Jump to content

Sexual effects of circumcision: Difference between revisions

Add links
From Wikipedia, the free encyclopedia
Browse history interactively
← Previous edit
Content deleted Content added
VisualWikitext
→Foreskin sensitivity: Delete Schober who did not study foreskin sensation and is inappropriate in this section.; Rearrange material for better flow.
fix redirect
Tag: Redirect target changed
 
(22 intermediate revisions by 8 users not shown)
Line 1: Line 1:
#REDIRECT [[Circumcision#Sexual effects]]
The sexual effects of [[circumcision]] are the subject of some debate. Studies have been conducted to investigate whether circumcision has any effect on sexual drive, erectile function, premature and delayed ejaculation, sexual satisfaction, sexual sensation and penile sensitivity. Studies have also assessed whether circumcision affects masturbation or other sexual practices, and whether a heterosexual woman's experience of sex is affected by her partner's circumcision status.

Those reviewing the literature have reached differing conclusions. 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">{{Cite journal|author= |title=Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision |journal=Pediatrics |volume=103 |issue=3 |pages=686–93 |year=1999 |month=March |pmid=10049981 |doi=10.1542/peds.103.3.686}}</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 = "AAFP" /> 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>{{Cite web|url=http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs |title=Male circumcision: pain, trauma, and psychosexual sequelae |first=Gregory J |last=Boyle |coauthors=Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem |publisher=Bond University Faculty of Humanities and Social Sciences |year=2002}}</ref>

==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.'' 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">{{cite journal
| last = Masood
| first = S
| coauthors = Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK
| year = 2005
| title = Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
| journal = Urol Internationalalis
| volume = 75
| pages = 62–6
| url = http://www.cirp.org/library/sex_function/masood1/
| pmid = 16037710
| doi = 10.1159/000085930
| issue = 1
}}</ref> In a survey of men circumcised as adults for medical (93%) or elective (7%) reasons, Fink ''et al.'' found an association between adult circumcision and decreased penile sensitivity that "bordered on statistical significance" (p=0.08).<ref name = "fink2002">{{cite journal
| last = Fink
| first = K.S.
| coauthors = C.C. Carson and R.F. DeVillis
| year = 2002
| month = May
| title = Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction
| journal = Journal of Urology
| volume = 167
| issue = 5
| pages = 2113–6
| url = http://www.circs.org/library/fink/
| doi = 10.1016/S0022-5347(05)65098-7
| pmid = 11956453
}}</ref>

In a 2008 study of Kenyan men, 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">{{cite journal
| last = Krieger
| first = JN
| coauthors = Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S
| year = 2008
| month = August
| title = Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya
| journal = The journal of sexual medicine
| volume = 5
| issue = 11
| pages = 2610–22
| pmid = 18761593
| doi = 10.1111/j.1743-6109.2008.00979.x
| url =
| format =
| quote =
| pmc=3042320
}}
</ref> In a 2009 study of 22 men in Mexico circumcised for medical or aesthetic reasons, Cortés-González ''et al.'' reported a statistically significant improvement in "perception of sexual events" (p=0.04).<ref name="cortes2009">{{cite journal |author=Cortés-González JR, Arratia-Maqueo JA, Martínez-Montelongo R, Gómez-Guerra LS |title=DOES CIRCUMCISION AFFECT MALE'S PERCEPTION OF SEXUAL SATISFACTION? |journal=Arch. Esp. Urol. |volume=62 |issue=9 |pages=733–736 |year=2009 |month=November |pmid=19955598 |doi= |url=http://www.arch-espanoles-de-urologia.es/apartados/sumarios/popup.php?ano=2009&id=62-09-18}}</ref>

===Glans sensation===
A number of studies have looked at the question of whether sensitivity of the glans is affected by circumcision.
Yang ''et al.'' (1998), who carried out their studies on dead American cadavers, apparently without foreskins, 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", the glans being the only remaining erogenous structure after circumcision in their study cadavers.<ref name = "yang1998">{{cite journal
| last = Yang
| first = CC
| coauthors = Bradley WE
| year = 1998
| month = July
| title = Neuroanatomy of the penile portion of the human dorsal nerve of the penis
| journal = British Journal Urology
| volume = 82
| issue = 1
| pages = 109–113
| url = http://www.cirp.org/library/anatomy/yang1/
| pmid = 9698671
| doi=10.1046/j.1464-410x.1998.00669.x
}}</ref>

