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Sozial Aspects
by Professor Brian J. Morris, University of Sydney (Australia)

Perhaps the first, albeit small and restricted, but interesting survey of circumcised vs uncircumcised men and their partners was conducted by Sydney scientist James Badger [25, 26] (who used to regard himself as neutral on the issue of circumcision, but would now appear swayed to the "pro" stance, not surprisingly for any scientist who follows the research findings). His study involved responses to a questionnaire placed in clinics of the Family Planning Association in Sydney. This led to 180 participants (79 male, 101 female) who were aged 15-60. The women were mainly (50%) in the 20-30 year-old age group cf. 25% of the men, more of whom (33%) were aged 30-40. It found that:
  • 18% of uncircumcised males underwent circumcision later in life anyway.
  • 21% of uncircumcised men who didn't, nevertheless wished they were circumcised. (There were also almost as many men who wished they hadn't been circumcised and it could be that at least some men of either category may have been seeking a scapegoat for their sexual or other problems. In addition, this would no doubt be yet another thing children could "blame" their parents for, whatever the decision was when their child was born.)
  • No difference in sexual performance.
  • Slightly higher sexual activity in circumcised men.
  • No difference in frequency of sexual intercourse for older uncircumcised vs. circumcised men.
  • Men who were circumcised as adults were very pleased with the result. The local pain when they awoke from the anaesthetic was quickly relieved by pain killers (needed only for one day), and all had returned to normal sexual relations within 2 weeks, with no decrease in sensitivity of the penis and claims of "better sex". (Badger's findings are, moreover, consistent with every discussion the author has ever had with men circumcised as adults, as well as an enormous number of email messages received from many such men. The only cases to the contrary were a testimonial in a letter sent to the author from a member of UNCIRC and a very brief email message that didn't say why.)
  • Women with circumcised lovers were more likely to reach a simultaneous climax - 29% vs. 17% of the study population grouped across the orgasmic spectrum of boxes for ticking labeled 'together', 'man first', 'man after' and 'never come'; some ticked more than one box. (Could this involve psychological factors? ... Could it be that more circumcised men have a better technique? ... Or could other factors be involved?)
  • Women who failed to reach an orgasm were 3 times more likely to have an uncircumcised lover. (These data could, however, possibly reflect behaviours of uncircumcised males that might belong to lower socio-economic classes and/or ethnic groups whose attitudes concerning sex and women may differ from the better-educated groups in whom circumcision is more common.)
  • A circumcised penis was favoured by women for appearance and hygiene. (Furthermore, some women were nauseated by the smell of the uncircumcised penis, where, as mentioned earlier, bacteria and other micro-organisms proliferate under the foreskin.)
  • An uncircumcised penis was found by women to be easier to elicit orgasm by hand.
  • An circumcised penis was favoured by women for oral sex (fellatio).

A survey of 5000 men aged 16-49 (78% circumcised, 19% not, 3% "don't know") was subsequently conducted by Badger. This was open to all, and so included men who were anti-circumcision activists and those who were not. Circumcision had been performed at birth in 72%, before puberty in 12% and after puberty in 16%. Of those who said someone else decided for them that they should be circumcised, only 16% said they were unhappy to be circumcised; 46% were happy and 38% didn't care. Overall only 11% said they would not circumcise any son(s).

These findings are consistent with later studies. In a survey of new mothers in the USA, hygiene and appearance were the two major reasons for choosing to have their newborn son circumcised [387]. There was a strong correlation between their son's circumcision status and the woman's ideal male partner's circumcision status for intercourse. Thus by being circumcised they thought that their sons would likewise be more attractive to a future sexual partner (with the implication that they would be at an advantage in passing on their, and therefore the mother's, genes to the subsequent generation). Their own preference thus affected their choice for their sons. 92% said the circumcised penis was cleaner, 90% said it looked 'sexier', 85% it felt nicer to touch and 55% smelled more pleasant. Even women who had only ever had uncircumcised partners preferred the look of the circumcised penis. Only 2% preferred an uncircumcised penis for fellatio, with 82% preferring the circumcised variety. Preference for intercourse for circ. vs uncirc. was 71% vs 6%, respectively; manual stimulation, 75% vs 5%; visual appeal, 76% vs 4%. What then is sexier about a circumcised penis? Quite likely it is that the glans is exposed in both the erect and un-erect state.

In Korea circumcision occurs at age 12. It is regarded as a "rite of passage" into adulthood and it is believed that it enhances sexual function [252]. Most (73%) Korean males aged 10–59 think circumcision is necessary, with only 7% believing it is not [252]. For parents 91% considered circumcision necessary, with only 2% considering it unnecessary [251]. Improved penile hygiene was the principal reason in 78% of men [252] and 82% of parents [251], and 63% of men [252] and 81% of parents [251] thought circumcision would prevent genital infection of the sexual partner. Mothers were most in favor, as were parents of higher socio-economic status [251]. Males also considered that circumcision improved erectile function, prevented premature ejaculation, and enhanced growth of the penis [252].

