= | |||
|date=1970-12-21 | |||
|volume=214 | |||
|issue=12 | |||
|pages=2194 | |||
|url=http://www.cirp.org/library/general/falliers1/ | |||
|quote= | |||
|pubmedID= | |||
|pubmedCID= | |||
|DOI= | |||
|accessdate=2019-12-21 | |||
}}</ref> | |||
</blockquote> | |||
And so began the investigation of the sexual effects of male circumcision. | |||
<!--Only medical trade associations, such as the [[American Academy of Pediatrics]] (AAP), 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 | <!--Only medical trade associations, such as the [[American Academy of Pediatrics]] (AAP), 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 | ||
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== Penile sensitivity and sexual sensation == | == Penile sensitivity and sexual sensation == | ||
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.'' | 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 | ||
|last=Masood | |last=Masood | ||
|first=S. | |first=S. | ||
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}}</ref> | }}</ref> | ||
<!--In a 2008 study, Krieger ''et al.'' stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name="Krieger2008">{{REFjournal | <!--In a 2008 study, Krieger ''et al.'' (2008) stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name="Krieger2008">{{REFjournal | ||
|last=Krieger | |last=Krieger | ||
|first=J.N. | |first=J.N. | ||
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Sorrells ''et al.'' (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers, They reported "[the] 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"/> < | Sorrells ''et al.'' (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers, They reported "[the] 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 === | === Foreskin sensitivity === | ||
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|last2=Cold | |last2=Cold | ||
|title=The prepuce | |title=The prepuce | ||
|journal= | |journal=BJU | ||
|volume=83 | |volume=83 | ||
|issue=Supplement 1 | |issue=Supplement 1 | ||
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|url=http://www3.interscience.wiley.com/cgi-bin/fulltext/119091418/PDFSTART | |url=http://www3.interscience.wiley.com/cgi-bin/fulltext/119091418/PDFSTART | ||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=10349413 | ||
|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI=10.1046/j.1464-410x.1999.0830s1034.x | ||
|date=1999-02 | |date=1999-02 | ||
|accessdate= | |accessdate= | ||
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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" /> | 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 | |||
|last=Schober | |last=Schober | ||
|first=J.M. | |first=J.M. | ||
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|first3=C. | |first3=C. | ||
|title=Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire | |title=Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire | ||
|journal=BJU Int | |journal=BJU Int | ||
|volume=103 | |volume=103 | ||
|issue=8 | |issue=8 | ||
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|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
==Erectile function== | ==Erectile function== | ||
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 | 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 | ||
|last=Shen | |last=Shen | ||
|first=Z. | |first=Z. | ||
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}}</ref><ref name="kimpang2006"/> | }}</ref><ref name="kimpang2006"/> | ||
Fink ''et al.'', in an American study of 123 men, found that medically necessitated circumcision resulted in worsened erectile function (p=0.01).<ref name=fink2002/> | Fink ''et al.'' (2002), in an American study of 123 men, found that medically necessitated circumcision resulted in worsened erectile function (p=0.01).<ref name=fink2002/> | ||
Kim & Pang (2007) reported no significant difference in erection.<ref name="kimpang2006">{{REFjournal | Kim & Pang (2007) reported no significant difference in erection.<ref name="kimpang2006">{{REFjournal | ||
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}}</ref> | }}</ref> | ||
Laumann ''et al.'' reported that the likelihood of having difficulty in maintaining an erection was lower for circumcised men, but only at the 0.07 level (OR 0.66; 95% CI, 0.42-1.03).<ref name="Laumann1997"/> | Laumann ''et al.'' (1997) reported that the likelihood of having difficulty in maintaining an erection was lower for circumcised men, but only at the 0.07 level (OR 0.66; 95% CI, 0.42-1.03).<ref name="Laumann1997"/> | ||
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|date=2005 | |date=2005 | ||
|accessdate= | |accessdate= | ||
}}</ref> Commenting on the study, Sorrells ''et al.'' said "Turkish men, the vast majority of whom are circumcised, had the shortest IELT [Intravaginal ejaculation latency time]."<ref name= "sorrells2007"/> | }}</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.'' conducted a prospective study of 15 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"/> | Collins ''et al.'' (2002) conducted a prospective study of 15 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 42 Turkish men circumcised for religious reasons, Senkul ''et al.'' did not find a statistically significant difference in BMSFI ejaculation scores, but found a significant increase in the mean time to ejaculate. The authors suggested that delayed ejaculation may be seen as a benefit.<ref name="senkul2004">{{REFjournal | In a study of 42 Turkish men circumcised for religious reasons, Senkul ''et al.'' (2004) did not find a statistically significant difference in BMSFI ejaculation scores, but found a significant increase in the mean time to ejaculate. The authors suggested that delayed ejaculation may be seen as a benefit.<ref name="senkul2004">{{REFjournal | ||
|last=Senkul | |last=Senkul | ||
|first=T. | |first=T. | ||
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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"/> | 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"/> | ||
==Female preferences and response== | ==Female preferences and response== | ||