Myth: Uncircumcised Men Enjoy Sex More

We are here to do yet another myth. And this myth is that uncircumcised men enjoy sex more than those who are circumcised. Now, circumcision in the male refers to the removal of the loose skin that covers the head or the end of the penis. The practice of removing the foreskin dates back to ancient times in many cultures. In Egypt circumcision was performed for hygienic reasons and perhaps aesthetic reasons way before biblical times. Later, both the Jewish and the Muslim faiths required ritual circumcision as a religious act, which continues to this day for millions and millions of men. Western cultures began advocating circumcision, at times almost universally, for health reasons, often without any scientific data to support the practice. Sometimes the rationales were really absurd, as in the early twentieth century when it was claimed to prevent all kinds of things; for instance, tuberculosis, gout, epilepsy, insanity, and of course that all time favorite, everybody’s most serious health concern, masturbation – and I say that to you, of course, with great derision, that is, jokefulness, because of course masturbation is not a health concern and in fact it is good for you as long as you don’t do it so much that it causes irritation. But we’ve talked about that before.

Now today in the West, the prevalence of circumcision in the United States is at about 60%, down from 95% about twenty years ago. And if we compare that rate to other western countries, it’s about 48% in Canadians and about 24% of men in the United Kingdom are circumcised each year. Now currently in the United States there are very strong feelings on both sides of the circumcision debate. One side claims that it is totally unnecessary, that it causes psychological damage, it reduces sexual pleasure, and they object to the fact that the individual has no choice in the decision. Proponents of circumcision argue that there are long term health benefits, not just to the man, but also for his partner, and that there is no reduction in sexual pleasure. As of this moment, both the American Academy of Pediatrics and the Canadian Pediatric Society are taking a kind of middle-of-the-road stance. They’re suggesting that parents review the evidence and their cultural or religious and aesthetic situation and points of view, checking how the father looks so that fathers and sons will match, because that certainly makes things easier, and if not they’re going to have to take that into account, and discuss this decision with their doctor and come to a decision as to what they want to do. So now let’s move to what the latest studies are in terms of this surgical procedure, and figure out what is really going on in terms of sexual pleasure, because that’s what we’re about here at Love and Health.

Circumcision and sexual pleasure

Does circumcision affect sexual pleasure, and does it have any benefits that might make the quite low level of surgical risk, like bleeding and infection, or possible discomfort even with anesthetic, worthwhile? And, if you are already one of the majority of men in the United States who are circumcised without being asked, are you missing out on anything of consequence? That’s our question. What I want to focus on here today is the widespread belief of some people that men with a foreskin get more pleasure from sex than men who have been circumcised. Now the basis for this belief has not in the past been scientific, just like the basis for circumcision has not been scientific in the past. And that’s because data have been really hard to obtain, since most men have not been in the position to experience participating in sexual behavior with and without their foreskin. Obviously – since it’s done early in life. There was a kind of logic, I think, to the position that it might be better to have a foreskin, because the foreskin covers the most sensitive part of the penis, that is, the head or the glans of the penis. And it seems logical to believe that this covering would protect that sensitive part of the penis from irritation and perhaps keep it more responsive for the times that it’s uncovered during sexual activity. I mean that seems to make sense. And also, being that the penis is one of the most – well, perhaps the most highly valued part of many men’s bodies, or every man’s body, it was not surprising that the thought of losing even a very small part of it would be considered negative. And finally, the fact that many men have a major concern about the size of the penis, the loss of even a millimeter of it would certainly not be construed as moving in the right direction. So we can understand that there would be a concern about removing any part of it, and removing this part that covers the most sensitive part.

So, we have three very recent studies that have addressed this question, about the possible changes in sexual satisfaction after circumcision in adult men with sexual experience. And these are quite new studies. The first was conducted in 2002 in the United States, and it questioned 15 adult men about the details of their sexual lives prior to undergoing circumcision. They were assessed on their sex drive, their erections, their ejaculations, their sexual problems, and their overall sexual satisfaction. The average age of these subjects was almost 37 years old, and they were asked again about these same aspects of their sexuality a minimum of three months after the circumcision took place. The researchers found that there were no differences before and after the circumcision in the men’s reports on their sex drives, their ejaculations, their erections, their sexual problems, or their overall satisfaction. So the researchers concluded that there appeared to be no adverse clinically important effects of circumcision on male sexual function in sexually active adults. So that’s our first piece of evidence – good news!

