For simplicity, this page may now be cited as www.circumstitions.com/sex.

The Foreskin

• The ridged band of the foreskin
• Garcia-Mesa et al. - Meissner's corpuscles
• Touch sensitivity
  • Sorrells et al. - first to test the foreskin A poster about the Sorrells study
  • Bossio et al. -  measured only the outside, ignored their own finding

First-person accounts:

• Men's experience
• Women's experience

The effect of circumcision on sex

• A man's first person account
• "If I had any more sensitivity..."
  
• "...I can still reach orgasm" (Now on their own page)

Science

• A Danish study, Frisch et al. - circumcision impairs sex
• A Belgian survey, Bronselaer, et al. - circumcision impairs sex
• Masters and Johnson - ignored the foreskin
• Hite - mechanical
• Bleustein et al. - ignored the foreskin
• Payne et al. - ignored the foreskin
• Schober et al. - based on self-reports, dance around the elephant in the room
• Laumann et al. - misreported
• Bossio et al. (2017) - plays down the obvious

• Shen et al.
• Gray et al.
• Bailey et al.
• Senol et al.
• Yang - circumcision desentisies the glans
• Dias et al.
• Namavar et al. - admit that the foreskin is erogenous
  

• The O'Haras
• The Williamsons
• Gray et al.
• Bossio et al. - selection bias, small sample, overinterpretation

• Men circumcised as adults
  
• Men who have restored their foreskins
  
• Gay men
  • Docking

• Morris et al. - compound all the others' faults
• Cox et al. (inc. Morris) -  usual bias

... the type, not just the amount, of skin lost to routine male circumcision is often overlooked. Anatomically and physiologically, the skin of the penis is designed to activate the male sexual reflex mechanism. To perform this interesting function it is richly endowed with smooth muscle fibres that cause its upper, (sexual contact) surface to 'firm up' and wrinkle - and become much more frictional - during erection.

During vaginal intromission these conformational changes in penile skin ensure stretching of ridged band and reflex contraction of bulb muscles .

In short, the penile skin behaves in exactly the same way, during erection, as scrotal skin. Almost certainly, uniquely-structuresd penile and scrotal skin play an important role in activating and moderating erogenous sensation and sexual reflexes for ejacuation. As far as I know, there is no female equivalent.

In short, male circumcision completely alters the way male sexual sensations and reflexes are generated during vaginal intercourse.

- John Taylor

What happens with me is that during entry into the vagina, the labia minora (inner vaginal lips) catches the foreskin and retracts it behind the ridge of the glans. That's where it stays until intercourse is complete and the erection subsides. My partner tells me that this is the normal course of events if the foreskin does not retract on its' own when it becomes erect. The labia minora are so shaped as to catch under the edge of the foreskin, which is usually partially retracted, and push it back. The exposed glans is then exposed to the full friction of the vaginal walls when thrusting.

European porn actor Mario Rossi:

Rossi: You know what? European girls know how to suck the European c ck. They are soft and nice and gentle and they know that. Because we're more sensitive so we need a gentle treatment.

Adair: So you're saying American girls are too rough?

Rossi: Yeah because if you're circumcised it means you're not as sensitive and so the girls have to be rough.

- from the film: "Georgia Adair - Self Portrait"

AlterNet
April 15, 2008

Uncut is better I have proof

by ashkewoof

Uncut by birth, got cut at 18 because I was confused that cut penises looked better.

I have tried to live without regret and I swore when I got circumcised, I would never regret it.

I now live with that regret. I am reminded of this regret every time I am intimate with a partner.

With my foreskin went a wonderful degree of sensuality and sensitivity that I will never get back and never knew I would miss until it was gone. I had a whole lot of experience with a foreskin before I was cut and a whole lot of experience without one after I was cut.

I am in a very good position to speak on the subject clearly since I have experienced both sides of the issue for long periods of time.

I want to scream when I hear parents making the choice to mutilate their child for cleanliness, aesthetics or misplaced notions of health. With a few necessary medical exceptions, this is barbarity and it is mutilating your son in the most intimate of ways.

My penis was always clean, happy and wonderful. Now part of it, a truly wonderful part of it is gone and restoration will not bring it back.

Stop butchering your children and STOP making this choice for them!

It should be illegal to do this to children. If they want to do so later on their journey through this life, when they are adults for whatever reason, religious or otherwise, let them. No one should mutilate children at an age especially when they can not consent to it.

... I was cut as an adult (medical error), so I know the difference. It would be a cliché to say "day and night", so I should describe it like this: if being intact is a milkshake, being cut is skimmed milk; circumcision greatly reduces the "flavor" of sex.

So you see, I can't regard circumcision as anything but absolutely evil. As far as I am concerned, anyone who performs a circumcision is even more depraved than someone who would rape that same child.

-Rodrigo Girao on Huffington Post October 3, 2011

im 50 now at the age of 30 i decided to get circumcised. since then i have no sensation whatsoever. i am numb and there is no pleasure. i do not enjoy masterbation like before and i do not enjoy sexual intercourse ... from someone who knows. don't do this to your babies

- meanmachinemarine on YouTube, 2009

I was intact until I was 19, and after some bad medical advice I was circumcised. There is no comparison in sensation - before I had an exquisitely sensitive sexual organ. Now the sensation is nil. I have erectile dysfunction and do not orgasm.

... I wish every day I could go back and not make that mistake. It has totally destroyed my life.

- Steve Bennett on MindofOwn, June 22, 2012

When I was younger I lived in Italy and the men I had sex with were very vocal and ecstatic in their lovemaking, and specifically in their orgasmic voice. Back in the USA my boyfriends did not express sexual pleasure the same way. They would kind of grunt, set their jaw or say, "Oh God, I'm going to cum!" but - not SING from the centers of their souls.

I thought that it was a cultural thing, that somehow the Italians had learned to express themselves (like some women learn to fake noises to thrill their partner) and the American guys had conversly learned to supress their expression of their feelings. At the time I didn't make a connection, I thought it had to do with Italian vs. American culture.

Then, years later, I had a British boyfriend who was culturally much more like an American than like an Italian, but when he came he sang and cried out - not with a feminine voice, but with a passion that was "feminine" only in as much as - in my American world - women have it and men don't....

At that point I was able to see that it was not Italians vs Americans, but Intact men vs circumcised men. It was a very sad realization.

Although I will never know what they were actually feeling - how it was different - I do know that what I could see and hear and feel as an observer there seemed to be a dramatic difference.

