Sexual effects of circumcision
The sexual effects of circumcision, if any, are controversial and poorly understood. The reader may wish to read the summary below in conjunction with the original studies, to which links can be found in the references.
Sexual Effects
There have been many claims about the effect of circumcision on sexual function. Collins, in a study of 15 men found no post-circumcision difference in sex drive, erections, ejaculations, and overall satisfaction. Senkul found no significant effect in a study of 42 men circumcised for religious reasons, other than a 60% increase in time to ejaculation at the 98% statistical confidence level. Senkul said that delayed ejaculation may in fact be seen as a benefit.
Fink found that medically necessitated circumcision resulted in worsened erectile function at the 99% confidence level, de-sensitization and/or delayed ejaculation at the 92% certainty level, but improved satisfaction at the 96% certainty level. In a pre- and post-circumcision survey of 95 men, Shen found that medical circumcision led to erectile dysfunction at the 99.9% level, "weakened erectile confidence" at the 96% level, and prolonged intercourse and "improved satisfaction" at the 96% level.
In a study of 150 men circumcised as adults for penile problems, Masood et al reported a slight reduction in erectile function scores, from 22.41 before to 21.13 afterwards (60% confidence). 69% noted less pain during intercourse (95% confidence). 38% reported improved penile sensation (99% confidence), 18% reported worse penile sensation, while the remainder (44%) reported no change. 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' and recommended discussing with prospective patients the results of this study during the informed consent process.
An analysis of a national US survey by Laumann found that uncircumcised males had a higher overall rate of all seven types of sexual dysfunctions considered, especially after the age of 45 years, at a cumulative 93% statistical confidence level. He also found that circumcised men tend to engage in "more elaborated set of sexual practices" and that circumcision is associated with an increased incidence of sexually transmitted diseases, though this only reached statistical significance in the case of chlamydia. Concerning the differences in sexual practices, Laumann speculated "..differences in the association between circumcision status and sexual practice across ethnic groups suggest that cultural, rather than physiological forces may be responsible." [1]
A multinational study by Waldinger et al found that circumcised men took on average 6.7 minutes to ejaculate, compared with 6.0 minutes for uncircumcised men. This difference was not statistically significant. The comparison excluded Turkey, which was significantly different from the other countries studied.
Glans sensitivity
An examinination of 7 circumcised and 6 uncircumcised males discerned no difference in keratinization of the glans penis [2]. Bleustein et al tested the sensitivity of the glans penis, and found no difference between circumcised and uncircumcised men [3], confirming an earlier study by Masters and Johnson[4]. Bleustein later followed up with a larger study, with the same finding.[5] These studies relied on laboratory tests of sensation thresholds to mechanical or thermal stimuli, rather than on subjective reports of sexual sensation.
Fink, in his survey of men circumcised as adults for medical (93%) or elective (7%) reasons, reported: "Adult circumcision appears to result in worsened erectile function (99% confidence), decreased penile sensitivity (92% confidence), no change in sexual activity (88% confidence) and improved satisfaction (96% confidence). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised." Fink attributes the improved satisfication to the respondee's aesthetic considerations and to a resolution of previous painful conditions. Fink grouped decreased sensitivity with ejaculation taking longer than the men desired. Only one question relating to ejaculation time had a significant result; the question directly addressing sensitivity had no significant difference. There is conflicting evidence whether this should be seen as evidence of decreased sensitivity or simply of delayed ejaculation. On the one hand, a study by Paick et al failed to find a correlation between increased vibrational sensitivity and premature ejaculation.[6] On the other hand, studies by Koos Slob et al. and several other groups cited therein demonstrated that ejaculation can be significantly delayed using a local anesthetic cream to numb the glans.
Some men who undergo foreskin restoration claim that the procedure improves glans sensitivity. If one accepts the supposition that delayed ejaculation after circumcision arises from desensitization, then this claim is in seeming agreement with the post-circumcision surveys of Fink and Senkul. However, it is in apparent disagreement with the sensation threshold work of Bleustein et al (2003), Bleustein et al (2005) and Masters and Johnson. Some have suggested that much of this perceived "improved sensitivity" of the glans reported by foreskin restorers is psychosexual and psychosomatic and an example of the placebo effect, with no real change in glans sensitivity.[7] [8]
Yang et al. 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."[9]
Foreskin sensitivity
Traditionally, many believed that the foreskin was sexually sensitive [10][11] and this belief has been documented by opponents of circumcision [12] [13] [14]. More recently, some researchers have also suggested that the foreskin may be sexually responsive [15] [16] [17]. Opponents of circumcision have also cited these studies, which report on the sensitivity or innervation of the prepuce. While there are no studies examining whether it or any other single part of the penis is specifically sexually sensitive, they claim a sexual role based upon the presence of nerve-endings in the foreskin sensitive to light touch, stroking and fluttering sensations. Not all agree, however. Genital integrity activist and author Kristen O'Hara argues that the glans is the "male clitoris", with the foreskin maintaining at best a supporting role during sexual intercourse.[18]
Pathologist, John R. Taylor, a critic of circumcision, [19] postulated that the relatively highly innervated and vascularised ridged band at the end of the foreskin, which is almost invariably removed in circumcision, is erogenous and plays a role in normal sexual function. He also speculated that the gliding action, possible only where sufficient loose penile shaft skin exists, serves to stimulate this band through contact with the corona of the glans penis during vaginal intercourse.[20] The gliding action was also mentioned by Lakshmanan, (1980) [21]. No scientific confirmation of Taylor's speculation has been made.