Szabo & Short (2000) examined of 7 circumcised and 6 noncircumcised 60-96 year-old male cadavers and found no difference in [[keratin]]ization of the [[glans penis]].<ref name = "Szabo">{{cite journal
| last = Szabo
| first = Robert
| coauthors = Roger V. Short
| year = 2000
| month = June
| title = How does male circumcision protect against HIV infection?
| journal = BMJ
| volume = 320
| issue = 7249
| pages = 1592&ndash;1594
| doi = 10.1136/bmj.320.7249.1592
| pmid = 10845974
| url = http://bmj.bmjjournals.com/cgi/reprint/320/7249/1592
| format = PDF
| accessdate = 2006-07-09
| pmc = 1127372
}}</ref>

In a position statement first published in 2002 and reaffirmed 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">{{cite web
| url = http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
| title = Circumcision: Position Paper on Neonatal Circumcision
| accessdate = 2007-01-30
| year = 2007
| publisher = [[American Academy of Family Physicians]]
}}</ref>

Bleustein ''et al.'' (2003) tested the sensitivity of the glans penis, and found no difference between circumcised and noncircumcised men.<ref name = "bleustein2003">{{cite conference | last = Bleustein | first = Clifford B. | coauthors = Haftan Eckholdt, Joseph C. Arezzo and Arnold Melman | title = Effects of Circumcision on Male Penile Sensitivity | booktitle = American Urological Association 98th Annual Meeting | place = Chicago, Illinois | date = April 26-May 1, 2003 | url = http://www.circs.org/library/bleustein/ }}</ref> Bleustein ''et al.'' (2005) divided 125 patients (62 uncircumcised men and 63 neonatally circumcised men) into groups based on their sexual dysfunction using the [[Sexological_testing#IIEF_.28International_Index_of_Erectile_Function.29|IIEF]](International Index of Erectile Function). Twenty-nine were placed in the functional group, and 96 in the dysfunctional group. Quantitative somatosensory testing (including vibration, pressure, spatial perception, and warm and cold thermal thresholds) was used on the dorsal midline glans of the penis. In the dysfunctional group, circumcised men (49 +/- 16 years) were significantly younger (P <0.01) than noncircumcised men (56 +/- 13 years). When controlling for age, hypertension, and diabetes, there was no difference in sensitivity. Bleustein ''et al''. did not test the sensation of the foreskin nor did he compute the loss of sensation from the foreskin caused by circumcision.<ref name= "bleustein2005">{{cite journal
| last = Bleustein
| first = Clifford B.
| coauthors = Fogarty JD, Eckholdt H, Arezzo JC, Melman A
| year = 2005
| month = April
| title = Effect of neonatal circumcision on penile neurologic sensation
| journal = Urology
| volume = 65
| pages = 773–7
| url = http://linkinghub.elsevier.com/retrieve/pii/S0090-4295(04)01343-3
| pmid = 15833526
| doi = 10.1016/j.urology.2004.11.007
| issue = 4
}}</ref>

Sorrells ''et al.'' (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 noncircumcised, live adult male volunteers, They reported "[the] glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds as measured at three points 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="sorrells"/> In a letter to ''BJU International'', however, on the basis of the unadjusted data, Waskett & Morris (2007) stated "we find no significant differences [...], consistent with previous findings."<ref name="waskett2007">{{cite journal
| last = Waskett
| first = Jake H.
| coauthors = Brian J. Morris
| year = 2007
| month = May
| title = Fine touch pressure thresholds in the adult penis
| journal = BJU Int
| volume = 99
| issue = 6
| pages = 1551–1552
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/118508593/HTMLSTART
| doi = 10.1111/j.1464-410X.2007.06970_6.x
| pmid = 17537227
}}</ref> However, in a further letter to ''BJU International'', Young (2007) responded to Waskett & Morris, stating that Sorrells ''et al.'' found that one point, at least, on the glans of the circumcised penis was less sensitive than that of the intact penis.<ref name="young">{{cite journal
| last = Young
| first = Hugh
| year = 2007
| month = July
| title = Fine touch pressure thresholds in the adult penis
| journal = BJU Int
| volume = 100
| issue = 3
| pages = 699
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/118508003/HTMLSTART
| doi = 10.1111/j.1464-410X.2007.07072_1.x
| pmid = 17669150
}}</ref>

Payne ''et al.'' (2007), in a study of the glans and shaft sensitivity of twenty circumcised and twenty uncircumcised men, reported that "No differences in genital sensitivity were found between the uncircumcised and circumcised groups." Payne ''et al''. did not test foreskin sensation.<ref name="payne2007">{{cite journal
| last = Payne
| first = Kimberley
| coauthors = Thaler, Lea; Kukkonen, Tuuli; Carrier, Serge; and [[Irving M. Binik|Binik, Yitzchak]]
| year = 2007
| month = May
| title = Sensation and sexual arousal in circumcised and uncircumcised men
| journal = J Sex Med
| volume = 4
| issue = 3
| pages = 667–674
| url = http://www.blackwell-synergy.com/doi/abs/10.1111/j.1743-6109.2007.00471.x
| pmid = 17419812
| doi = 10.1111/j.1743-6109.2007.00471.x
}}</ref>