- S on Facebook, July 10, 2011

LILAC COLORED GLASSES

Ooh, and here's the best part. Okay, girls who have done it with a cut penis, hopefully you know what I mean...you know right when the penis is going in, there's almost like, a sharp sensation? Not, like, ouch, knife sharp but more like...like how an orange must feel when you stick a wooden juicer into the middle of it? Well when the penis has foreskin, that sensation isn't there. Entry feels a lot smoother and to me that's much more enjoyable.

And you know that drop of pre-ejaculate (pre cum in laymen's terms)? Well when I was with circumcized guys that was kind of like "ew, wipe it off" but with foreskin that drop of fluid is preserved and serves as a lubricant for the man. Know what that means? No rawness or chafing after repeated intercourse! Hooray!!

- a 26-year-old from Pittsburgh living in Belgium

THE JOYS OF THE UNCIRCUMCISED PENIS
I have never been with anyone who was uncircumcised until I met my new boyfriend, and it's amazing. The extra skin is like having an extra ridge there. When I have children, I won't have the boys circumcised, because I want their wives to be very happy. It's almost like he has a cock ring on. You know those condoms that have the big ridges on them? Well, that's what it's like. Besides, a dick is a dick. It just looks a little different. And my boyfriend's is the perfect size. You usually don't remember how big men's dick's are, but you remember the really small ones. Girth matters and size and length matter. Basically, I have to have a perfect dick. And now I've got the length and the girth and a bonus I didn't even know existed.

- Heidi Mark, Playboy's Miss July, 1995

The foreskin is my go-to guy when I'm lazy during BJ or handjobs! It's the dick that strokes itself!

- dictaste on Dodson and Ross, April 8, 2010

My sons will NOT be cut! I think the increased sexual pleasure far outweighs the rare risk of problems (which still can be handled later in life if need be).
From the female point of view, my intact boyfriends were MUCH, MUCH, MUCH! more sensitive during intercourse, and neither had any problems with odor or infection. One I was with for over 10 years, so I certainly would have known.
When I discovered my current significant other was uncircumcised, I felt I had hit the jackpot! Women who are "afraid" of an uncircumcised man have no idea what they are missing!
Sincerely,
Enlightened female in the US.

-Bargain shopper on Amazon.com, June 2, 2011

I have two sons under three. Their father is cut, but I persuaded him not to circumcise them. A previous longtime boyfriend had been uncircumcised, and as a woman with a narrow vaginal opening, the sex with him, which had often been painful with others even with lubricant, was much easier and kinder on my body. (After giving birth, this was no longer an issue :) ..

- newtrack on the Chronicle of Highr Education, June 23, 2010

... someone who was probably done at birth, ... and who has absolutely no idea what it's like to have a foreskin. Or indeed any idea of what it's like from a woman's point of view to put up with a circumcised man pounding away for what seems like hours, getting more and more sore. I've only got a sample of two to go by, but the experience with those two men was fundamentally different to those where the men had all their equipment.

Sunday Morning in the Independent, May 7, 2011

A love letter to your uncircumcised dick

Dear boyfriend,

I love your dick.

I'm using a throwaway account even though I have a throwaway account already, because you know about my real throwaway account, and I don't want you to think I'm some dick-obsessed psycho. I feel like if you read this, you'd know it was me, but you probably won't ask me, because saying, "Hey, did you write a post on Reddit about how much you love my dick?" is a weird thing to ask someone, so I think I'm in the clear. But anyway, I really need to write this. So, new throwaway, here goes.

I love your dick.

I love giving you blowjobs.

I love having sex with you.

I love the way your dick looks when it's hard.

And I also love the way it looks when it's flaccid, because guess what?

I love your foreskin.

Honestly, I do. Your dick is my favourite one I've ever had the privilege of seeing. Not that I've seen that many dicks in real life, but out all all the ones I've seen, I like yours the best. I've told you that before, but you shrugged it off because that's the kind of thing that girls say to every single boyfriend they have for reassurance. But it is the truth.

You don't believe me because girls aren't supposed to like uncircumcised dicks. We're supposed to be grossed out by them and not know what to do with them and think you're some kind of weird-dicked freak. The first time you pulled down your pants, you probably expected me to be disappointed that you weren't cut, like everyone else I've ever been with. You still try to cover your dick whenever it's soft, with a blanket after sex, or your hand when you get dressed. You think it's embarrassing because when it's flaccid, you cant just pull your foreskin back and make it look cut.

But I love it. I love the slightly taboo nature of your dick. I love how your foreskin is like some rare and secret special thing that not everyone else has. It's like a gift. I love how there's something raw about having sex with you. How even when we're "fucking" it still feels like "making love", because it's like you're somehow closer to me (that might be because I fucking love you, but I'm sure your dick doesn't hurt either). I love how having sex with you feels. So much. It literally turns me on to type this. Physically (duh) and emotionally. You're the best sexual partner I've ever had. It's somehow more intimate to be with you than anyone else I've ever been with.

One day I'm gonna just tell you to your face how much I love your dick and how I masturbate thinking about it and how it's literally become a fetish for me since we started dating. I tell you everything, but goddamn, it's hard to tell someone that something they think is weird is the biggest turn on ever for you. But I'm gonna tell you. Hopefully you won't think I'm too crazy.

But for now, I'll just post this on reddit, and go touch myself and think about you.

Sincerely,

Your dick-crazed girlfriend.

- oopsiloveyourdick on reddit, April 14, 2014

Int J Epidemiol. 2011 Jun 14. [Epub ahead of print]

Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark.

Frisch M, Lindholm M, Grønbæk M.

Abstract

BACKGROUND:
One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes.

METHODS:
Participants in a national health survey (n = 5552) provided information about their own (men) or their spouse's (women) circumcision status and details about their sex lives. Logistic regression-derived odds ratios (ORs) measured associations of circumcision status with sexual experiences and current difficulties with sexual desire, sexual needs fulfilment and sexual functio ning.

RESULTS:
Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, OR(adj) = 3.26; 95% confidence interval (CI) 1.42-7.47], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, OR(adj) = 2.09; 95% CI 1.05-4.16) and frequent sexual function difficulties overall (31 vs 22%, OR(adj) = 3.26; 95% CI 1.15-9.27), notably orgasm difficulties (19 vs 14%, OR(adj) = 2.66; 95% CI 1.07-6.66) and dyspareunia [painful intercourse] (12 vs 3%, OR(adj) = 8.45; 95% CI 3.01-23.74). Findings were stable in several robustness analyses, including one restricted to non-Jews and non-Moslems.

