Circumcision and Sexual Function
Summary of Research Results
Male Circumcision does not effect Sexual Function
In spite of the claims often made by those who oppose the procedure, circumcision does not negatively effect sexual function for the man, and/or diminish sexual pleasure in the partner. This has been scientifically corroborated by several medical research articles, some of which are discussed below. One survey done in 2009 even reported that circumcision improves sex for women (the online article can be found here).
In a study done in Uganda in 2009, researchers studied 455 partners of men in Uganda who were recently circumcised. Nearly 40% said sex was more satisfying afterward. About 57% reported no change in sexual satisfaction, and only 3% said sex was less satisfying after their partner was circumcised (see here for further information).
A recent Canadian study has shown that in tests for responses to pain, heat, and stimulation, no major difference was found between men who are circumcised and those who are not. The study also suggests there is no difference in sensitivity between those adult men who were circumcised as babies and those who were not. The findings also suggest the foreskin is not the most sensitive part of a penis. For further information see here.
For further information also see the Section "Function and Sensation" on the CircFacts.org website.
Medical Articles and Abstracts
Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya.Nordstrom MP, Westercamp N, Jaoko W, Okeyo T, Bailey RC.
J Sex Med. 2017 Apr;14(4):601-612. doi: 10.1016/j.jsxm.2017.02.014.
BACKGROUND: Two cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision. AIM: To assess the effects of VMMC on sexual function and satisfaction in a large population-based cohort of men circumcised as adults and uncircumcised controls in Kenya.
METHODS: Sexual function and satisfaction of young (median age = 20 years) sexually active men (1,509 newly circumcised men and 1,524 age-matched uncircumcised controls after 5% loss to follow-up) were assessed at baseline and 6, 12, 18, and 24 months, with data collected in 2008 to 2012. Self-reported data on lack of sexual interest or pleasure, difficulty getting or maintaining erections, orgasm difficulties, premature ejaculation, pain during intercourse, and satisfaction with sexual intercourse were analyzed with mixed-effect models to detect differences between circumcised and uncircumcised men and changes over time.
OUTCOMES: Changes over time in sexual interest, desire and pleasure, erectile and ejaculatory function, and pain during intercourse (dyspareunia) in circumcised and uncircumcised men; group differences in time trends; satisfaction with sexual performance; and enjoyment of sex before and after circumcision.
RESULTS: Sexual dysfunctions decreased in the two study groups from 17% to 54% at baseline to 11% P < .001), except dyspareunia, which decreased only in circumcised men (P < .001). Sexual satisfaction outcomes increased in the two study groups from 34% to 82% at baseline to 66% to 93% at 24 months, with greater improvements in circumcised men. On average, 97% of circumcised men were satisfied with sexual intercourse and 92% rated sex as more enjoyable or no different after circumcision compared with before circumcision.
CLINICAL TRANSLATION: Results are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.
STRENGTHS AND LIMITATIONS: Large-scale population-based longitudinal data restricted to sexually active individuals and adjusted for differences in baseline levels of outcomes and potential confounders are used. The questionnaire used, although not a standardized survey instrument, includes all major domains of male sexual function and satisfaction used in the most common standardized tools.
CONCLUSIONS: Results are consistent with large cohort studies of VMMC using data from randomized controlled trials and indicate that VMMC has no significant detrimental effect or might have beneficial effects on male sexual function and satisfaction for the great majority of men circumcised as adults. Link to onsite abstract
Examining the association between male circumcision and sexual function: evidence from a British probability survey.Homfray V, Tanton C, Mitchell KR, Miller RF, Field N, Macdowall W, Wellings K, Sonnenberg P, Johnson AM, Mercer CH
AIDS. 2015 Jul 17;29(11):1411-1416
OBJECTIVE: Despite biological advantages of male circumcision in reducing HIV/sexually transmitted infection acquisition, concern is often expressed that it may reduce sexual enjoyment and function. We examine the association between circumcision and sexual function among sexually active men in Britain using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Natsal-3 asked about circumcision and included a validated measure of sexual function, the Natsal-SF, which takes into account not only sexual difficulties but also the relationship context and overall level of satisfaction. METHODS: A stratified probability survey of 6293 men and 8869 women aged 16-74 years, resident in Britain, undertaken 2010-2012, using computer-assisted face-to-face interviewing with computer-assisted self-interview for the more sensitive questions. Logistic regression was used to calculate odds atios (ORs) to examine the association between reporting male circumcision and aspects of sexual function among sexually active men (n?=?4816).