===Foreskin sensation===

Winkelmann (1956) (1959) stated that the [[foreskin]] is sexually responsive and primary erogenous tissue.<ref>{{cite journal
| last = Winkelmann
| first = R.K.
| year = 1956
| month = January
| 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/
| pmid = 13295637
| doi=10.1038/jid.1956.5
}}</ref><ref>{{cite journal
| last = Winkelmann
| first = R.K.
| year = 1959
| month = January
| 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/
| pmid = 13645790}}</ref>

Circumcision amputates more than fifty percent of the skin and mucosa of the penis and invariably excises the heavily innervated [[ridged band]] at the end of the foreskin.<ref name="taylor" /> 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}}</ref><ref name="taylor">{{cite journal
| last = Taylor
| first = J.R.
| coauthors = A.P. Lockwood and A.J. Taylor
| year = 1996
| month = February
| title = The prepuce: Specialized mucosa of the penis and its loss to circumcision
| journal = British journal of urology
| volume = 77
| issue = 2
| pages = 291–295
| url = http://www.cirp.org/library/anatomy/taylor/
| pmid = 8800902
| doi=10.1046/j.1464-410X.1996.85023.x
}}</ref><ref name="taylorcold1999">{{cite journal
| last = Taylor
| first = J.R.
| coauthors = C.J. Cold
| year = 1999
| month = February
| title = The prepuce
| journal = British journal of urology
| volume = 83
| issue = Supplement 1
| pages = 34–44
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/119091418/PDFSTART
| format = PDF
| pmid =
}}</ref> {{Citation needed|date=August 2007}} — than the areas of the foreskin with smooth mucus membranes. <!-- commented out until someone can explain how blood vessels relate to sensitivity: and a rich blood supply (intense vascularity)--> 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.<ref name="taylor2">{{cite journal
| last = Taylor
| first = J.R.
| coauthors =
| year = 2000
| month = October
| title = Back and forth (letter)
| journal = Pediatric news
| volume = 34
| issue = 10
| pages = 50
| url = http://www.cirp.org/library/anatomy/taylor2/
| pmid =
}}</ref> This gliding action was also described by Lakshmanan (1980).<ref>{{cite journal
| last = Lakshmanan
| first = S
| coauthors = S. Parkash
| year = 1980
| month =
| title = Human prepuce: some aspects of structure and function
| journal = Indian journal of surgery
| volume = 44
| issue =
| pages = 134–137
| url = http://www.cirp.org/library/anatomy/lakshmanan/
| pmid =
}}</ref>

Boyle ''et al.'' (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref name="boyle2002">{{cite journal | last = Boyle | first = Gregory J. | coauthors = Gillian A. Bensley | year = 2001 | month = July | title = Adverse Sexual and Psychological Effects of Male Infant Circumcision | journal = Psychological reports | volume = 88 | issue = 3,Part 2 | pages = 1105–1106 | url = http://www.cirp.org/library/psych/boyle5/ | format = | pmid = 11597060 | doi = }}</ref> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

Schoen (2007) claims that "anecdotally, some have claimed that the foreskin is important for normal sexual activity and improves sexual sensitivity. Objective published studies over the past decade have shown no substantial difference in sexual function between circumcised and noncircumcised men."<ref>{{cite journal |author=Schoen EJ |title=Should newborns be circumcised?: YES |journal=Can Fam Physician |volume=53 |issue=12 |pages=2096–8, 2100–2 |year=2007 |month=December |pmid=18077736 |doi= |url=http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=18077736 |pmc=2231533}}</ref>

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="sorrells" /> This is disputed by Waskett & Morris, (2007) 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 (2007) criticizes Waskett & 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"/>

The College of Physicians and Surgeons of British Columbia (2009) has written that the [[foreskin]] "is rich in specialized sensory nerve endings and erogenous tissue."<ref>{{cite web
|url=https://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf
|title=Circumcision (Infant Male)
|author=College of Physicians and Surgeons of British Columbia
|accessdate=April 22, 2012
|format=PDF
|year=2009}}</ref> The [[Royal Australasian College of Physicians]] (2010) states that "the foreskin is a primary sensory part of the penis, containing some of the most sensitive areas of the penis. The effects of circumcision on sexual sensation however are not clear, with reports of both enhanced and diminished sexual pleasure following the procedure in adults and little awareness of advantage or disadvantage in those circumcised in infancy."<ref>{{cite journal
| author=Paediatrics & Child Health Division, The Royal Australasian College of Physicians
| authorlink=Royal Australasian College of Physicians
| year=2010
| month=September
| title=Circumcision of Infant Males
| format=PDF
| accessdate=April 22, 2012
| url=http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
| quote=}}</ref> The [[Royal Dutch Medical Association]] states that many sexologists view the foreskin as "a complex, erotogenic structure that plays an important role ‘in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation’."<ref>{{Cite web|title=Non-therapeutic circumcision of male minors (2010) |publisher=KNMG |date=12 June 2010 |url=http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm}}</ref>

