Erectile function is a complex process in which the foreskin plays no important role [341]. Control of penile erection resides in the hypothalamus, cerebral cortex and spinal cord. Erection is a neurovascular event involving sensory, motor and autonomic nerves, neurotransmitters, penile cavernosal structures and penile blood circulation and hormones. Just as the rest of the penis, the foreskin contains sensory nerve endings, but the foreskin is not needed for arousal [341, 512]. There is no evidence that the extra complement of nerve endings owing to the presence of a foreskin has any effect on sexual pleasure. Nor is there any evidence for speculative nonsense as to whether circumcision deletes afferent projections to particular neurones in the brain. In fact the scientific research evidence does not support such speculation.
The Badger study in Australia:
As far as attitudes and sexual behaviour are concerned, perhaps the first, albeit small and restricted, but interesting survey of circumcised versus uncircumcised men and their partners was conducted by Sydney biomedical scientist James Badger [49, 50] (who used to regard himself as neutral on the issue of circumcision, but would now appear swayed by the evidence into adopting a ‘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 to 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.
The US National Health and Social Life Survey:
As far as performance during sex is concerned, the National Health and Social Life Survey (NHSLS) of 1,410 men in the USA found that uncircumcised men were more likely to experience sexual dysfunctions [327]. 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 contradicts the purported wisdom in Victorian times that circumcision would reduce the urge to masturbate. (In fact, as described in details, with references, earlier, this is largely a myth, having little common currency at the time [371]). Of course, circumcision would have prevented smegma and itching, so stopping males scratching their genitalia, a behavior that would have offended polite Victorian sensitivities.)
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 [327]. There was little difference between different Christian religious groups. The study also noted that the men’s female partners found the circumcised penis to have greater esthetic appeal.
Australia-wide survey by Richters:
A telephone-based survey of 10,000 men in Australia found circumcised men had fewer sexual difficulties for a month or more in the previous year [465]. This was greatest in men over 50, in whom 27% of uncircumcised, but only 15% of circumcised, men reported difficulty keeping an erection [465]. Physical pain during intercourse was also less common among circumcised men. (This contradicts part of the anti-circ mantra that claims the penis is an ‘internal organ’ [?!?] and the ‘lubrication’ under the foreskin produces a gliding action during penetration. It is always good to compare such claims with scientific research findings, which, like most other claims of the anti-circ movement, are not supported, in fact here contradicted, by the evidence.) The Australian study observed no difference in premature ejaculation, nor masturbation. The circumcised men had significantly more liberal sexual attitudes, just as found above in the US study. Although this study, unlike the one in the USA, found uncircumcised men received as much fellatio as the circumcised, this finding did not indicate what type of penis women preferred. This presents an opportunity for further research in Australia such as conducted in the US and described in the next paragraph.
US survey of new mothers by Willamson & Williamson:
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 [627]. 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.
In this US study, 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.
Korean survey:
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 [407]. Most (73%) Korean males aged 10–59 think circumcision is necessary, with only 7% believing it is not [407]. For parents 91% considered circumcision necessary, with only 2% considering it unnecessary [406]. Improved penile hygiene was the principal reason in 78% of men [407] and 82% of parents [406], and 63% of men [407] and 81% of parents [406] thought circumcision would prevent genital infection of the sexual partner. Mothers were most in favor, as were parents of higher socio-economic status [406]. Males also considered that circumcision improved erectile function, prevented premature ejaculation, and enhanced growth of the penis [407].
African views:
A randomized controlled trial in Uganda of 4456 sexually-experienced men aged 15-49 found no difference in sexual satisfaction or clinically significant function between the 2210 randomized to receive circumcision and the 2246 who remained uncircumcised over the 2 years of the trial [295a]. At 6 months, difficulty with penetration was seen in 1.4% of circumcised men and 0.6% of uncircumcised men, pain on intercourse 0.6% of circumcised and 1.2% of uncircumcised men. At 12 months and 24 months these were all identical between each group. Sexual satisfaction in circumcised men was 98.5% at enrolment and 98.4% at 2 years, and in uncircumcised men was 98.0% and 99.4% in uncircumcised men at these times.
In Africa, women preferred men who were circumcised because they considered they were at less risk of STI [397]. 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 [397]. For example, women from tribes that do not practice circumcision report deriving greater sexual pleasure from circumcised men [380]. Female preference is for the circumcised penis in partner(s) and son(s) [55, 293, 318, 518] and after information this increased to ~90% [293]. Most men, including those who were uncircumcised, preferred circumcision [293, 318, 357, 454, 518]. Men who preferred to remain uncircumcised were concerned about pain and cost rather than losing their foreskin [357].
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 [293].
Magazine surveys:
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).
Questionable ‘research’ by anti-circs:
A “preliminary” survey by lay anti-circ activists of women “recruited through … an announcement in an anti-circumcision newsletter”, not surprisingly, found the opposite [404]. 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 [55].
Another flawed study was conducted in Korea. This examined masturbation, rather than a male’s typical sexual expression, namely vaginal intercourse, and confused ‘sexuality’ (in the title of the article) with ‘male sexual response’ [296]. The various flaws, including poor study design, and the authors’ statement that all men in Korea are circumcised, then giving a tally of circumcised men that exceeded the n value of the cohort, makes one wonder about the thinking of the authors, not to mention the source of the uncircumcised men, all of which has been severely criticized [624].
Movies and television:
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 other 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.
The hit TV series ‘House’ has also had some apt segments concerning the uncircumcised penis.
Conclusion:
Thus societal attitudes clearly favour the circumcised penis.