RESULTS: The prevalence of male circumcision in Britain was 20.7% [95% confidence interval (CI): 19.3-21.8]. There was no association between male circumcision and, being in the lowest quintile of scores for the Natsal-SF, an indicator of poorer sexual function (adjusted OR: 0.95, 95% CI: 0.76-1.18). Circumcised men were as likely as uncircumcised men to report the specific sexual difficulties asked about in Natsal-3, except that a larger proportion of circumcised men reported erectile difficulties. This association was of borderline statistical significance after adjusting for age and relationship status (adjusted OR: 1.27, 95% CI: 0.99-1.63).
Data from a large, nationally representative British survey suggest that circumcision is not associated with men's overall sexual function at a population level.Link to onsite abstract
Male Circumcision Does Not Reduce Sexual Function, Sensitivity or Satisfaction.Brian J. Morris, John N. Krieger
Advances in Sexual Medicine, 5, 53-60. doi: 10.4236/asm.2015.53007
Abstract: We disagree with Boyle's recent article questioning our systematic review in Journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we assigned to 7 of the 36 articles that met our inclusion criteria. These had been ranked for quality by the Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, "the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction." This conclusion was supported by two randomized controlled trials, regarded as high-quality (1++) evidence and the majority of surveys and studies involving physiological measurements comparing uncircumcised and circumcised men. Here we explain why the 2 randomized controlled trials merit a 1++ ranking and why 4 reports that Boyle believes merit a higher ranking only meet the criteria set down for low quality (2-) evidence according to the SIGN system. We therefore stand by our conclusions. These are supported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of the histological correlates of male sexual sensation.
Link to the onsite abstract
Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference?Guy Cox MA, DPhil, John N. Krieger MD and Brian J. Morris DSc, PhD
Sexual Medicine Volume 3, Issue 2, pages 76-85, June 2015
Abstract: The question of whether removal of sensory receptors in the prepuce by circumcision affects sensitivity and/or sexual pleasure is often debated.
To examine histological correlates relevant to penile sensitivity and sexual pleasure. Methods Systematic review of the scientific literature on penile structures that might affect sensitivity and sexual sensation. Articles were included if they contained original data on human male penile histology or anatomy. Individual articles, including reference lists, were evaluated. They were then considered in relation to physiological data from articles retrieved by a previous systematic review.
Results: Results: We retrieved 41 publications on penile structure. Considered in the light of 12 reporting physiological measurements, our evaluation finds that sexual response is unlikely to involve Meissner's corpuscles, whose density in the prepuce diminishes at the time of life when male sexual activity is increasing. Free nerve endings also show no correlation with sexual response. Because tactile sensitivity of the glans decreases with sexual arousal, it is unrelated to sexual sensation. Thermal sensitivity seems part of the reward mechanism of intercourse. Vibrational sensitivity is not related to circumcision tatus. Observations that penile sexual sensation is higher post circumcision are consistent with greater access of genital corpuscles to sexual stimuli after removal of the prepuce. This is based on the distribution of these corpuscles (which are located in the glans) and, in uncircumcised men, the position of the retracted prepuce during intercourse, rather than any change in the number of genital corpuscles. The scientific literature suggests that any sexual effect of circumcised men may depend solely on exposure of the glans and not on the absence of the prepuce.
Based on histological findings and correlates of sexual function, loss of the prepuce by circumcision would appear to have no adverse effect on sexual pleasure. Our evaluation supports overall findings from physiological measurements and survey data.
Effects of adult male circumcision on premature ejaculation: results from a prospective study in China.Gao J, Xu C, Zhang J, Liang C, Su P. et al.
Biomed Res Int. 2015;2015:417846. doi: 10.1155/2015/417846. Epub 2015 Jan 28
Abstract: < 0.001 for all). Similarly, when compared with the control group, the circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P < 0.001 for all). These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was not significantly associated with the development of PE.
Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review.Morris BJ, Krieger JN
J Sex Med. 2013 Nov;10(11):2644-57
Abstract: 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.
The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.
Links to further Information
Male Circumcision Improves Sex for Women.
Abstract: Women whose male sexual partners were circumcised report an improvement in their sex life, a survey shows.
Top reasons cited by women for their better sex life: improved hygiene, longer time for their partner to achieve orgasm, and their partner wanting more frequent sex ... Rakai Health Sciences Program in Kalisizo, Uganda.
Men feel much the same way, he adds. In a previous survey, 97% of men said their level of sexual satisfaction was either unchanged or better after they were circumcised.
Circumcised or not, it matters little to sexual partners, study shows