In Africa, women preferred men who were circumcised because they considered they were at less risk of STI [245]. The foreskin was also regarded as a source of a bad smell and men too thought it was cleaner. Increased sexual pleasure to both partners was also stated [245]. For example, women from tribes that do not practice circumcision report deriving greater sexual pleasure from circumcised men [234]. Female preference is for the circumcised penis in partner(s) and son(s) [29, 182, 199, 322] and after information this increased to ~90% [182]. Most men, including those who were uncircumcised, preferred circumcision [182, 199, 227, 283, 322]. Men who preferred to remain uncircumcised were concerned about pain and cost rather than losing their foreskin [227]. Young adults stated that circumcision reduces friction during sexual intercourse, enhances the sexual pleasure of both partners, and likened the presence of a foreskin to wearing a condom in that it reduced sensitivity [182].

Many surveys have been carried out by women's and men's magazines over the years and all report a preference by women for a man with a circumcised penis. One in Sydney by "Men's Health" (July 2001 issue) found that only 16% of women preferred the uncircumcised penis, 46% preferred the circumcised, and 31% didn't care (6% had never seen an uncircumcised penis and 1% had not seen a circumcised penis).

A "preliminary" survey by lay anti-circ activists of women "recruited through … an announcement in an anti-circumcision newsletter", not surprisingly, found the opposite [250]. The authors acknowledged this "shortcoming". They also state "this study has some obvious methodological flaws" and that "it is important that these findings be confirmed by a prospective study of a randomly selected population of women." Thus bias arising from the seriously flawed study design causes this particular study to lack credibility and it should be ignored. Moreover, others have obtained findings that are the complete opposite, e.g., in one study that found a preference by women for the circumcised man the respondents remarked that circumcised men enter the woman more easily and cause less trauma [29].

In the visual arts, for scenes involving the naked male it is quite plausible that American producers of erotic films and publishers of photographic works choose circumcised men, or at least uncircumcised men whose foreskin is smooth and free from loose, wrinkled skin, as the latter lacks visual appeal, especially to those who are not used to seeing an uncircumcised penis. Societal attitudes, at least in the USA, are reflected in the entertainment industry, such as TV shows. With apologies for introducing anecdotal material, a few examples are nonetheless potentially illuminating. For example, the character 'Elaine', in an episode of the TV sitcom 'Seinfeld' stated that "[the uncircumcised penis] looks like an alien!" Similarly in an episode of 'Sex in the City', also set in New York, one character recoiled in shock on seeing her new boyfriend was uncircumcised. It was clear that the quite sexually experienced 30-something women in this show were unused to the foreskin, describing it as resembling a Shar Pei (a dog breed with excessive rolls of skin). The new boyfriend's status had been bothering him anyway so he got circumcised, and liked his new look and improvement in sex so much he dumped the new girlfriend so he "could take the doggy for a walk", i.e., try it out on ther women around town. The moral: "You can take the Shar Pei out of the penis, but you can't take the dog out of the man". In the TV cartoon series 'South Park' the boys were alarmed to hear a new baby was going to be circumcised, thinking the penis was going to be cut off. Later when told it made the penis bigger they all wanted it. (Being set in America's heartland it is certain they already were circumcised (and didn't know what it was) - that is if one can apply this kind of rationale to cartoon characters!) These illustrations involve of course actors or characters who are following a script, and is therefore not scientific by any means, but do reflect thinking and behaviors in these US settings.

As far as performance during sex is concerned, the National Health and Social Life Survey (NHSLS) of over 1400 men in the USA found that uncircumcised men were more likely to experience sexual dysfunctions [207]. This was slight at younger ages, but became quite significant later in life and included finding it twice as difficult to achieve or maintain an erection. It was also discovered that circumcised men engaged in a more elaborate set of sexual practices, i.e., enjoyed a more elaborate sexual lifestyle, and their female partners were more pleased with the esthetics of a circumcised penis over an uncircumcised one. Not surprisingly, in view of the findings above, circumcised men received more fellatio. However, they also masturbated more, a finding that, ironically, contradicts the apparent wisdom in Victorian times that circumcision would reduce the urge to masturbate. (Contrary to anti-circ. propaganda, circumcision may not have been used so much to reduce masturbation in that era, but rather to prevent smegma and itching, so stopping males scratching their genitalia, which would have offended polite Victorian sensitivities, and where such genital touching sometimes led to arousal.) As noted in other studies, circumcision rates were greatest among whites and those who were better educated, reflecting their exposure to and ability to evaluate and respond to scientific information about circumcision [207]. There was little difference between different Christian religious groups. The study also found that the men"s female partners found the circumcised penis to have greater esthetic appeal.

Masters & Johnson undertook clinical and neurological testing of the ventral and dorsal surfaces, as well as the glans, and detected no difference in penile sensitivity between circumcised and uncircumcised men [223]. Sexual pleasure also appears to be about the same.