The second study was conducted in Turkey in 2004 with 42 adult men. Now, 39 of these men had their circumcisions for religious reasons, and 3 for cosmetic reasons. The men ranged in age from 19 to 28 and the average age was about 22 years and 4 months. These men were also questioned about their sexual functioning before the surgery in the same way as the men in that first study I told you about. They were also evaluated for the time that it took them to ejaculate. This time that it takes you before you ejaculate, from the beginning when you start stimulation until after you ejaculate, or until the time you ejaculate, is called ejaculatory latency time. And then, three months after their circumcision, the 42 men were evaluated in exactly the same way again. No differences were found between the men’s reports of their sex drives, their erections, their ejaculations, their sexual problems, and their overall sexual satisfaction before and after the circumcision. But there was a change in their ejaculatory latency time. The average time it took them to ejaculate was a bit longer than prior to the surgery. The researchers concluded that adult circumcision does not affect sexual functioning and, based on their sample, the increase in ejaculatory latency time, they felt, could be considered an advantage.

The last study was conducted in the United States in 2005. The research was designed specifically to evaluate differences in sensation between two groups of men – one group was circumcised at birth, and the second group was uncircumcised. There were 125 men in the circumcised group, and 62 men in the uncircumcised group. This was a very, very interesting study because they used what’s called quantitative somatosensory testing. And this involves different kinds of touch on the head, or the glans, of the penis. Now these evaluations tested sensitivity to five kinds of sensations – vibration, pressure, spatial perception – that is, it’s the kind of thing where you have two places being touched and they see if you can tell whether it’s one or two places that are being touched, it’s that kind of spatial perception – and when one can feel the first feeling of warmth or the first feeling of cold – so it starts at room temperature or body temperature and then it gets a little bit warmer or a little bit colder, and you tell exactly when (you have your eyes closed of course) you can first feel the warmth or the cold. So it tells you how sensitive you are to temperature. So those are the kinds of tests that they gave – it’s very precise sensory testing. When age, hypertension, diabetes, and any erectile problems were accounted for, there were no differences in the sensitivity to all these different kinds of touch between the circumcised and the uncircumcised men. That’s a very precise kind of measurement of sensitivity. This is, I think, probably the best study done so far, and the results were quite clear. They also agree with the other studies of men who were circumcised in adulthood. So, based on these studies, I feel quite confident in saying to you at this point that there are no identifiable differences in sexual pleasure between circumcised and uncircumcised men. And so I think we can lay that aside, and say that there probably aren’t any differences.

Circumcision benefits and health risks

Now I’m going to move on to health issues. There appear to be some health benefits to circumcision that have been identified by research. Now these health benefits are relatively small, and they are about some relatively rare, but nevertheless, I think, important medical problems – that is, the ones that are medical problems that you could be born with or that could happen to you. And they are more likely in uncircumcised males than in circumcised males. The first one is called phimosis, and that’s a condition that you’re born with where the foreskin cannot be pulled back over the head of the penis. And that’s something that can be fixed by surgery. The second is called paraphimosis, and that’s a condition in which the foreskin is trapped behind the head of the penis, and it can’t come over, it can’t be pulled over the glans of the penis. And again, that’s something else that can be fixed by surgery. Third is an inflammation of the glands of the foreskin, which is something that’s again more likely to happen with men who have a foreskin than ones who have been circumcised. Now there are three more health problems that deserve noting because of their seriousness, and these are not so rare and may be more serious. But these all probably can be dealt with with good daily – underline daily – hygiene. But it’s something that you really have to attend to if you have a foreskin. The first is the possibility that being uncircumcised might increase the risk of HIV/AIDS, both acquiring it and transmitting it to somebody else. Now the first study is not very definitive but I want to mention it to you. It’s an overall analysis of 37 studies on the effects of circumcision in preventing the acquisition of the AIDS virus and it showed an association between circumcision and the prevention of HIV. Now association doesn’t mean cause and effect – it means that the two things seem to go together. It’s not causal, but it alerts us that there might be a relationship between one thing and another thing. The researchers warned, however, that the differences among the methods used in all these different studies and the rigor with which the research studies were done was very very low, and so their findings should not be taken as definitive.