[Graph created for this site based on the above data]

Conclusions
Our study shows hitherto unrecognized associations between male circumcision and sexual difficulties in both men and women. While confirmatory findings in other settings are warranted, notably from areas where neonatal circumcision is more common, our findings may inform doctors and parents of baby boys for whom the decision of whether or not to circumcise is not dictated by religious or cultural traditions. Additionally, since it appears from our study that both men and women may have fewer sexual problems when the man is uncircumcised, and because preputial plasties may sometimes serve as suitable alternatives to standard circumcision, our study may stimulate a more conservative, tissue-preserving attitude in situations where foreskin pathology requires surgical intervention.

-

This study was attacked by, predictibly, circumcision advocates Brian Morris, Jake Waskett and Ronald Gray. Frisch as roundly defended it, saying inter alia:

... as these critics repeatedly refer to Morris’ pro-circumcision manifesto¹ as their source of knowledge, their objectivity must be questioned.

...

Morris et al. argue that our finding of considerably higher rates of frequent orgasm difficulties in (partially) circumcised than uncircumcised Danish men (11 vs 4%, OR 3.26) may not apply in countries where circumcision means complete amputation of the foreskin. This may well be the case. If partial amputation of the foreskin truly entails frequent orgasm difficulties in a noticeable proportion of men (as experienced by 11% of circumcised men in our study), comparable proportions may well be larger and associated ORs even higher in countries where circumcised men experience greater tissue loss due to more extensive circumcision procedures. Obviously, more data are needed from rigorous studies using carefully constructed questionnaires. ...

Morris et al. should be commended for their creative attempt to dismiss the higher prevalence of frequent dyspareunia in women with circumcised (12%) than uncircumcised (4%) spouses (ORs between 4.17 and 9.00). They suggest that Danish women with circumcised spouses may be so psychologically troubled by the shape of their spouse's penis that it might result in painful intercourse. A more plausible explanation would be that reduced penile sensitivity may raise the need among some circumcised men for more vigorous and, to some women, painful stimulation during intercourse in their pursuit of orgasm.

Two of the authors, Morris and Waskett, both internationally recognized circumcision activists,^6,7 forget to declare their conflicts of interest. Even in situations that are out of context, Morris promotes himself as a neutral ‘authority on the extensive medical benefits of this simple surgical procedure',⁸ whereas at the same time he argues that neonatal male circumcision 'should be made compulsory' and that 'any parents not wanting their child circumcised really need good talking to'.⁹

...

Like in critical letters to the editor following other recent studies that failed to support their agenda,^10–12 Morris et al. air a series of harsh criticisms against our study. As seen, however, the points raised are not well founded. It seems that the main purpose, as with prior letters, is to be able in future writings to refer to our study as an 'outlier study' or one that has been 'debunked', 'rejected by credible researchers' or 'shown wrong in subsequent proper statistical analysis'. This in spite of the fact that our study was carried out using conventional epidemiological and statistical methods, underwent peer-review and was published in an international top-ranking epidemiology journal.

I would like to thank the IJE editors for withstanding the pressure from one particularly discourteous and bullying reviewer who went to extremes to prevent our study from being published. After the paper's online publication, I have received emails from colleagues around the world who felt our contribution was useful and potentially important. One colleague informed me that the angry reviewer was the first author of the above letter to the editor. In an email, Morris had called people on his mailing list to arms against our study, openly admitting that he was the reviewer and that he had tried to get the paper rejected. To inspire his followers, Morris had attached his two exceedingly long and aggressive reviews of our paper (12 858 words and 5291 words, respectively), calling for critical letters in abundance to the IJE editors. Breaking unwritten confidentiality and courtesy rules of the peer-review process, Morris distributed his slandering criticism of our study to people working for the same cause. Rather than resorting to such selective distribution among friends, Morris should make both reviews freely available on the internet by posting them in their entirety on his pro circumcision homepage (www.circinfo.net). Alternatively, interested readers should feel free to request them from me at the e-mail address above. Despite poorly founded criticisms and attempts at obstruction our findings suggest that male circumcision may be associated with hitherto unappreciated negative sexual consequences in a non-trivial proportion of men and women.

Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe

BJU International 99 (4), 864-869 (British Journal of Urology International,
Volume 99 Issue 4 Page 864 - April 2007)

Circumcision removes the most sensitive part of a man's penis. Sorrells and others enlisted 159 men from the San Francisco Bay area, 91 of them circumcised, and conducted touch-sensitivity tests, using instruments that press with calibrated hairs, on 11 or 17 different places on their penises. The men could not see where they were being touched.

Larger image

Larger image

They found that the most sensitive part of a circumcised penis is on the scar in the middle underneath (19). But several places on the foreskin (3, 4, 13, 14) are more sensitive than that. The glans (8, 9, 10 11) is the least sensitive part of the penis, contrary to a common claim, but where it is covered by the foreskin (8, 9,11), the glans of the intact penis is more sensitive than the circumcised.

Larger image

The experimenters took into account the men's age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education.

BJU Int. 2013 Feb 4. doi: 10.1111/j.1464-410X.2012.11761.x. [Epub ahead of print]

Male circumcision decreases penile sensitivity as measured in a large cohort.

Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T'sjoen G, Vlietinck R, Hoebeke PB.
Department of Urology, Ghent University Hospital, Ghent, Belgium.

Abstract
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The sensitivity of the foreskin and its importance in erogenous sensitivity is widely debated and controversial. This is part of the actual public debate on circumcision for non-medical reason. Today some studies on the effect of circumcision on sexual function are available. However they vary widely in outcome. The present study shows in a large cohort of men, based on self-assessment, that the foreskin has erogenous sensitivity. It is shown that the foreskin is more sensitive than the uncircumcised glans mucosa, which means that after circumcision genital sensitivity is lost. In the debate on clitoral surgery the proven loss of sensitivity has been the strongest argument to change medical practice. In the present study there is strong evidence on the erogenous sensitivity of the foreskin. This knowledge hopefully can help doctors and patients in their decision on circumcision for non-medical reason.

OBJECTIVES:
To test the hypothesis that sensitivity of the foreskin is a substantial part of male penile sensitivity. To determine the effects of male circumcision on penile sensitivity in a large sample.

SUBJECTS AND METHODS:
The study aimed at a sample size of >1000 men. Given the intimate nature of the questions and the intended large sample size, the authors decided to create an online survey. Respondents were recruited by means of leaflets and advertising.

RESULTS:
The analysis sample consisted of 1059 uncircumcised and 310 circumcised men. For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis). For the penile shaft a higher percentage of circumcised men described discomfort and pain, numbness and unusual sensations. In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage of them reported discomfort or pain and unusual sensations at the penile shaft.

