Sexual effects of circumcision

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The sexual effects of circumcision, the removal of the foreskin from the penis, are not very well understood and researchers' findings are often contested.

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[edit] Sexual Effects

There have been many claims about the effect of circumcision on sexual function.

  • In a British 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,' given the pre-procedure penile disease state and recommended discussing with prospective patients the results of this study during the informed consent process.
  • In an American study of 123 men, 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.
  • Shen ( China, 2004) questioned 95 patients before and after circumcision. Eighteen patients suffered from mild erectile dysfunction before circumcision, but 28 suffered from mild or moderate erectile dysfunction afterwards (P = 0.001). Adult circumcision appeared to have resulted in weakened erectile confidence in 33 cases (P = 0.04), difficult insertion in 41 cases (P = 0.03), prolonged intercourse in 31 cases (P = 0.04) and improved satisfaction in 34 cases (P = 0.04). Shen concluded that more importance should be attached to the effect of adult circumcision on erectile function.
  • In a study of 42 Turkish men circumcised for religious reasons, Senkul found no significant effect other than a 60% increase in time to ejaculation at the 98% statistical confidence level. Senkul suggested that delayed ejaculation may in fact be seen as a benefit.
  • In a study of 15 American men, Collins, found no post-circumcision difference in sex drive, erections, ejaculations, and overall satisfaction.

[edit] Comparative studies

  • An analysis of a national U.S. 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.

[edit] Glans sensitivity

An examinination of 7 circumcised and 6 uncircumcised males found 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. A study by Paick et al failed to find a correlation between increased vibrational sensitivity and premature ejaculation.[6] while studies by Koos Slob et al. and several other groups they cited showed that ejaculation can be significantly delayed using a local anesthetic cream to numb the glans and penile shaft.

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."[7]

[edit] Foreskin sensitivity

Traditionally many believed that the foreskin was sexually sensitive [8][9] and this belief has been documented by opponents of circumcision [10] [11] [12]. Some more recent researchers have also suggested that the foreskin may be sexually responsive [13] [14] [15] [16]. 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. However, these studies have not been followed up.

Circumcision removes the ridged band at the end of the foreskin [17]. John R. Taylor, a pathologist and a critic of circumcision, [18] observed that the ridged band had more Meissner's corpuscles - a kind of nerve ending that is concentrated in areas of greatest sensitivity [19] - than the areas of the foreskin with smooth mucus membranes. Taylor 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.[20] This gliding action was also described by Lakshmanan, (1980) [21]. However, Taylor's claim about the sexual sensitivity of the ridged band has not been followed up by other researchers.

[edit] Female Arousal

Vaginal dryness and 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[23]. Boyle et al. state that self-selection is unreliable[24].

Female visual arousal A study (1988) of randomly selected young 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, a majority of the 24 women with dual experience also found the circumcised penis more visually arousing.

[edit] 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 Worse after 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 Worse after circumcision Yes; p=0.001
Laumann (1997) National probability study Yes 1410 Better in circumcised males Yes; p<0.10
Richters (2006) Telephone survey Yes 10,173 Better in circumcised males Yes; p=0.022
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
Richters (2006) Telephone survey Yes 10,173 Circumcised men more likely to ejaculate prematurely No; p=0.11
Penile sensation
Fink (2002) Cross-sectional, adult circumcision patients Yes 40 Worse after circumcision Almost; p=0.08
Masood (2005) Not stated; adult circumcision patients Yes 88 Better after circumcision in 38%, worse in 18% Yes; p=0.01
Denniston (2004), cited by Denniston (2004) Not stated; survey of males circumcised in adulthood No 38 Better after circumcision in 58%, worse 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
Richters (2006) Telephone survey Yes 10,163 Better in circumcised males No; p=0.192
Overall satisfaction
Fink (2002) Cross-sectional; adult circumcision patients Yes 40 Better after 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 "Sixty-one percent were satisfied with the circumcision (p = 0.04). ... Fourteen patients (17%) were not satisfied with the circumcision, but only 1 patient in this group had any obvious post-operative complications (bleeding)." The authors conclude "The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process." Not stated
Shen (2004) Not stated; adult circumcision patients Yes 95 Improved satisfaction in 34 cases 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.

[edit] See also

[edit] References

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