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| Sensory testing to determine fine-touch pressure thresholds
| Sensory testing to determine fine-touch pressure thresholds
| Yes || 159 (68 uc, 91 c) || Glans of uncircumcised penis had significantly lower mean pressure thresholds at 0.161 (0.078) g. The five penile areas most sensitive to fine-touch are located on the foreskin.|| Yes p = 0.040 (glans)
| Yes || 159 (68 uc, 91 c) || Glans of uncircumcised penis had significantly lower mean pressure thresholds at 0.161 (0.078) g. The five penile areas most sensitive to fine-touch are located on the foreskin.|| Yes p = 0.040 (glans)
|-
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Overall satisfaction
| colspan="7" style="bgcolor: #f2f2f2; font-weight: bold;" | Overall satisfaction
|-
|-

Revision as of 16:01, 11 August 2012

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.[1] 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."[2] 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—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".[3]

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.[4] 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).[5]

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."[6] 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).[7]

Glans sensitivity

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."[8] Sorrells et al. criticised this early study for being poorly documented and not subject to peer review.[9] 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." [2]

Yang et al. (1998) 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."[10]

An examination of 7 circumcised and 6 uncircumcised 60-96 year-old male cadavers found no difference in keratinization of the glans penis.[11] Bleustein et al. (2003) tested the sensitivity of the glans penis, and found no difference between circumcised and uncircumcised men.[12] Bleustein et al. (2005) divided 125 patients (62 uncircumcised men and 63 neonatally circumcised men) into groups based on their sexual dysfunction using the 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 uncircumcised men (56 +/- 13 years). When controlling for age, hypertension, and diabetes, there was no difference in sensitivity.[13]

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."[9] In a letter to BJU International, however, on the basis of the unadjusted data, Waskett and Morris stated "we find no significant differences [...], consistent with previous findings."[14] However, in a further letter to BJU International, Young responded to Waskett and 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.[15]

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."[16]

Foreskin sensitivity

The College of Physicians and Surgeons of British Columbia has written that the foreskin "is rich in specialized sensory nerve endings and erogenous tissue."[17] The Royal Australasian College of Physicians 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."[18] 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’."[19] Some researchers have also stated that the foreskin is sexually responsive.[20][21][22][23]

Circumcision removes the ridged band at the end of the foreskin.[22] 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 [citation needed] — 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.[24] This gliding action was also described by Lakshmanan (1980).[25]

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.[9] 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.[14] 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.[15] 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.[26] It must be noted here that only 11 of the 81 participants actually had a foreskin, so it is bound to rank low as only a small fraction of the participants can report it being high on their list of most sensitive regions.

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—many of which are lost to circumcision."[27] They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

Erectile function

Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have variously found a statistically significant increase,[5][28] or decrease,[7][29][30] in erectile dysfunction among circumcised men, while other studies have shown little to no effect.[4][31][32][33][34][35]

Fink et al., in an American study of 123 men, found that medically necessitated circumcision resulted in worsened erectile function (p=0.01).[5]

Kim and Pang reported no significant difference in erection.[35]

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).[30]

Cortés-González et al. reported a statistically significant improvement in erectile function following circumcision (p=0.0007).[7]

Frisch et al. found no statistically significant differences in erectile function between circumcised and uncircumcised men.[36]

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 median IELT varied between countries, with the median value for Turkey being the lowest, i.e., 3.7 minutes (0.9–30.4 minutes), which was significantly different from each of the other countries. Comparison of circumcised (N = 98) and not-circumcised (N = 261) men in countries excluding Turkey resulted in median IELT values of 6.7 minutes (0.7–44.1 minutes) in circumcised compared with 6.0 minutes (0.5–37.4 minutes) in not-circumcised men (not significant). The median IELT value was not affected by condom use. They concluded: The IELT distribution is positively skewed. The overall median value was 5.4 minutes but with differences between countries. For all five countries, median IELT values were independent of condom usage. In countries excluding Turkey, the median IELT values were independent of circumcision status. .[37] 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]."[9]

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.[33]

In a study of 42 Turkish men, 39 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.[32]

In a telephone survey 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.[29]

Kigozi et al. 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.[34]

Krieger et al. 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.[31]

In a study 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.[35]

In a study of men circumcised for benign disease, Masood et al. 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.[4]

In a study of 22 men circumcised as adults, Cortés-González et al. reported that 31.8% suffered from premature ejaculation before the procedure; this diminished to 13.6% afterwards.[7]

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.[36]

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%. Masturbatory difficulty increased in 63% but was easier in 37%. They concluded that there was a decrease in masturbatory pleasure after circumcision.[35]