CONCLUSIONS:
This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality.

In January 2001, PhD student Tina Kimmel tried to find out just what the experiments were that have proved so influential in maintaining the claim that "circumcision has no effect on sexuality".

William H. Masters, 85, was in a nursing home in Arizona with Parkinson's disease and had no memory of the experiments. He died a few weeks later.

Collaborator Robert Kolodny said that he never once heard Masters or Johnson refer to this study, but thought Masters might have done it in collaboration with his physiologist at the time, Dr. William Slater.

Slater died years ago.

Kolodny says most of the research notes from that period have been discarded, because of the rising costs of storage.

He guessed that "light tactile discrimination" meant single-point threshold sensitivity, although he had no idea what "exteroceptive discrimination" meant.

Ms Kimmel could not reach Virginia Johnson in St. Louis, but everyone she spoke to thought Johnson was most probably not involved in the study at all.

In sharp contrast is the importance Masters and Johnson attach to the role of the clitoral hood (female prepuce) in intercourse:

But the role they attach to the female prepuce is still a passive one, and they do not consider the possibility that it may be the source of erotic sensation in its own right, either.

In "The Hite Report" (Dell/Summit, 1977, p. 271) and "The New Hite Report", Shere Hite grants the importance of the role of the clitoral hood, but pours scorn on Masters and Johnson's emphasis on the role of "active penile thrusting" calling it "a Rube Goldberg model".

In response to an enquiry about the role of the clitoral hood, "Charlou" at RichardDawkins.net wrote:

EFFECTS OF CIRCUMCISION ON MALE PENILE SENSITIVITY

Clifford B Bleustein*, Haftan Eckholdt, Joseph C Arezzo, Arnold Melman, Bronx, NY

Introduction and Objective: Controversy continues to exist about the effect of circumcision on penile sensitivity and sexual satisfaction. This study was designed to evaluate penile sensitivity in both circumcised and uncircumcised males. We evaluated both large and small axon nerve fibers using vibration, pressure, spatial perception, and warm and cold thermal thresholds. Measurements both in functional men and men with erectile dysfunction (ED) were obtained to evaluate for differences in penile sensitivities.

Methods: Seventy-nine patients were evaluated. In the cohort evaluated, 54% (43/79) were uncircumcised, while 46% (36/79) were circumcised. All patients completed the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire. Patients were subsequently tested on the dorsal midline glans of the penis. In uncircumcised males, the foreskin was retracted for testing. [They compared the exterior of the foreskin with the glans, while it is the interior where the ridged band is] Vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2) were measured. [These tests are all tuned to the kinds of sensitivity the glans is best at.] Bivariate relationships were assessed using chi square, t test, and Pearson correlations. [With such small samples, such sophisticated statistical methods are suspect.] Composite null hypotheses were assessed with mixed models repeated measures analysis of variance allowing us to covary for age, diabetes, and hypertension.

Results: Functional group t test analysis only demonstrated a significant (p= 0.048) difference for warm thermal thresholds with a higher threshold (worse sensation) for uncircumcised men. However, significance was lost when we controlled for age, hypertension, and diabetes. For the dysfunctional groups t test analysis only demonstrated a significant (p= 0.01) difference for vibration (biothesiometry) with a higher threshold (worse sensation) for uncircumcised men. Again, this also lost significance (p=0.08) when controlling for age, hypertension, and diabetes. We also found that overall race is related to circumcision status with Caucasian men 25 times and African American men 8 times more likely to be circumcised than Hispanics.

[Again, with such a small and non-random sample - all urology patients - it is preposterous to generalise to the whole population. This breaks down to actual numbers as

J Sex Med. 2007 Apr 6; [Epub ahead of print]

Sensation and Sexual Arousal in Circumcised and Uncircumcised Men.

Payne K, Thaler L, Kukkonen T, Carrier S, Binik Y.
Riverside Professional Center, Ottawa, Canada

Introduction. Research, theory, and popular belief all suggest that penile sensation is greater in the uncircumcised as compared with the circumcised man. However, research involving direct measurement of penile sensation has been undertaken only in sexually functional and dysfunctional groups, and as a correlate of sexual behavior. There are no reports of penile sensation in sexually aroused subjects, and it is not known how arousal affects sensation. In principle, this should be more closely related to actual sexual function.

Aim. This study therefore compared genital and nongenital sensation as a function of sexual arousal in circumcised and uncircumcised men.

Methods. Twenty uncircumcised men and an equal number of age-matched circumcised participants underwent genital and nongenital sensory testing at baseline and in response to erotic and control stimulus films. Touch and pain thresholds were assessed on the penile shaft, the glans penis, [but not the foreskin] and the volar surface of the forearm. [volar = of the palm - meaning upper when the palm is up?] Sexual arousal was assessed via thermal imaging [of one small region] of the penis.

Results. In response to the erotic stimulus, both groups evidenced a significant increase in penile temperature, which correlated highly with subjective reports of sexual arousal. Uncircumcised men had significantly lower penile temperature than circumcised men, and evidenced a larger increase in penile temperature with sexual arousal.

[This is news, suggesting the foreskin functions as a radiator - but the surface of the one small region of the penis they measured, "just below {proximal to?} the glans penis, adjacent to the coronal ridge on the lateral right surface of the penile shaft" is skin on the intact man, but may be mucosa on the circumcised. Since they ignore the foreskin, they also ignore the fact that the foreskin rolls back on arousal, so that mucosa is exposed on both.]

No differences in genital sensitivity were found between the uncircumcised and circumcised groups. Uncircumcised men were less sensitive to touch on the forearm than circumcised men [Suggesting overall hypersensitivity is a long-term consequence of circumcision?]. A decrease in overall touch sensitivity was observed in both groups with exposure to the erotic film as compared with either baseline or control stimulus film conditions. No significant effect was found for pain sensitivity.

Conclusion. These results do not support the hypothesized penile sensory differences associated with circumcision [so long as you ignore the foreskin]. However, group differences in penile temperature and sexual response were found.

PMID: 17419812 [PubMed - as supplied by publisher]

In the full text, it says :

BJU International 103 (2009), 1096 – 1103

Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire

Justine M. Schober, Heino F.L. Meyer-Bahlburg and Curtis Dolezal

[This study will be hard for European and other intact men to comprehend, without adopting the authors' apparent assumption that circumcision is not genital surgery and has no effect on the parameters measured.]

...
SUBJECTS AND METHODS
For this methodological study we targeted English-speaking men with no history of genital surgery and with a variable educational background.

...