==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">{{cite journal
| last = Shen
| first = Z
| coauthors = Chen S, Zhu C, Wan Q, Chen Z
| year = 2004
| month = January
| title = Erectile function evaluation after adult circumcision
| journal = Zhonghua Nan Ke Xue
| volume = 10
| issue = 1
| pages = 18–9
| pmid = 14979200
}}</ref> or decrease,<ref name="cortes2009"/><ref name= "richters2006">{{cite journal
| last = Richters
| first = J
| coauthors = Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK
| year = 2006
| title = Circumcision in Australia: prevalence and effects on sexual health
| journal = International Journal of Sexually Transmissible Diseases and AIDS
| volume = 17
| pages = 547–554
| url = http://www.cirp.org/library/general/richters1/
| pmid = 16925903
| issue = 8
| doi = 10.1258/095646206778145730
}}</ref><ref name="Laumann1997"/> in erectile dysfunction among circumcised men, while other studies have shown little to no effect.<ref name="masood2005"/><ref name="krieger2008">{{cite journal |author=Krieger JN, Mehta SD, Bailey RC, ''et al.'' |title=Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya |journal=The journal of sexual medicine |volume= 5|issue= 11|pages= 2610–22|year=2008 |month=August |pmid=18761593 |doi=10.1111/j.1743-6109.2008.00979.x |url= |pmc=3042320}}</ref><ref name="senkul2004"/><ref name = "Collins2002">{{cite journal
| last = Collins
| first = S
| coauthors = Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P
| year = 2002
| title = Effects of circumcision on male sexual function: debunking a myth?
| journal = Journal of Urology
| volume = 167
| pages = 2111–2112
| url = http://www.circs.org/library/collins/
| doi = 10.1016/S0022-5347(05)65097-5
| pmid = 11956452
| issue = 5
}}</ref><ref name = "kigozi2007">{{cite journal
| last = Kigozi
| first = G
| coauthors = Watya S, Polis CB, Buwembo D, Kiggundu V, Wawer MJ, Serwadda D, Nalugoda F, Kiwanuka N, Bacon MC, Ssempijja V, Makumbi F, Gray RH.
| year = 2007
| month = January
| title = The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda
| journal = [[British Journal of Urology|BJU International]]
| volume = 101
| issue = 1
| pages = 65–70
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/119420541/PDFSTART
| format = PDF
| pmid = 18086100
| doi = 10.1111/j.1464-410X.2007.07369.x
}}</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/>

Kim and Pang reported no significant difference in erection.<ref name="kimpang2006">{{cite journal
| last = Kim
| first = DaiSik
| coauthors = Myung-Geol Pang
| year = 2007
| month = March
| title = The effect of male circumcision on sexuality
| journal = BJU International
| volume = 99
| issue = 3
| pages = 619–622
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/118508378/PDFSTART
| format = PDF
| pmid = 17155977
| doi = 10.1111/j.1464-410X.2006.06646.x
}}</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"/>

Cortés-González ''et al.'' reported a statistically significant improvement in erectile function following circumcision (p=0.0007).<ref name="cortes2009"/>

Frisch ''et al.'' found no statistically significant differences in erectile function between circumcised and uncircumcised men.<ref name = "Frisch2011"/>

==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">{{cite journal
| last = Waldinger
| first = M.D.
| coauthors = Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M
| year = 2005
| title = Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
| journal = Journal of Sexual Medicine
| volume = 2
| pages = 492–497
| url = http://www3.interscience.wiley.com/journal/118719267/abstract
| doi = 10.1111/j.1743-6109.2005.00070.x
| pmid = 16422843
| issue = 4
}}</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="sorrells"/>

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"/>

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">{{cite journal
| last = Senkul
| first = T
| coauthors = C. Iseri, B. Sen, K. Karademir, F. Saracoglu and D. Erden
| year = 2004
| title = Circumcision in Adults: Effect on Sexual Function
| journal = Urology
| pmid = 14751371
| volume = 63
| pages = 155–8
| url = http://www.circs.org/library/senkul/
| doi = 10.1016/j.urology.2003.08.035
| issue=1
}}</ref>

In a study of men circumcised for benign disease, Masood ''et al.' (2005)' reported that of those who stated they had prior premature ejaculation, 13% reported improvement after circumcision, 33% reported that it became worse, and 53% reported no change.<ref name="masood2005"/>

