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Sexual effects of circumcision

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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:
<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
|init=WKC
Morgan (1967) addressed the issue again in the ''Medical Journal of Australia'':
<blockquote>
The subcutaneous tissue of the glans is provided with special sensory receptors that are concerned with appreciating the pleasurable sensations that occur during coitus. They are stimulated normally only when the glans is exposed. In the circumcised subject these receptors are constantly stimulated and lose their sensitivity. 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 the vaginal [[mucosa]].<ref name="morgan1967">{{REFjournal
|last=Morgan
|first=William Keith C.
|date=1999-03
|accessdate=
}}</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>{{REFweb
|quote=
|url=http://www.cirp.org/library/psych/boyle6/
}}</ref>
An examination of 7 [[circumcised ]] and 6 [[intact ]] males found no difference in [[keratinization]] of the [[glans penis]].<ref name="Szabo">{{REFjournal
|last=Szabo
|first=Robert
}}</ref>
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 ===
}}</ref> Proponents of [[genital integrity]] 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 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
|last=Taylor
|init=JR
==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
|last=Shen
|init=Z
|date=2006
|accessdate=
}}</ref> <ref name="Laumann1997"/> in erectile dysfunction among [[circumcised ]] men, while other studies have shown little to no effect.<ref name="masood2005"/<ref name="senkul2004"/><ref name="Collins2002">{{REFjournal
|last=Collins
|init=S
}}</ref>
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"/>
== Ejaculatory function ==
Waldinger et al. 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
|last=Waldinger
|init=MD
}}</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 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
}}</ref>
Morten Frisch et al. (2013) surveyed a very large group of men and women in [[Denmark]]. They concluded:
<blockquote>
"Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment."<ref>{{FrischM LindholmM GroenbaekM 2011}}</ref>
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