Given that this was a largely healthy sample with no history of genital surgery, the initial ratings of genital anatomy, which showed little variability, are not described here. [It might have been interesting, with sufficient sample size, to compare intact and circumcised men's rating of their genital anatomy.]

...

Note that, because there were few (11) uncircumcised men in this sample, 'area A/foreskin' was excluded from statistical analysis, but for comparison purposes included in the Fig. 2B–E). Ranked by degree of 'sexual pleasure' (Table 1), the area 'underside of the glans' [Yes, the frenulum, in circumcised men the last remnant of Taylor's ridged band] was highest, followed by 'underside of the penile shaft', 'upper side of the glans', 'left and right sides of the glans', 'one or both sides of the penis', 'upper side of the penile shaft' '(foreskin)' [apparently they merged foreskin measurements with upper shaft measurements for no apparent reason], 'skin between the scrotum and anus', 'back side of the scrotum', 'front side of the scrotum', and 'around anus', but not all pair differences were significant.

...

Surgical modification or removal of genital tissue, as it occurs in genital reconstruction surgery or circumcision, increases the potential [just the potential?] for (objective) variations in sensory thresholds and might also alter structural integrity, meatal position, straightness during erection, erectile capacity, and personal and partner views of cosmesis [25–27]. In recent years, genital surgery, especially when done without the patient's consent as is common in intersex children [and very common in normal boys], has come under harsh criticism by patients, because of recurrent reports of the experience after surgery of poor cosmetic quality and/or impaired sexual functioning in adulthood [28]. Some intersex activists have even called for a moratorium on genital surgery, until more adequate followup data are provided [29]. ["Even"? Is that so outlandish, just to be left alone?]

...

Men with a history of genital masculinizing surgery or genital excision surgery were excluded. Circumcision status was documented, but this genital surgery was not an exclusion criterion.

[The only time they admit that circumcision is genital surgery. If it had been an exclusion criterion, they would only have had 11 subjects! Intact and circumcised subjects should certainly have been treated separately on all measures.]

DISCUSSION
... The present study provided somewhat surprising data on orgasmic sensitivity. Both the ventral penile shaft and the area of the ventral glans penis were rated at an almost equal level of orgasmic sensitivity and sexual pleasure, significantly above the levels of all other areas rated. This is different from what might be expected, considering the nerve density shown by Yucel and Baskin's example of the fetal penis. The terminal nerves there end in the foreskin and dorsal glans. The difference noted in the present study might be a consequence of the high circumcision rate of the respondents of the study. When terminal nerves are excised, a dermatome [area of skin served by one spinal nerve] might migrate. It could also be that sexual sensitivity ratings include a pressure-related sensation rather than only a fine-touch or tactile sensation.

[Now what we need is someone to use the SAGASF-M with more sagasfity, comparing and contrasting intact men with circumcised.]

Fetal and infant brains exhibit an admirable adaptability to unique developmental conditions—whether those conditions are unique to individuals within a species (as with armless wonders [people born without arms]) or are unique among species (as with jerboas [long-legged jumping rats]). This adaptability is essential given the unpredictable size and confor­mation of our bodies. Predetermined brain function is neither feasible nor desired. Instead ... the functional organization of the nervous system reflects how it interacts during development with its particular sensory and motor systems.

That individuals can exhibit compensatory responses to sensory loss might be familiar even to people who have not met an "armless wonder." Have you ever wondered whether the extraordinary musical ability of Stevie Wonder owes anything to sensory compensation resulting from his congenital blindness? There is now evidence that it does. Moreover, sensory compen­sation is accompanied by brain reorganization. For example, in congenially blind humans, the part of the cerebral cortex that, in sighted people, would process light arriving from the eyes is recruited to process tactile information arriving from the fingers. This reorganization was demonstrated experimentally by disrupting the functioning of the "visual" part of the brain (by exposing it to powerful magnetic stimulation) as blind indi­viduals used their fingers for Braille reading. This stimulation distorted the tactile perceptions of these blind subjects, whereas similar manipulations of the brains of sighted individuals dis­rupted vision without affecting tactile perceptions. Thus, even after millions of years of processing visual information, the mammalian "visual" cortex remains open to inputs from other sensory systems.

This reorganization of the cerebral cortex also has been observed in short-tailed opossums that were experimentally blinded soon after birth. When their adult brains were examined, sensory maps of the brain surface showed extensive encroachment of the areas responding to sound and touch into areas that, in a sighted animal, would respond only to light. We might say that in the absence of visual stimulation, the visual cortex is colonized by other sensory systems.

... For all of the reasons discussed so far, it is clear that sensory organs on the periphery "instruct" the developing brain to pro­duce functional map-like representations. But this instruction is not mindless. On the contrary, it appears that the final organi­zation of the cortex reflects the structure of the peripheral organ and the uses put to that organ early in development. ... We know from research in human adults that experience sach as playing a stringed instrument—can modify cortical organization. Such experience is even more profound in early infancy, when the most fundamental relationships between peripheral structures and the brain—and among systems within the brain—are being established. When new sensory structures arise ... they take advantage of the inherent plasticity of the infant brain to make sense of the sensory information provided. One neuro-scientist sums up these relationships in one simple sentence: "The developing nervous system is also an evolving nervous system."

Every undergraduate, graduate, and medical student learning about the brain must memorize the various lobes of the cere­bral cortex and their particular roles in vision, hearing, touch, and smell. I certainly did. But such lessons in memorization are rarely accompanied by the caveat that our current discussion demands: that each lobe of the brain reliably can be ascribed a particular function only because the eyes, ears, fingers, and nose reliably send their neural connections to particular locales within the brain.

Thus, our brains are not preprogrammed to expect the presence of any appendage, whether arms, legs [or] eyes .... Rather, it is the reliability of sensory targeting (and other developmental factors) that produces the illusion of a preprogrammed brain. So, if we were to examine the brain of an armless wonder, we would find a cere­bral cortex that lacks map-like representations of the missing arms. In their place, we would discover enlarged representations of legs, feet, and toes. [And if we were to examine the brain of a circumcised man, we would find a cerebral cortex that lacks a map-like prepresentation of the missing foreskin. In its place, we would discover an enlarged representation of the glans and frenulum.]