In a telephone survey (2006) of 10,173 Australian men, 22% of uncircumcised men and 26% of circumcised men reported reaching orgasm too quickly for at least one month in the previous year. The difference was not statistically significant.<ref name="richters2006"/>

In a study (2006) of 255 circumcised men and 118 uncircumcised men, Kim and Pang reported no statistically significant difference in ejaculation or ejaculation latency time between circumcised and uncircumcised participants.<ref name="kimpang2006"/>

Kigozi ''et al.'' (2007) reported that, in a randomised controlled trial of 4,456 men of whom 2,474 were selected to be circumcised, the authors did not find a statistically significant effect on premature ejaculation.<ref name="kigozi2007"/>

Krieger ''et al.' (2007)' reported on a randomised controlled trial of 2,784 participants, of whom 1,391 were randomised to be circumcised. 54.5% of circumcised men described their ease of reaching orgasm as "much more" at 24 months after randomisation.<ref name="krieger2008"/>

In a study of 22 men circumcised as adults, Cortés-González ''et al.'' (2009) reported that 31.8% suffered from premature ejaculation before the procedure; this diminished to 13.6% afterwards.<ref name="cortes2009"/>

Frisch ''et al.'' (2011) studied participants in a Danish national health survey, and found that circumcised men were equally likely to report "occasional" orgasm difficulties (29% v 32%), but were more likely to report "frequent" orgasm difficulties (11% v 4%); the difference remained after adjustment for potential confounding factors. Premature ejaculation was not associated with circumcision status.<ref name = "Frisch2011"> {{cite journal |author=Frisch M, Lindholm M, Grønbæk M |title=Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark |journal=Int J Epidemiol. |volume = Epub ahead of print |issue= |pages= |year=2011 |month=June |pmid=21672947 |doi= 10.1093/ije/dyr104|url=http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.abstract}}</ref>

== Sexual practice and masturbation ==
In a study by Korean researchers of 255 men circumcised after the age of 20 and 18 who were not circumcised, Kim and Pang reported that masturbatory pleasure decreased in 48% of the respondents and increased in 8%. [[Masturbation|Masturbatory]] difficulty increased in 63% but was easier in 37%. They concluded that there was a decrease in masturbatory pleasure after circumcision.<ref name="kimpang2006"/>

Laumann ''et al.'' reported that circumcised men in their survey displayed a greater rates of experience of various sexual practices, including oral sex, anal sex, and masturbation.<ref name = "Laumann1997">{{cite journal
| last = Laumann
| first = E.O.
| coauthors = C.M. Masi and E.W. Zuckerman
| year = 1997
| title = Circumcision in the United States: prevalence, prophylactic effects, and sexual practice
| journal = [[Journal of the American Medical Association|JAMA]]
| volume = 277
| pages = 1052–7
| url = http://www.circs.org/library/laumann/
| doi = 10.1001/jama.277.13.1052
| issue=13
| pmid=9091693
}}</ref> For example, among whites the "estimated ratio of the odds of masturbating at least once a month for circumcised men was 1.76 that for uncircumcised men." Dr. Laumann provides two explanations for the difference in sexual practices. "One is that uncircumcised men, a minority in this country, may feel a stigma that inhibits them. Another is that circumcision reduces sensitivity in the penis, leading circumcised men to try a range of sexual activities."<ref>Study Is Adding to Doubts About Circumcision
By SUSAN GILBERT
Published: April 2, 1997. New York Times. [http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C07E4D91F3AF931A35757C0A961958260]</ref>

Fink ''et al.'' did not find a change in sexual activity with adult circumcision (p=0.22).<ref name = "fink2002"/>

== Sexual drive ==
Several studies have investigated the effect of circumcision on sexual drive. Studies that did not find a statistically significant difference include Kim and Pang,<ref name="kimpang2006"/> Collins ''et al.'',<ref name="Collins2002"/> Senkul ''et al.'',<ref name="senkul2004"/> Cortés-González ''et al.'',<ref name="cortes2009"/> and Frisch ''et al.''<ref name = "Frisch2011"/>

== Satisfaction ==
Kim and Pang found that 20% reported that their sex life was worse after circumcision and 6% reported that it had improved. They concluded that "there was a decrease ... sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings."<ref name="kimpang2006"/>

Masood ''et al.'', in their study mentioned earlier of men circumcised for benign disease, found that 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.<ref name=masood2005/>

Krieger ''et al.'' reported that in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya, in which 1,391 men elected to be circumcised, more than 99% were "satisfied" with their circumcisions.<ref name="krieger2008"/>

Kigozi ''et al.'' reported finding "no trend in satisfaction among circumcised men". The authors concluded that "[a]dult male circumcision does not adversely affect sexual satisfaction or clinically significant function in men".<ref name="kigozi2007"/>

