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Sexual effects of circumcision

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Masters & Johnson (1966) in their book, ''Human Sexual Response'', showed little interest or understanding of the human foreskin. One illustration, labelled normal pe-nis anatomy, showed a drawing of a penis without a foreskin. A listing of penile pathology in their book included “uncircumcised penis”! Their work was done in St. Louis, located in the highly circumcised Midwest, and almost all of their subjects were circumcised. There testing was quite limited. With regard to the foreskin, they said only:
<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.<ref name="masters-johnson1966">{{REFbook
|last=Masters
|first=William L.
|author-link=
|last2=Johnson
|first2=Virginia E.
|author2-link=
|year=1966
|title=Human sexual response
|url=
|work=
|editor=
|edition=
|volume=
|chapter=
|pages=
|location=Toronto, New York
|publisher=Bantam
|isbn=0-553-20429-7
|quote=
|accessdate=2019-12-21
|note=
}}</ref>
</blockquote>
Therefore, it appears that Masters & Johnson performed little or no testing on the foreskins of their few intact subjects and provided no useful information.<ref name="sorrells2007">{{REFjournal
|last=Sorrells
|first=Morris L.
|author-link=Morris L. Sorrells
|first2=James L.
|last2=Snyder
|first3=Mark D.
|last3=Reiss
|first4=Christopher
|last4=Eden
|first5=Marilyn F.
|last5=Milos
|author5-link=Marilyn Fayre Milos
|first6=Norma
|last6=Wilcox
|first7=Robert S.
|last8=Van Howe
|author8-link=Robert Van Howe
|title=Fine-touch pressure thresholds in the adult penis
|journal=BJU International
|volume=99
|issue=4
|pages=864-869
|url=http://www3.interscience.wiley.com/cgi-bin/fulltext/118508429/PDFSTART
|quote=
|pubmedID=17378847
|pubmedCID=
|DOI=10.1111/j.1464-410X.2006.06685.x
|date=2007-03
|accessdate=2019-12-16
}}</ref>
There were, however, some other little noticed papers overlooked by Masters & Johnson, that told a different story. Winkleman (1956) investigated the innervation of the prepuce and found it to be highly innervated.<ref name="winkleman1956">{{REFjournal
|last=Winkelmann
|first=R.K.
|title=The cutaneous innervation of human newborn prepuce
|journal=Journal of investigative dermatology
|volume=26
|issue=1
|pages=53-67
|url=http://www.cirp.org/library/anatomy/winkelmann2/
|quote=
|pubmedID=13295637
|pubmedCID=
|DOI=
|date=1956-01
|accessdate=2019-12-21
}}</ref> Winkleman (1959) later identified the prepuce as "specific erogenous tissue".<ref name="winkleman1959">{{REFjournal
|last=Winkelmann
|first=R.K.
|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=1959-01
|accessdate=2019-12-21
}}</ref>
 
William Keith L. 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>
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
|last=Morgan
|first=W.K.C.
|author-link=
|title=The rape of the phallus
|journal=JAMA
|date=1965
|volume=193
|issue=
|pages=123-4
|url=http://www.cirp.org/library/general/morgan/
|quote=
|pubmedID=14310332
|pubmedCID=
|DOI=10.1001/jama.1965.03090030045013
|accessdate=2019-12-21
}}</ref>
</blockquote>
 
<!--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
A number of studies have looked at the question of whether sensitivity of the glans is affected by circumcision.
 Masters and Johnson (1966) reported: "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="masters1966">{{REFbook |last=Masters |first=W.H. |last2=Johnson |first2=V.E. |year=1966 |title=Human Sexual Response |url=http://www.circs.org/library/masters/index.html |work= |editor= |edition= |volume= |chapter= |pages= |location=Toronto; New York |publisher=Bantam Books |isbn=0-553-20429-7 |quote= |accessdate= |note=}}<johnson1966"/ref> Sorrells ''et al.'' criticised this early study for being poorly documented and not subject to peer review.<ref name="sorrells2007">{{REFjournal |last=Sorrells |first=Morris L. |author-link=Morris L. Sorrells |first2=James L. |last2=Snyder |first3=Mark D. |last3=Reiss |first4=Christopher |last4=Eden |first5=Marilyn F. |last5=Milos |author5-link=Marilyn Fayre Milos |first6=Norma |last6=Wilcox |first7=Robert S. |last8=Van Howe |author8-link=Robert Van Howe |title=Fine-touch pressure thresholds in the adult penis |journal=BJU International |volume=99 |issue=4 |pages=864-869 |url=http://www3.interscience.wiley.com/cgi-bin/fulltext/118508429/PDFSTART |quote= |pubmedID=17378847 |pubmedCID= |DOI=10.1111/j.1464-410X.2006.06685.x |date=2007-03 |accessdate=2019-12-16}}</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. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."
<ref name="AAFP">{{REFweb
| quote=
=== Foreskin sensitivity ===
Some recent researchers have asserted that the [[foreskin]] may be sexually responsive.<ref>{{REFjournal |lastname=Winkelmann |first=R.K. |title=The cutaneous innervation of human newborn prepuce |journal=Journal of investigative dermatology |volume=26 |issue=1 |pages=53-67 |url=http:"winkleman1956" //www.cirp.org/library/anatomy/winkelmann2/ |quote= |pubmedID=13295637 |pubmedCID= |DOI= |date=1956-01 |accessdate=}}</ref><ref>{{REFjournal |lastname=Winkelmann |first=R.K. |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:"winkleman1959" //www.cirp.org/library/anatomy/winkelmann/ |quote= |pubmedID=13645790 |pubmedCID= |DOI= |date=1959-01 |accessdate=}}</ref><ref name="taylortaylor1996">{{REFjournal
|last=Taylor
|first=J.R.
}}</ref> Opponents of circumcision have cited these studies, which report on the sensitivity or innervation of the foreskin, claiming a sexual role based upon the presence of nerve-endings in the foreskin sensitive to light touch, stroking and fluttering sensations.
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 corpuscle]]s — 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 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="taylor2taylor2000">{{REFjournal
|last=Taylor
|first=J.R.
}}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."
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" /> <!--This is disputed by Waskett and Morris, who argue that when they re-analyse Sorrells' data, no significant differences are found; that light touch is only one form of sensitivity, and that sexual pleasure may sometimes require less sensitivity. They also criticized Sorrells' recruitment methods.<ref name="waskett2007"/> In response, Young criticizes Waskett and Morris's use of the [[Bonferroni correction]] and argues that the methods of selecting subjects would not affect the results, that the two most sensitive positions on the circumcised penis represent small areas of [[circumcision scar]], as compared to a much larger area of sensitive tissue on the foreskin, and that sales of sensation-dulling products do not necessarily indicate that such are widely used other than on scar tissue.<ref name="young"/>-->   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>{{REFjournal
|last=Schober
|first=J.M.
|date=2005
|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="sorrellssorrells2007"/>
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"/>
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