- "Freaks of Nature" by Mark S. Blumberg,
Oxford (2009) pp 146-7, 150-1

All of us must learn how our particular bodies work. We are not hardwired for sex and there is no innate instruction manual. Getting sex right, for our partners and us, entails many trials and a lot of errors. As with any learning process, feedback is essential. Slicing away at sexual organs to produce a cosmetic improvement severs communication between genitals and brain, thereby thwarting the very learning process that makes the development of sexual behavior possible.

ibid p211 (in the context of gender assignment surgery)

Marilyn Milos writes:

I have dealt, time and again, with talk show hosts who say "If I had any more sensitivity, I couldn't stand it." I think the reason for this is that, without the Meissner's corpuscles in the ridged band of the foreskin to provide sensory feedback, a man doesn't know where he is in relation to the orgasmic threshold. Many men think their inability to control orgasmic timing is due to over-sensitivity rather than the fact the lack tens of thousands of important nerve endings that provide essential feedback.

Like Masters and Johnson, the Laumann study "Circumcision in the United States: prevalence, prophylactic effects, and sexual practice" is widely misrepresented as "showing that circumcised men enjoy more varied sexual practices and less sexual dysfunction than intact men."

It was extracted from a much larger study that was not designed to study circumcision. It relied on self-reporting to determine circumcision status. Self-reporting has been shown to be remarkably inaccurate in other studies.

In statements that have been much more widely broadcast than the original study, Edward Laumann himself misquoted his own study:

The reference to the white population is usually left out. The reference to anal sex is false. This CNN report later says

The only significant results of the study are:

Masturbation
Of white men (N=1067, to p<=0.05 t test), 50% of circumcised men said they had masturbated as much as once a month or more in the last year, vs 34% of intact men. (That figure sounds suspiciously low.)

Heterosexual oral sex
Again, only white men (84% of circumcised vs 73% of intact) said they had ever experienced either "active" or "passive heterosexual oral sex" and black men (N=189, 71% of circumcised vs 57% of intact) had ever had "passive heterosexual oral sex" only - but these terms are not defined.

Homosexual oral sex
Only Hispanics (N=90) and only "active" (10% of circumcised vs 2% of intact)

Heterosexual anal sex
NOT AT ALL. In no group was there a significant difference.

Notice that the actual differences are quite small, or in the case of homosexual oral sex, the actual prevalence is small. They are quoted as if ALL circumcised men have much more of ALL the practices than ANY intact man.

To draw any conclusions from these results, whether "circumcision makes men enjoy sex more" or "circumcised men desparately seek out more varied practices to make up for what they have lost", is beside the point when the data are so weak.

Such significance as there is can readily be explained by class-differences and more conservative attitudes towards sex in general of classes that are less likely to circumcise.

Sexual dysfunction

CNN: "The study found circumcised men have a slightly lower risk of sexual dysfunction, especially later in life."

WRONG: The study found circumcised men over 44 are somewhat less likely to report certain kinds of sexual dysfunction, but not others, than intact men over 44 - but that kind of result doesn't make headlines.

The study asked the men if they had ever experienced "lack of interest in sex, unable to ejaculate, ejaculated prematurely, experienced pain during sex, did not enjoy sex, was anxious about performance, had trouble achieving/maintaining erection". (Some of those categories overlap: a man who experienced pain during sex would probably not enjoy sex, for example.)

Only in men aged 45-59 (N=340) were there any significant differences:

• 37% of the intact men reported premature ejaculation, vs 25% of the circumcised men
• 22% of the intact men reported performance anxiety, vs 13% of the circumcised men
• 29% of the intact men reported trouble achieving or maintaining erection vs 13% of the circumcised men. Only this measure achieved significance for men of all ages (17% of all the intact men vs 10% of all the circumcised men).

The measure "had any dysfunction" - apparently a summation of the others - was significant only for the 45-59 age group (58% of the intact men vs 40% of the circumcised men).

It needs some explaining why cutting part of the penis off could make it easier to achieve or maintain an erection, but no explanation is forthcoming.

For the actual study, see http://www.cirp.org/library/general/laumann/

Erectile function evaluation after adult circumcision

[Article in Chinese]

Shen Z, Chen S, Zhu C, Wan Q, Chen Z.
Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China. shenzhj@mail.hz.zj.cn

OBJECTIVE: To evaluate the erectile function of adults after circumcision.
METHODS: Ninty-five patients were investigated on erectile function by questionnaire before and after circumcision, respectively.
RESULTS: Eighteen patients suffered from mild erectile dysfunction before circumcision, and 28 suffered from mild or moderate erectile dysfunction after circumcision(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).
CONCLUSIONS: Adult circumcision has certain effect on erectile function, to which more importance should be attached.

PMID: 14979200 [PubMed - in process]

[This is quite a small sample, and it is not clear why the men were circumcised, but what makes it interesting is that the social climate in China, unlike the US, would not predispose them to circumcision, nor very much against it.]

BJU International
January 2008

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

Godfrey Kigozi, Stephen Watya, Chelsea B. Polis, Denis Buwembo, Valerian Kiggundu, Maria J. Wawer, David Serwadda, Fred Nalugoda, Noah Kiwanuka, Melanie C. Bacon, Victor Ssempijja, Frederick Makumbi and Ronald H. Gray

OBJECTIVE
To investigate the relationship between adult male circumcision and sexual satisfaction and function in men, as observational studies on the effect of adult male circumcision on sexual satisfaction show conflicting results.

SUBJECTS AND METHODS

We investigated self-reported sexual satisfaction and function among men enrolled in a randomized trial of male circumcision for human immunodeficiency virus (HIV) prevention conducted in Rakai, Uganda. In all, 4456 sexually experienced HIV-negative males aged 15–49 years were enrolled; 2210 were randomized to receive immediate circumcision (intervention arm) and 2246 to circumcision delayed for 24 months (control arm). Men were followed up at 6, 12 and 24 months, and information on sexual desire, satisfaction and erectile dysfunction was collected. These variables were compared between the study arms and over time within the study arms, using chi-square or Fisher's exact tests. The trial registration number is NCT00425984.

RESULTS
There were no differences between the study arms at enrolment and problems with sexual satisfaction and function were reported by <2% of participants in both study arms at all time points. At 6 months, no difficulty with penetration was reported by 98.6% of circumcised men and 99.4% of controls (P = 0.02), and no pain on intercourse was reported by 99.4% circumcised and 98.8% of uncircumcised men (P = 0.05). There were no differences between the study arms in penetration or dyspareunia at later visits. Sexual satisfaction increased from 98.0% at enrolment to 99.9% at 2 years among the controls (P < 0.001), but there was no trend in satisfaction among circumcised men (enrolment 98.5%, 2 years 98.4%, P = 0.8).

CONCLUSION
Adult male circumcision does not adversely affect sexual satisfaction or clinically significant function in men.

