Turtleneck or Crewneck: The Circumcision Decision
As an obstetrician I do circumcisions. I trained to do them 25 years ago and have been offering this options to patients. My counseling was always very centered on the logistics of the surgical procedure that I was going to be performing. For those of you who do not know, a circumcision is a procedure where the foreskin of the penis is removed. It is a surgical procedure that is done with local anesthesia. It is seen by some people as cosmetic and by others as medically necessary. It is also sometimes done for religious, cultural or ethnic reasons. As with any surgery there are risks including bleeding, infection and scarring. There is also a risk that too much or too little foreskin could be removed. I tell my patients that it is essentially turning a turtleneck into a crewneck.
About 5 years into my career I met a physician at a conference who was anti-circumcision. He pointed out that at the base of the underside of the penis there is a bundle of nerves that gets crushed and severed during this routine procedure. This is an area where during penile penetration the foreskin pulls back and stimulates this bunch of nerves and provides increased stimulation to the penis owner. This makes them more gentle lovers because they need less friction and force for stimulation of the glans or the head of the penis.
I am now a medical consultant for a local college sex education group and they asked me: “Does a circumcision affect male sensation during sex”. I decided to dive down the research rabbit hole and find out what the latest studies show re; the necessity of circumcision and the effects of the surgery. What I found is this:
The American Academy of Pediatrics believes that circumcision has potential medical benefits and advantages, as well as risks.
Current evidence suggests that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. However, existing scientific evidence is not sufficient to recommend routine circumcision.
Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections.
Risks of circumcision include bleeding and infection. Later risk include the possible narrowing of the opening of the urethra and a “skin bridge” - an adhesion from the head of the penis to the shaft that requires surgical correction.
There are a lot of studies that have come out in the last 25 years discussing the longer term affects of circumcision on sensitivity, stimulation to orgasm and sex. Some of the studies say yes, the foreskin increases penile sensitivity and overall sexual satisfaction thus the circumcised penis has less sensitivity. A large study in the British Medical Journal in 2013 showed that there was no change in erection or ejaculation. Recently (in 2023) a study was published in The Journal of Sexual Medicine where surveys were done on 227 circumcised men and 175 uncircumcised men. There was no difference in rating in sensation of pleasure in 12 different anatomic regions of the penis or in orgasmic function. Finally a study in 2024 reviewed 61 articles about circumcision and showed that circumcision was beneficial from a medical standpoint and made no difference in function or pleasure.
None of these studies looked surveyed partners of circumcised or uncircumcised partners. If a baby is circumcised within the first few days of life (he/they) will never know anything other than what it feels like to have a circumcised penis. They will learn how to find pleasure with what they have. In studies where adult men have been circumcised many reported increased pleasure with intercourse over time. Interestingly, in one of the studies, men who were uncircumcised (the control group in the study) had decreased sexual disfunction over time at the same rate as the men who were circumcised. Is this because they were being counseled about sex or maybe because they were getting older and more experienced?
So to circumcise or not to circumcise… it remains a personal choice. It is not difficult to teach a child how to pull back and clean under the skin of the head of the penis. Families do not always have to look the same. It is a difficult decision to make, but there is no right or wrong choice. The most important thing about the penis is how it is being used, consensual penile penetration should be pleasurable regardless of the “cut and style” of the foreskin.
Morris BJ, Krieger JN. The Contrasting Evidence Concerning the Effect of Male Circumcision on Sexual Function, Sensation, and Pleasure: A Systematic Review. Sex Med. 2020 Dec;8(4):577-598. doi: 10.1016/j.esxm.2020.08.011. Epub 2020 Sep 30. PMID: 33008776; PMCID: PMC7691872.
Zaliznyak M, Isaacson D, Duralde E, Gaither TW, Naser-Tavakolian A, Bresee C, Stelmar J, Yuan N, Topp K, Garcia MM. Anatomic maps of erogenous sensation and pleasure in the penis: are there difference between circumcised and uncircumcised men? J Sex Med. 2023 Feb 27;20(3):253-259. doi: 10.1093/jsxmed/qdac032. PMID: 36763960.
Morris B, Rivin BE, Sheldon M, Krieger JN. Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review. Cureus. 2024 Feb 23;16(2):e54772. doi: 10.7759/cureus.54772. PMID: 38405642; PMCID: PMC10889534.
Payne K, Thaler L, Kukkonen T, Carrier S, Binik Y. Sensation and sexual arousal in circumcised and uncircumcised men. J Sex Med. 2007 May;4(3):667-674. doi: 10.1111/j.1743-6109.2007.00471.x. Epub 2007 Apr 6. PMID: 17419812.
Caring for Your Baby and Young Child: Birth to Age Five 7th edition (Copyright © 2019 American Academy of Pediatrics)
Last Updated 2/12/2024
Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med. 2008 Nov;5(11):2610-22. doi: 10.1111/j.1743-6109.2008.00979.x. Epub 2008 Aug 28. PMID: 18761593; PMCID: PMC3042320.