Shen ''et al.'' reported that adult circumcision appeared to result in improved satisfaction in 34 cases (of 95 adults being circumcised), the association was statistically significant.<ref name="shen2004"/>

Senkul ''et al.'' reported that they did not find a statistically significant difference in BMSFI satisfaction scores in their study of 42 adult circumcision patients.<ref name="senkul2004"/>

Collins ''et al.'' reported on a study of 15 adult circumcision patients. No statistically significant difference in BMSFI scores was observed.<ref name="Collins2002"/>

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"/>

Cortés-González ''et al.'' found no statistically significant differences in terms of overall sexual satisfaction (p=0.15), pain during intercourse (p=0.23), or enjoyment of intercourse (p=0.32).<ref name="cortes2009"/>

Frisch ''et al.'' reported that circumcised and uncircumcised men were "equally likely to report incomplete sexual needs fulfilment in the last year".<ref name = "Frisch2011"/>

Peterson reported that, after adult circumcision, 46.4% of men were "very satisfied", 50% were "satisfied" and 3.5% were "very dissatisfied".<ref name="peterson">{{cite journal |title=Elective, adult circumcision does not affect patient perception of sexual health as defined by the Male Sexual Health Questionnaire (MSHQ) |author=A C Peterson |journal=Journal of men's health |year=2010 |volume=7 |issue=4 |pages=368&ndash;372 |doi=10.1016/j.jomh.2010.09.225}}</ref>

==Female preferences and response==
A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised.<ref>{{cite journal
| last = Bensley
| first = Gillian A.
| coauthors = Gregory J. Boyle
| year = 2003
| month = September
| title = Effects of male circumcision on female arousal and orgasm
| journal = New Zealand medical journal
| volume = 116
| issue = 1181
| pages = 595–596
| url = http://www.nzma.org.nz/journal/116-1181/595/
| format =
| pmid = 14581975
}}</ref> Cortés-González ''et al.'' studied 19 female partners of men scheduled for circumcision. They reported a significant reduction in vaginal lubrication following circumcision, from 78% to 63%, but found no statistically significant differences in "general sexual satisfaction, pain during vaginal penetration, desire, [or] vaginal orgasm".<ref>{{cite journal |author=Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS |title=[Does circumcision has an effect on female's perception of sexual satisfaction?] |language=Spanish; Castilian |journal=Rev. Invest. Clin. |volume=60 |issue=3 |pages=227–30 |year=2008 |pmid=18807735 |doi= |url=}}</ref>

Kigozi ''et al.'' reported on a prospective study of 455 female partners of men circumcised as part of a randomised trial. 39.8% reported improved sexual satisfaction following circumcision, 57.3% reported no change, and 2.9% reported reduced sexual satisfaction after their partners were circumcised.<ref>{{cite journal |author=Kigozi G, Lukabwe I, Kagaayi J, ''et al.'' |title=Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai, Uganda |journal=BJU Int. |volume= 104|issue= 11|pages= 1698–701|year=2009 |month=June |pmid=19522862 |doi=10.1111/j.1464-410X.2009.08683.x |url=}}</ref>

Williamson ''et al.'' (1988) studied randomly selected young mothers in Iowa, where most men are circumcised, and found that 76% would prefer a circumcised penis for achieving sexual arousal through viewing it.<ref>[http://www.circs.org/library/williamson/index.html Williamson ML, Williamson PS. Women's Preferences for Penile Circumcision in Sexual Partners.] J Sex Educ Ther 1988; 14: 8</ref> Wildman and Wildman (1976) surveyed 55 young women in Georgia, US, reporting that 47 (89%) of respondents preferred the circumcised penis (the remainder preferred the uncircumcised penis).<ref>{{cite journal |title=Note on males' and females' preferences for opposite-sex body parts, bust sizes, and bust-revealing clothing |journal=Psychological Reports |year=1976 |volume=38 |pages=485&ndash;6 |url=http://circs.org/library/wildman/index.html |pmid=1265180 |issue=2 |author=Wildman RW, Wildman RW, Brown A, Trice C |doi=10.2466/pr0.1976.38.2.485}}</ref> Bailey et al. report that there is a preference by women for circumcised men, mentioning that the circumcised penis enters a woman more easily and is less likely to cause injury to the vagina.<ref>AIDS Care. 2002 Feb;14(1):27-40. The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. Bailey RC, Muga R, Poulussen R, Abicht H. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11798403&dopt=Abstract]</ref>{{Verify source|date=October 2008}}

Frisch ''et al.'' (2011) studied participants in a Danish national health survey, and found that male circumcision was associated "with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment."<ref name="Frisch2011" />