A second study was published in 2005, and was conducted to determine the probability of female to male transmission of the AIDS virus between circumcised and uncircumcised men. Now this was done by taking detailed accounts of sexual behavior in a population of men with multiple sexual partners. And the subjects were quite a large group – there were 745 Kenyan truck drivers. Now, they used Kenyan truck drivers because these are men who travel across Africa and they have been thought to be one of the major transmitters of AIDS around the continent of Africa, and they are known to have lots of partners. And their sexual behavior was recorded every three months in interviews, and they were interviewed about their sexual behavior with their wives, with casual partners, and with prostitutes. Now after accounting for the level of individual rates of sexual behavior among the men, the researchers found that uncircumcised men were twice as likely to acquire the AIDS virus per individual sex act when they were compared to circumcised men. So the uncircumcised men were twice as likely to acquire the AIDS virus per individual sex acts with a partner than were the circumcised men. Pretty scary. Again, good hygiene would probably lower this rate, and maybe lower it to be equal to the circumcised men.

Now, two recent studies published in 2002 also appear to support this finding that uncircumcised men are more likely to be at high risk for infection and for transmitting another virus – not the AIDS virus, but another virus. This virus is the one that causes genital warts. And it’s also the same virus that’s identified as related to cervical cancer in women. So it causes genital warts and it’s believed pretty strongly now that it’s the cause of cervical cancer in women. The name of this virus is human papillomavirus, and you also have probably heard it called HPV for short. Now, the first study evaluated 216 Danish men, and it was found that a man was more likely to be infected with HPV if he had a higher number of lifetime sex partners, if he was younger than older, in this study, and if he was uncircumcised. In the second study, which was conducted in Spain with two groups of men – 847 who were uncircumcised, and 292 who were circumcised – and in Spain, more men are uncircumcised than circumcised – 19.6% (that’s just about 1 out of 5) of the uncircumcised men were found to be infected with HPV, that is, with the genital wart virus, whereas only 5.5% of the circumcised men were infected. You see, the foreskin probably has a lot of places where these viruses can hide – there’s not so many places to hide in a circumcised man. So unless an uncircumcised man cleans himself regularly every day, it’s probably easier for these little viruses to hide there. After the findings were adjusted for age at first intercourse, lifetime number of partners, and other potential influences, the differences were still strongly maintained between the circumcised and the uncircumcised men. Now when they looked at the monogamous women – that is, women who did not have any other partners except a man who was in this study – whose male partners had six or more sexual partners and were circumcised, those women, those monogamous women, had a lower risk of cervical cancer than the women whose partners were uncircumcised. So the women who had circumcised partners were at lower risk for having cervical cancer than the women whose partners were uncircumcised. So circumcision seems to have some real health benefits, not just for men, but for their partners as well.

Finally, and this is the final health risk – and although this is very rare, it’s a scary one! Circumcised men appear to be at lower risk for a rare form of cancer which may also be related to that same virus which causes cervical cancer in women, that HPV virus. A study published in 2005 evaluated 62 men with invasive cancer of the penis and compared them with men who were chosen because they were very similar but did not have cancer. The researchers found that men who were not circumcised were at increased risk for this kind of rare cancer – and, the cancer was also related to cigarette smoking and phimosis. And remember, phimosis is a condition in which the foreskin cannot be pulled back behind the head of the penis, which is also, of course, found in men that are uncircumcised. And they found that that same HPV virus was detected in more than ¾ of those cancers, those invasive cancers that were in these men that were more likely to be uncircumcised. And that’s the same virus that is found in many women who have cervical cancer, and those women are more likely to be having sex with men who are uncircumcised. So it all sort of fits together.

So – what’s the story about circumcision? There appear to be some benefits of circumcision, but they’re probably small IF uncircumcised men are careful and consistent in their daily hygiene. And if you’re circumcised, the data suggests that you don’t have to worry about pleasure – you’ve lost nothing from being circumcised, in your sexual pleasure, and you may have gained a few strokes. And that’s the end of this month’s myth.

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