Female Arousal
A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness tends to be a problem when the male partner is circumcised.[22] Bensley et al. reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder. The authors hypothesized that the gliding action possibly involved in intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication. The researchers state that the respondents were self-selected and that larger sample sizes are needed, but concluded that "circumcised men experienced significantly reduced sexual sensation along with associated long-lasting negative emotional consequences."[23]. Boyle et al. state that self-selection is unreliable[24]. A study (1988) of 145 randomly selected new mothers in Iowa, where most men are circumcised, found that 76% found the circumcised penis more visually arousing.[25] Although 88% of the women surveyed had only had experiences with circumcised penises, the pattern was repeated among the 24 women with dual experience.
Summary of research findings
| Study | Design | Peer reviewed | Sample size (c, uc)1 | Finding | Significant2 | |
|---|---|---|---|---|---|---|
| Sexual drive | ||||||
| Collins (2002) | Prospective; adult circumcision patients | Yes | 15 | No difference | No; p>0.68 | |
| Senkul (2004) | Prospective; adult circumcision patients | Yes | 42 | No difference | No; p=0.32 | |
| Erectile function | ||||||
| Fink (2002) | Cross-sectional; adult circumcision patients | Yes | 40 | Favours non-circumcision | Yes; p=0.01 | |
| Collins (2002) | Prospective; adult circumcision patients | Yes | 15 | No difference | No; p>0.96 | |
| Senkul (2004) | Prospective; adult circumcision patients | Yes | 42 | No difference | No; p=0.89 | |
| Masood (2005) | Not stated; adult circumcision patients | Yes | 88 | No difference | No; p=0.40 | |
| Shen (2004) | Not stated; adult circumcision patients | Yes | 95 | Favours non-circumcision | Yes; p=0.001 | |
| Laumann (1997) | National probability study | Yes | 1410 | Favours circumcision | Yes; p<0.10 | |
| Ejaculation | ||||||
| Collins (2002) | Prospective; adult circumcision patients | Yes | 15 | No difference | No; p>0.48 | |
| Senkul (2004) | Prospective; adult circumcision patients | Yes | 42 | No difference in BMSFI (Brief Male Sexual Function Inventory) Greater time to ejaculate after circumcision | No; p=0.85 Yes; p=0.02 | |
| Shen (2004) | Not stated; adult circumcision patients | Yes | 95 | Greater time to ejaculate after circumcision | Yes; p=0.04 | |
| Laumann (1997) | National probability study | Yes | 1410 | Circumcised men less likely to ejaculate prematurely | Yes; p<0.10 | |
| Waldinger (2005) | Multinational, stopwatch assessment | Yes | 500 | No difference | No | |
| Penile sensation | ||||||
| Fink (2002) | Cross-sectional, adult circumcision patients | Yes | 40 | Favours non-circumcision | Almost; p=0.08 | |
| Masood (2005) | Not stated; adult circumcision patients | Yes | 88 | Favours circumcision in 38%, non-circumcision in 18% | Yes; p=0.01 | |
| Denniston (2004), cited by Denniston (2004) | Not stated; survey of males circumcised in adulthood | No | 38 | Favours non-circumcision in 58%, circumcision in 34% | Not stated | |
| Masters (1966) | Neurologic testing; subjects matched for age | No | 70 (35, 35) | No difference | Not stated | |
| Bleustein (2003) | Quantitative somatosensory testing | No | 79 (36, 43) | No difference when controlled for other variables | No; p=0.08 | |
| Bleustein (2005) | Quantitative somatosensory testing | Yes | 125 (63, 62) | No difference when controlled for other variables | No | |
| Overall satisfaction | ||||||
| Fink (2002) | Cross-sectional; adult circumcision patients | Yes | 40 | Favours circumcision | Yes; p=0.04 | |
| Collins (2002) | Prospective; adult circumcision patients | Yes | 15 | No difference | No; p>0.72 | |
| Senkul (2004) | Prospective; adult circumcision patients | Yes | 42 | No difference | No; p=0.46 | |
| Masood (2005) | Not stated; adult circumcision patients | Yes | 88 | Favours circumcision (61% satisfaction) | Not stated | |
| Shen (2004) | Not stated; adult circumcision patients | Yes | 95 | Favours circumcision | Yes; p=0.04 | |
1 c = circumcised; uc = uncircumcised.
2 If stated, author's analysis is used. Otherwise, significance is considered to be p <= 0.05.
See also
References
- Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: debunking a myth? J Urol. 2002 May; 167(5): 2111-2
- Senkul T, Iseri C, Sen B. et al. Circumcision in adults: effect on sexual function. Urology 2004; 63(1): 155-8.
- Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002 May; 167(5): 2113-6.
- Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int 2005;75(1):62-6.
- Shen Z, Chen S, Zhu C, Wan Q, Chen Z. Erectile function evaluation after adult circumcision. Zhonghua Nan Ke Xue. 2004 Jan;10(1):18-9.
- Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997; 277(13): 1052-1057
- Denniston GC, Hill G. Circumcision in adults: effect on sexual function. Urology 2004;64(6);1267.
- Masters WH, Johnson VE. Human Sexual Response. Boston: Little, Brown & Co 1966: 189-91
- Bleustein CB, Eckholdt H, Arezzo JC, Melman A. Effects of circumcision on male penile sensitivity. Paper read at the American Urological Association 98th Annual Meeting at Chicago Illinois, April 26-May 1, 2003. Publishing ID 1260, Abstract ID: 100769.
- Bleustein CB, Fogarty JD, Eckholdt H, Arezzo JC, Melman A. Effect of neonatal circumcision on penile neurologic sensation. Urology. 2005 Apr;65(4):773-7.
- Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Medicine. 2005; 2: 492
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