==Summary of research findings==

{| class="wikitable"
! scope="col" | Study
! scope="col" | Design
! scope="col" | Peer reviewed
! scope="col" | Sample size
! scope="col" | Finding
! scope="col" | Significant¹
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Sexual drive
|-
! scope="row" | Collins (2002)<ref name = "Collins2002"/>
| Prospective; adult circumcision patients
| Yes || 15 || No difference found || No; p > 0.68
|-
! scope="row" | Senkul (2004)<ref name = "senkul2004"/>
| Prospective; adult circumcision patients
| Yes || 42 || No difference found || No; p = 0.32
|-
! scope="row" | Kim and Pang (2006)<ref name = "kimpang2006"/>
| Prospective; adult circumcision patients
| Yes || 373 || No difference found || Not stated
|-
! scope="row" | Senol (2008)<ref name="senol2008">{{cite journal |author=Senol MG, Sen B, Karademir K, Sen H, Saraçoğlu M |title=The effect of male circumcision on pudendal evoked potentials and sexual satisfaction |journal=Acta Neurol Belg |volume=108 |issue=3 |pages=90–3 |year=2008 |month=September |pmid=19115671 |doi= |url=}}</ref>
| Prospective; adult circumcision patients
| Yes || 43 || No difference found || No; p = 0.11
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Erectile function
|-
! scope="row" | Fink (2002)<ref name = "fink2002"/>
| Cross-sectional; adult circumcision patients
| Yes || 40 || Worse after circumcision || Yes; p = 0.01
|-
! scope="row" | Collins (2002)<ref name = "Collins2002"/>
| Prospective; adult circumcision patients
| Yes || 15 || No difference found || No; p > 0.96
|-
! scope="row" | Senkul (2004)<ref name = "senkul2004"/>
| Prospective; adult circumcision patients
| Yes || 42 || No difference found || No; p = 0.89
|-
! scope="row" | Masood (2005)<ref name= "masood2005"/>
| Not stated; adult circumcision patients
| Yes || 88 || No difference found || No; p = 0.40
|-
! scope="row" | Shen (2004)<ref name = "shen2004"/>
| Not stated; adult circumcision patients
| Yes || 95 || Worse after circumcision || Yes; p = 0.001
|-
! scope="row" | Laumann (1997)<ref name = "Laumann1997"/>
| National probability study
| Yes || 1410 || Better in circumcised males || Yes; p < 0.10
|-
! scope="row" | Richters (2006)<ref name= "richters2006"/>
| Telephone survey
| Yes || 10,173 || Better in circumcised males || Yes; p=0.022
|-
! scope="row" | Kim and Pang (2006)<ref name = "kimpang2006"/>
| Prospective; adult circumcision patients
| Yes || 373 || No difference found || Not stated
|-
! scope="row" | Senol (2008)<ref name="senol2008"/>
| Prospective; adult circumcision patients
| Yes || 43 || No difference found || No; p = 0.23
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Ejaculation
|-
! scope="row" | Collins (2002)<ref name = "Collins2002"/>
| Prospective; adult circumcision patients
| Yes || 15 || No difference found || No; p > 0.48
|-
! scope="row" | Senkul (2004)<ref name = "senkul2004"/>
| Prospective; adult circumcision patients
| Yes
| 42 || No difference found in BMSFI (Brief Male Sexual Function Inventory)<br>Greater time to ejaculate after circumcision
| No; p = 0.85<br>Yes; p = 0.02
|-
! scope="row" | Shen (2004)<ref name = "shen2004"/>
| Not stated; adult circumcision patients
| Yes || 95 || Greater time to ejaculate after circumcision || Yes; p=0.04
|-
! scope="row" | Laumann (1997)<ref name = "Laumann1997"/>
| National probability study
| Yes || 1410 || Circumcised men less likely to ejaculate prematurely || Yes; p < 0.10
|-
! scope="row" | Waldinger (2005)<ref name = "Waldinger2005"/>
| Multinational, stopwatch assessment
| Yes || 500 || No difference found || No
|-
! scope="row" | Richters (2006)<ref name= "richters2006"/>
| Telephone survey
| Yes || 10,173 || Circumcised men more likely to ejaculate prematurely || No; p = 0.11
|-
! scope="row" | Senol (2008)<ref name="senol2008"/>
| Prospective; adult circumcision patients
| Yes || 43 || No difference found in BMSFI<br>Greater time to ejaculate after circumcision|| No; p = 0.48<br>Yes; p = 0.001
|-
! scope="row" | Frisch (2011)<ref name = "Frisch2011"/>
| National health survey
| Yes || 2345<br>(2220 uc, 125 c) || Circumcised men more likely to report frequent orgasm difficulties || Yes; p < 0.05
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Penile sensation
|-
! scope="row" | Fink (2002)<ref name = "fink2002"/>
| Cross-sectional, adult circumcision patients
| Yes || 40 || Worse after circumcision || No; p = 0.08
|-
! scope="row" | Masood (2005)<ref name= "masood2005"/>
| Not stated; adult circumcision patients
| Yes || 88 || Better after circumcision in 38%, worse in 18% || Yes; p = 0.01
|-
! scope="row" | Denniston (2004), cited by Denniston (2004)<ref name= "Dennniston2004">{{cite journal
| doi = 10.1016/j.urology.2004.03.059
| last = Denniston
| first = G.C
| pmid = 15596221
| coauthors = Hill G
| year = 2006
| title = Circumcision in adults: effect on sexual function
| journal = Urology
| volume = 64
| pages = 1267
| url = http://www.cirp.org/library/sex_function/denniston3/
| issue=6
}}</ref>
| Not stated; survey of males circumcised in adulthood
| No || 38 || Better after circumcision in 34%, worse in 58% || Not stated
|-
! scope="row" | Masters (1966)<ref name="masters1966"/>
| Neurologic testing; subjects matched for age
| No || 70<br>(35 c, 35 uc)² || No difference found || Not stated
|-
! scope="row" | Bleustein (2003)<ref name = "bleustein2003"/>
| Quantitative somatosensory testing
| No || 79<br>(36 c, 43 uc)² || No difference found when controlled for other variables || No; p = 0.08
|-
! scope="row" | Bleustein (2005)<ref name= "bleustein2005"/>
| Quantitative somatosensory testing
| Yes || 125<br>(63 c, 62 uc)² || No difference found when controlled for other variables || No
|-