Two US studies published in 2002 both found similar or greater sexual satisfaction in men after circumcision as adults [72, 110]. The mean age of the men in each study was 37 and 42, respectively. In the smaller survey [72] there was no difference in sexual drive, erection, ejaculation, problem assessment or satisfaction compared with what the men recalled sex being like prior to foreskin removal. Penile sensitivity was the same. The Collins paper stated that their study was prompted by reports by proponents of "foreskin restoration", in particular the "disparity between the mythology and medical reality of circumcision regarding male sexuality" [72]. In the Fink study of 123 men [110], 62% said they were satisfied with having been circumcised (they liked their new look) and 50% reported benefits. There was no change in sexual activity. Penile sensitivity, although not tested directly, was thought by some of the men in this study to be slightly lower (but not statistically so), which may have contributed to their claims of better sex. Although there was no change in sexual activity, some of the men thought erectile function was slightly less (category scores: 12.3 vs 11.1, P = 0.05), which is the opposite of the very much larger National Health and Social Life Survey [207]. Fink and co-workers point out that this would, however, have to be confirmed by duplex Doppler ultrasound before a definitive conclusion could be made. Furthermore, the outcome of this study could have been affected by the fact that 93% of the men had been circumcised for a medical problem. Both the men and their partners preferred the appearance of the penis after it had been circumcised. As in other studies [207] oral sex became more frequent, but there was no change in anal sex or masturbation [110]. Their partners were also more likely to initiate sex with them.

A report in 2004 of men circumcised for non-medical reasons in Turkey showed an increase in ejaculatory latency time, which may or may not reflect decreased sensitivity, but this was considered by the men as an advantage in that they could prolong intercourse [323]. A US study involving a battery of quantitative somatosensory tests to evaluate the spectrum of small to large axon nerve fiber function found no difference in sensitivity of the glans penis between 43 uncircumcised and 36 neonatally circumcised men [42]. The authors controlled, moreover, for factors that can alter neurologic testing (age, erectile function status, diabetes, and hypertension). A study of 150 men aged 18 to 60 circumcised for benign disease in London found identical erectile dysfunction scores before and after [222]. Of these 74% had no change in libido, 69% had less pain during intercourse (P < 0.05), 44% of the men (P = 0.04) and 38% of the partners (P = 0.02) thought appearance was better after circumcision. Sensation improved in 38% (P = 0.01), was unchanged in 44%, and was worse in 18%. Overall, 61% were pleased and 17% were not.

In a study of 500 couples, intravaginal ejaculatory latency time (= time from start of vaginal intromission to start of intravaginal ejaculation, recorded by stopwatch) was 6.7 minutes (range 0.7 to 44.1) in circumcised men, being not statistically different from the time found in uncircumcised men of 6.0 minutes (range 0.5 to 37.4) [371]. These times were similar in the Netherlands, UK, Spain and the USA. Rate in Turkey, however (3.7 minutes; range 0.9-30.4) was significantly lower. Intravaginal ejaculatory latency time decreased significantly with age: in men aged 18-30 years time it was 6.5 min, compared with 4.3 min in men over 51 years (P < 0.0001). The data were not affected by condom use.

The foreskin contains sensory nerve receptors as are prevalent over the rest of the penis. There is no scientific evidence that the extra complement of these in uncircumcised men leads to greater sexual pleasure. Uncircumcised men often complain that their penis is too sensitive, leading to pain, and seek circumcision to relieve this. Diminishing sensitivity is in fact desired by many men and women in order to prolong the sex act by preventing premature ejaculation [51]. Orgasm, the culmination of the sex act, is not related to the foreskin, and involves activity of neurones in the hypothalamus of the brain. It should also be added that anecdotes cannot be accepted, and any hypothesis they might suggest must be tested by scientific research before receiving serious consideration. Fanciful speculation by anti-circ proponents must be disregarded, as should dubious publications involving biased study groups [250].

In Britain a class distinction is associated with circumcision. Circumcision traditionally indicated that a doctor had attended the birth (an indicator of family wealth) rather than a midwife (more likely to be used instead by poorer people). The Royal Family and the upper classes are circumcised and the lower classes and those who left school before 17 much less so [249]. Queen Victoria believed her family descended from King David (of the Biblical Old Testament) and sanctioned circumcision. Prince Charles was circumcised by a mohel (a rabbi who specializes in circumcision). Princess Diana decided that Princes William and Harry would go uncircumcised. The NHSLS in the USA saw greatest rates among whites and the better educated. There was little difference between different religious groups.

Some ancient cultures and some even today practice infibulation (drawing a ring or similar device through the prepuce or otherwise occluding it for the principal purpose of making coition impossible) [321]. A foreskin was thus a prerequisite for infibulation. It is, moreover, the opposite of circumcision. Infibulation was espoused in Europe and Britain in previous centuries as a way of reducing population growth amongst the poor and to prevent masturbation [321]. Ancient Greece was similarly faced with severe overpopulation, putting pressure on food and resources. Infibulation was one method used to address this. Not to circumcise then became embedded in Greek cultural practice.
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