There were six measures,

• desire [Laumann et al. found 12-16% of men "lacked interest in sex"]
• difficulty with penetration
• difficulty with ejaculating (nothing about premature ejaculation)
• pain on intercourse/dyspareunia
• "a problem regaining erection after ejaculation" (?)
• satisfaction (on a 4-point scale - but they reported only two, satisfied or not satisfied. Why did they fail to report what might have been a salient difference?)

and the lowest measure in anything was 98.4% Laumann et al. found a 39-46% incidence of sexual dysfunction in this age group in the US. (Maybe we should all move to Uganda - it's a sexual paradise!)

It seems their measures were too crude to measure anything. Remember, this is only a part of their study of circumcision and HIV, and they didn't want to find that circumcision harmed sexual satisfaction - as the word "reassuring" implies.

Also

1. The subjects were all volunteers for circumcision. Those who enjoyed having their foreskins would be much less likely to volunteer.
2. The subjects were all paid (substantially, by local standards) to take part.
3. The subjects were members of another culture than the experimenters. What does that culture say about e.g. telling people what they want to hear? (It's pretty obvious that someone who circumcised you thinks circumcision is a good thing.)
4. What does that culture say about sexual satisfaction and how it is measured?
5. What does that culture say about admitting to sexual failures?

Already this null finding has been reported around the world with headlines like "Circumcision Good For Sex" (Modern Ghana), "Circumcision Does Not Deter Men from Enjoying Sex" (Dr Bruno's Blog) and "Study: Circumcision Does Not Affect Sexual Satisfaction" (Fox News). Now watch these studies of adult volunteers in Uganda being used to "prove" that circumcising babies in the US is harmless!

J Sex Med. 2008 Nov;5(11):2610-22. Epub 2008 Aug 28

Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya.

Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S.

INTRODUCTION: Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function.
AIM: To assess adult male circumcision's effect on men's sexual function and pleasure.
METHODS: Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya were uncircumcised, HIV negative, sexually active men, aged 18-24 years, with a hemoglobin >or=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized 1:1 to either immediate circumcision or delayed circumcision after 2 years (control group). Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months.
MAIN OUTCOME MEASURES: (i) Sexual function between circumcised and uncircumcised men; and (ii) sexual satisfaction and pleasure over time following circumcision.
RESULTS: Between February 2002 and September 2005, 2,784 participants [men who had all volunteered to be circumcised in the hope it would protect them from HIV] were randomized, including the 100 excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range. For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24. [In other words some other factor caused sexual dysfunction to decrease over time, vastly more than any difference circumcision might have made.] Changes over time were not associated with circumcision status. Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," and 54.5% rated their ease of reaching orgasm as "much more" at month 24. [Yes, and what did the men who were not circumcised report? Since everybody's sexual dysfunction decreased dramatically over the time of the experiment, did the non-circumcised men's sensitivity and/or ease of reaching orgasm also increase?]
CONCLUSIONS: Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity [What ever became of "If I was any more sensitive ..."?] and enhanced ease of reaching orgasm. [Some call it "enhanced ease of reaching orgasm", others may call it greater tendency to premature ejaculation.] These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function.

[Another paper flowing from the same study, and therefore with the same faults, gained worldwide headlines in April 2009: Krieger, J; Mehta, S; Bailey, R; Agot, K; Ndinya-Achola, J; Parker, C; Moses, S. Adult male circumcision: effects on sexual function and penile coital injuries. J Urol, suppl, 2009: 181, 4 ]

... The questionnaires used to assess potential sexual problems in the two cited randomized controlled trials in Kenya and Uganda were not presented in detail in the original publications.^4,5 Rather than blindly accepting such findings as any more trustworthy than other findings in the literature, it should be recalled that a strong study design, such as a randomized controlled trial, does not offset the need for high-quality questionnaires. Having obtained the questionnaires from the authors (RH Gray and RC Bailey, personal communication), I am not surprised that these studies provided little evidence of a link between circumcision and various sexual difficulties.^4,5 Several questions were too vague to capture possible differences between circumcised and not-yet circumcised participants (e.g. lack of a clear distinction between intercourse and masturbation-related sexual problems and no distinction between premature ejaculation and trouble or inability to reach orgasm). Thus, non-differential misclassification of sexual outcomes in these African trials probably favoured the null hypothesis of no difference, whether an association was truly present or not.

Acta Neurologica Belgica 108: 90-93 (2008)

The effect of male circumcision on pudendal evoked potentials and sexual satisfaction

M.G. Senol, B. Sen, K. Karademir, H. Sen, M. Saracoglu

Circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout life. [The authors are in Turkey.] The influence of circumcision on sexual satisfaction has always been argued. In this study, the assessment of the pudendal evoked potentials (PEP) in adults before and at least 12 weeks after circumcision vas done. Healthy males aged between 18-27 years, who were willing to undergo circumcision were included in the study, Before and after circumcision, sexual performance was evaluated with the Brief Male Sexual Function Inventory (BMSFI), consisting of sexual drive, erection, ejaculation, problem assessment, and overall satisfaction sections. Forty-three adult males were enrolled in the study. Mean PEP latency was 41.97 +/- 0.25 (39.90-44.50) ms and 44.73 +/- 0.33 (40.90-47.60) ms before and after circumcision, respectively. Mean difference between pre- and postoperative PEP values was 2.76 ms which was statistically significant (p < 0.001). [But significant of what? A long PEP - the time for signals to go from the genitals to the brain - is a symptom of erectile dysfunction.] Mean ejaculatory, latency time was significantly longer after circumcision (p < 0.001). In the light of our findings, we conclude that circumcision may contribute to sexual satisfaction by prolonging PEP latency but further studies are warranted also regarding the other dimensions of circumcision. [References: 13]

[This is bizarre. These doctors asked the men some questions about their sexual satisfaction but don't mention the answers (presumably non-significant, because they asked the wrong questions) and jump to the conclusion that circumcision is a Good Thing because of an electrical measurement of the nerves!

In Turkey, men aged over 18 who had not been circumcised and were willing to be, or needed to be, would be a very skewed sample of the population. This is truly junk science. ]

Zhonghua Nan Ke Xue. 2008 Apr;14(4):328-30
Circumcision affects glans penis vibration perception threshold
[Article in Chinese]
Yang DM, Lin H, Zhang B, Guo W.

Abstract

OBJECTIVE:
To evaluate the effect of circumcision on the glans penis sensitivity by comparing the changes of the glans penis vibrotactile threshold between normal men and patients with simple redundant prepuce and among the patients before and after the operation.