! scope="row" | Yang (2008)<ref name = "yang2008">
{{Cite journal
| last = Yang
| first = DM
| authorlink =
| coauthors = Lin H, Zhang B, Guo W
| title = Circumcision affects glans penis vibration perception threshold
| journal = Zhonghua Nan Ke Xue
| volume = 14
| issue = 4
| pages = 328–330
| publisher = Nanjing Jun Qu Nanjing Zong Yi Yuan zhu ban, Zhonghua Nan Ke Xue Za Zhi Bian Ji Bu bian ji chu ban
| location = China
| date = April 2008
| pmid = 18481425 }}
</ref>
| Used biological vibration measurement instrument to determine sensitivity
| Yes || 169 (73 uc, 96 c) || Worse after circumcision || Yes; p < 0.05
|-
! scope="row" | Payne (2007)<ref name="payne2007"/>
| Sensory testing to determine sensitivity to touch and pain
| Yes || 40 (20 uc, 20 c) || No difference found || No
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Overall satisfaction
|-
! scope="row" | Fink (2002)<ref name = "fink2002"/>
| Cross-sectional; adult circumcision patients
| Yes || 40 || Better after circumcision || Yes; p=0.04
|-
! scope="row" | Collins (2002)<ref name = "Collins2002"/>
| Prospective; adult circumcision patients
| Yes || 15 || No difference found || No; p > 0.72
|-
! scope="row" | Senkul (2004)<ref name = "senkul2004"/>
| Prospective; adult circumcision patients
| Yes || 42 || No difference found || No; p=0.46
|-
! scope="row" | Masood (2005)<ref name= "masood2005"/>
| 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 one patient in this group had any obvious post-operative complications (bleeding)."
| Not stated
|-
! scope="row" | Shen (2004)<ref name = "shen2004"/>
| Not stated; adult circumcision patients
| Yes || 95 || Improved satisfaction in 34 cases || Yes; p = 0.04
|-
! scope="row" | Kim and Pang (2006)<ref name = "kimpang2006"/>
| Prospective; adult circumcision patients
| Yes || 373 || Better after circumcision in 6%, worse in 20% || Yes; p < 0.05
|-
! scope="row" | Kigozi (2007)<ref name = "kigozi2007"/>
| Randomised trial; adult circumcision patients
| Yes || 4456 || "no trend in satisfaction among circumcised men" || No; p = 0.8
|-
! scope="row" | Senol (2008)<ref name="senol2008"/>
| Prospective; adult circumcision patients
| Yes || 43 || No difference found || No; p = 0.07
|}

Notes:
# If stated, author's analysis is used. Otherwise, significance is considered to be p <= 0.05.
# c = circumcised; uc = uncircumcised.

==See also==
*[[Foreskin]]
*[[Erection]]
*[[Circumcision]]
*[[Ridged band]]

==References==
{{Reflist}}

<!-- commented out due to not being used in the article:

* Denniston GC, Hill G (2004) [http://www.cirp.org/library/sex_function/denniston3/ Circumcision in adults: effect on sexual function]. ''Urology'', '''64'''(6);1267.
-->

{{Circumcision series}}

[[Category:Circumcision]]

Latest revision as of 04:09, 23 December 2018

Redirect to:

Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Sexual_effects_of_circumcision&oldid=875009656"