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.[30] 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."[38]

Fink et al. did not find a change in sexual activity with adult circumcision (p=0.22).[5]

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,[35] Collins et al.,[33] Senkul et al.,[32] Cortés-González et al.,[7] and Frisch et al.[36]

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."[35]

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.[4]

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.[31]

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".[34]

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.[28]

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.[32]

Collins et al. reported on a study of 15 adult circumcision patients. No statistically significant difference in BMSFI scores was observed.[33]

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.[5]

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).[7]

Frisch et al. reported that circumcised and uncircumcised men were "equally likely to report incomplete sexual needs fulfilment in the last year".[36]

Peterson reported that, after adult circumcision, 46.4% of men were "very satisfied", 50% were "satisfied" and 3.5% were "very dissatisfied".[39]

Female preferences and response

O'Hara and O'Hara found that women with intact partners reported higher likeliness of orgasms and a reduction in vaginal dryness. They conclude "women preferred vaginal intercourse with an anatomically complete penis over that with a circumcised penis" and argue that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman's overall clitoral stimulation and helping her achieve orgasm more quickly and more often.[40] A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised.[41] 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".[42]

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.[43]

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.[44] 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).[45] 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.[46][verification needed]

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."[36]

Summary of research findings

Study Design Peer reviewed Sample size Finding Significant¹
Sexual drive
Collins (2002)[33] Prospective; adult circumcision patients Yes 15 No difference found No; p > 0.68
Senkul (2004)[32] Prospective; adult circumcision patients Yes 42 No difference found No; p = 0.32
Kim and Pang (2006)[35] Prospective; adult circumcision patients Yes 373 No difference found Not stated
Senol (2008)[47] Prospective; adult circumcision patients Yes 43 No difference found No; p = 0.11
Erectile function
Fink (2002)[5] Cross-sectional; adult circumcision patients Yes 40 Worse after circumcision Yes; p = 0.01
Collins (2002)[33] Prospective; adult circumcision patients Yes 15 No difference found No; p > 0.96
Senkul (2004)[32] Prospective; adult circumcision patients Yes 42 No difference found No; p = 0.89
Masood (2005)[4] Not stated; adult circumcision patients Yes 88 No difference found No; p = 0.40
Shen (2004)[28] Not stated; adult circumcision patients Yes 95 Worse after circumcision Yes; p = 0.001
Laumann (1997)[30] National probability study Yes 1410 Better in circumcised males Yes; p < 0.10
Richters (2006)[29] Telephone survey Yes 10,173 Better in circumcised males Yes; p=0.022
Kim and Pang (2006)[35] Prospective; adult circumcision patients Yes 373 No difference found Not stated
Senol (2008)[47] Prospective; adult circumcision patients Yes 43 No difference found No; p = 0.23
Ejaculation
Collins (2002)[33] Prospective; adult circumcision patients Yes 15 No difference found No; p > 0.48
Senkul (2004)[32] Prospective; adult circumcision patients Yes 42 No difference found in BMSFI (Brief Male Sexual Function Inventory)
Greater time to ejaculate after circumcision 		No; p = 0.85
Yes; p = 0.02
Shen (2004)[28] Not stated; adult circumcision patients Yes 95 Greater time to ejaculate after circumcision Yes; p=0.04
Laumann (1997)[30] National probability study Yes 1410 Circumcised men less likely to ejaculate prematurely Yes; p < 0.10
Waldinger (2005)[37] Multinational, stopwatch assessment Yes 500 No difference found No
Richters (2006)[29] Telephone survey Yes 10,173 Circumcised men more likely to ejaculate prematurely No; p = 0.11
Senol (2008)[47] Prospective; adult circumcision patients Yes 43 No difference found in BMSFI
Greater time to ejaculate after circumcision		 No; p = 0.48
Yes; p = 0.001
Frisch (2011)[36] National health survey Yes 2345
(2220 uc, 125 c)		 Circumcised men more likely to report frequent orgasm difficulties Yes; p < 0.05
Penile sensation
Fink (2002)[5] Cross-sectional, adult circumcision patients Yes 40 Worse after circumcision No; p = 0.08
Masood (2005)[4] 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)[48] Not stated; survey of males circumcised in adulthood No 38 Better after circumcision in 34%, worse in 58% Not stated
Masters (1966)[8] Neurologic testing; subjects matched for age No 70
(35 c, 35 uc)²		 No difference found Not stated
Bleustein (2003)[12] Quantitative somatosensory testing No 79
(36 c, 43 uc)²		 No difference found when controlled for other variables No; p = 0.08
Bleustein (2005)[13] Quantitative somatosensory testing Yes 125
(63 c, 62 uc)²		 No difference found when controlled for other variables No
Yang (2008)[49] Used biological vibration measurement instrument to determine sensitivity Yes 169 (73 uc, 96 c) Worse after circumcision Yes; p < 0.05
Payne (2007)[16] Sensory testing to determine sensitivity to touch and pain Yes 40 (20 uc, 20 c) No difference found (Foreskin sensitivity not tested) No
Sorrells (2007)[9] Sensory testing to determine fine-touch pressure thresholds Yes 159 (68 uc, 91 c) Glans of uncircumcised penis had significantly lower mean pressure thresholds at 0.161 (0.078) g. The five penile areas most sensitive to fine-touch are located on the foreskin. Yes p = 0.040 (glans)
Overall satisfaction
Fink (2002)[5] Cross-sectional; adult circumcision patients Yes 40 Better after circumcision Yes; p=0.04
Collins (2002)[33] Prospective; adult circumcision patients Yes 15 No difference found No; p > 0.72
Senkul (2004)[32] Prospective; adult circumcision patients Yes 42 No difference found No; p=0.46
Masood (2005)[4] 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
Shen (2004)[28] Not stated; adult circumcision patients Yes 95 Improved satisfaction in 34 cases Yes; p = 0.04
Kim and Pang (2006)[35] Prospective; adult circumcision patients Yes 373 Better after circumcision in 6%, worse in 20% Yes; p < 0.05
Kigozi (2007)[34] Randomised trial; adult circumcision patients Yes 4456 "no trend in satisfaction among circumcised men" No; p = 0.8
Senol (2008)[47] Prospective; adult circumcision patients Yes 43 No difference found No; p = 0.07