METHODS:
The vibrotactile thresholds were measured at the forefinger and glans penis in 73 normal volunteer controls and 96 patients with simple redundant prepuce before and after circumcision by biological vibration measurement instrument, and the changes in the perception sensitivity of the body surface were analyzed.

RESULTS:
The G/F (glans/finger) indexes in the control and the test group were respectively 2.39 +/- 1.72 and 1.97 +/- 0.71, with no significant difference in between (P > 0.05). And those of the test group were 1.97 +/- 0.71, 2.64 +/- 1.38, 3.09 +/-1.46 and 2.97 +/- 1.20 respectively before and 1, 2 and 3 months after circumcision, with significant difference between pre- and post-operation (P < 0.05).

CONCLUSION:
There is a statistic [significant?] difference in the glans penis vibration perception threshold between normal men and patients with simple redundant prepuce. The glans penis perception sensitivity decreases after circumcision.

Andrologia. 2013 Apr 20. doi: 10.1111/and.12101. [Epub ahead of print]

Adult circumcision and male sexual health: a retrospective analysis

ABSTRACT
We aimed to evaluate possible associations of circumcision with several sexual dysfunctions and to identify predictors for the development of these outcomes post-operatively. Telephone surveys about sexual habits and dysfunctions before and after intervention were conducted post-operatively to patients that underwent circumcision in Centro Hospitalar Vila Nova de Gaia/Espinho during 2011.

McNemar test was used for a matched-pairs analysis of pre- and post-operative data. Odds ratios, adjusted in a multivariate analysis, explored predictors of de novo sexual dysfunctions after circumcision. With intervention [circumcision], there was an increase in frequency of erectile dysfunction (9.7% versus 25.8%, P = 0.002) and delayed orgasm [as a sexual dysfuntion, i.e. trouble reaching orgasm] (11.3% versus 48.4%, P < 0.001), and a significant symptomatic improvement in patients with pain with intercourse (50.0% versus 6.5%, P < 0.001). Significant predictors for de novo erectile dysfunction were diabetes mellitus (OR 9.81, P = 0.048) and lack of sexual desire (OR 8.76, P = 0.028). Less than three sex partners (OR 7.04, P = 0.007) and low sexual desire (OR 7.49, P = 0.029) were significant predictors for de novo delayed orgasm.

I studied in North America at University, once arriving at the University and living in halls, with the English accent and dry humour, I did pretty well with the lady's. However, once the word went round, like wild fire, that I was 'uncut', I have never had so much action in my life, I had girls coming up to me in bars, in the cafeteria, and they couldn't stop examining it! I didn't complain the 1 year exchange was the happiest time of my life!

- scott, cornwall, UK, in the Daily Mail, January 27, 2012

-

A dire power

Meta-analyses appear to be the ideal subject of sci­entific debate - by combining dozens or hundreds of previous studies, they allow us to have a truly massive set of trials to work our statistics on, and at the same time seem to offer balance in so far as irregularly positive studies are often balanced out by uncharacteristi­cally negative ones. However, there is a dire power within a meta-analysis, secretly wielded by the author, and it is this highly subjective aspect that lends each analysis its unique end result.

Put simply, the author gets to weigh how much an experiment counts to the aggregate through his evaluation of its quality. ... In other words, if you want a study to count less, you tend to find more flaws with it, and if you want it to count more, you tend to gloss over flaws that might exist. In a normal study, this power would wreak comparatively minor havoc, because the trial number is low enough that a modest result doesn't lead to massive odds-against-chance num­bers. However, when you exercise this power with millions of pieces of data, the impact is colossal ...

Dale DeBakcsy, "When Big Evidence Isn't: The Statistical Pitfalls of Dean Radin's Supernormal" Skeptical Inquirer, January-February, 2014

J. Sex Med.2013 Aug 12. doi: 10.1111/jsm.12293. [Epub ahead of print]

Does male circumcision affect sexual function, sensitivity, or satisfaction?-A systematic review.

by Morris BJ and Krieger JN.

ABSTRACT

Introduction
Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial.

Aims.
The study aims to conduct a systematic review of the scientific literature.

Methods
A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed.

Main Outcome Measures
The main outcome measure is the assessment of findings in publications reporting original data relevant to the search terms and rating of quality of each study based on established criteria.

Results
Searches identified 2,675 publications describing the effects of male circumcision on aspects of male sexual function, sensitivity, sensation, or satisfaction. Of these, 36 met our inclusion criteria of containing original data.

Those studies reported a total of 40,473 men, including 19,542 uncircumcised and 20,931 circumcised. Rated by the Scottish Intercollegiate Guidelines Network grading system, 2 were 1++ (high quality randomized controlled trials) and 34 were case-control or cohort studies (11 high quality: 2++; 10 well-conducted: 2+; 13 low quality: 2-). The 1++ , 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. Support for these conclusions was provided by a meta-analysis.

Impairment in one or more parameters was reported in 10 of the 13 studies rated as 2-. These lower-quality studies contained flaws in study design (11), selection of cases and/or controls (5), statistical analysis (4), and/or data interpretation (6); five had multiple problems.

Conclusion
The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.

News Flash! Circumcision advocates advocate circumcision!

Circumcision advocates Brian Morris and John Krieger's "meta-analysis" (annotated version here) compounds the faults of the above studies.

• They rank the ill-defined and circumcision-driven Masters and Johnson "study", never peer-reviewed or published in a scientific journal, as "2++ (high quality)".
• They review a Kenyan study in detail, entirely uncritically, though one of them is a co-author.
• They refer to their own critiques of studies that find detriments of circumcision, without reference to rebuttal of those critiques.
• Several of the studies cited provide no data on sexual satisfaction.
• They unfailingly mark down all studies finding detriment to circumcision and mark up all those finding benefit.

"Ken McGrath, senior lecturer of pathology at Auckland University of Technology...an internationally recognised researcher on the effects of circumcision...recently simulated circumcision by anaesthetising his foreskin. He describes it as a disturbing experience, going from full sensitivity to almost none."

"Foreskin's Lament"
Sunday Star-Times
(New Zealand)
July 29,2001

Intactivists have been inclined to suppose that male and female genitalia are differently innervated - the clitoris apparently being richly endowed with nerves compared to the glans penis - and it has been assumed that the clitoral prepuce, the woman's equivalent to a foreskin, is correspondingly nerveless. (This, in part, gives rise to the failure to communicate between opponents of FGM and of MGM.)

However, one women's experience suggests that that is not the case and that a woman's "foreskin" is as sensitive as a man's:

If this is true, it is obscured by the (generally agreed) fact that women's sexual response is more "global" and less centred on the genitalia than men's,