Notes:

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

See also

References

  1. ^ "Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision". Pediatrics. 103 (3): 686–93. 1999. doi:10.1542/peds.103.3.686. PMID 10049981. {{cite journal}}: Unknown parameter |month= ignored (help)
  2. ^ a b "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. Retrieved 2007-01-30.
  3. ^ Boyle, Gregory J (2002). "Male circumcision: pain, trauma, and psychosexual sequelae". Bond University Faculty of Humanities and Social Sciences. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ a b c d e f g Masood, S (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?". Urol Internationalalis. 75 (1): 62–6. doi:10.1159/000085930. PMID 16037710. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ a b c d e f g h Fink, K.S. (2002). "Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction". Journal of Urology. 167 (5): 2113–6. doi:10.1016/S0022-5347(05)65098-7. PMID 11956453. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  6. ^ Krieger, JN (2008). "Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya". The journal of sexual medicine. 5 (11): 2610–22. doi:10.1111/j.1743-6109.2008.00979.x. PMC 3042320. PMID 18761593. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  7. ^ a b c d e f Cortés-González JR, Arratia-Maqueo JA, Martínez-Montelongo R, Gómez-Guerra LS (2009). "DOES CIRCUMCISION AFFECT MALE'S PERCEPTION OF SEXUAL SATISFACTION?". Arch. Esp. Urol. 62 (9): 733–736. PMID 19955598. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ a b Masters, W.H. (1966). Human Sexual Response. Toronto; New York: Bantam Books. ISBN 0-553-20429-7. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ a b c d e Sorrells, Morriss L. (2007). "Fine-touch pressure thresholds in the adult penis" (PDF). BJU International. 99 (4): 864–869. doi:10.1111/j.1464-410X.2006.06685.x. PMID 17378847. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  10. ^ Yang, CC (1998). "Neuroanatomy of the penile portion of the human dorsal nerve of the penis". British Journal Urology. 82 (1): 109–113. doi:10.1046/j.1464-410x.1998.00669.x. PMID 9698671. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  11. ^ Szabo, Robert (2000). "How does male circumcision protect against HIV infection?" (PDF). BMJ. 320 (7249): 1592–1594. doi:10.1136/bmj.320.7249.1592. PMC 1127372. PMID 10845974. Retrieved 2006-07-09. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  12. ^ a b Bleustein, Clifford B. (April 26-May 1, 2003). "Effects of Circumcision on Male Penile Sensitivity". American Urological Association 98th Annual Meeting. Chicago, Illinois. {{cite conference}}: Check date values in: |date= (help); Unknown parameter |booktitle= ignored (|book-title= suggested) (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ a b Bleustein, Clifford B. (2005). "Effect of neonatal circumcision on penile neurologic sensation". Urology. 65 (4): 773–7. doi:10.1016/j.urology.2004.11.007. PMID 15833526. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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