March 12, 2012

The Pros and Cons of Circumcision: Part 2

New research from Denmark suggests that male circumcision affects sexual function--in men as well as in their female partners.

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Male circumcision is a tricky topic. An important religious rite to some, a life-saving preventative health service to others, and a controversial, abusive practice to others still–the topic of removing foreskin continues to invoke heightened emotions in cultures around the world.

Last time, in The Pros and Cons of Circumcision: Part 1, we discussed the public health implications of studies showing that circumcision reduced the risk of sub-Saharan African men who have sex with women (MSW) of contracting HIV, including the public health significance as well as the damage created by media distortion and misinterpretation of the studies’ findings. This week, we’ll be looking at some of the possible negative consequences of circumcision on sexual pleasure and fulfillment, focusing on a recent study from Denmark, a country with a low prevalence of male circumcision.

Despite being such a controversial subject (or perhaps it is because of this), the academic literature on the subject of male circumcision is limited and often conflicting. Previous studies examining the impact of male circumcision on female sexual function have also frequently been unreliable and subject to strong bias (i.e: recruiting female study participants through an anti-circumcision newsletter).

The Danish study uniquely approaches the topic of circumcision and sexual function from a pleasure-oriented perspective; that is, (as the researchers themselves put it,) that “the pleasures of sexual intimacy and orgasm are ubiquitously important for well-being and health.”

The study focused on the sexual experiences of 5552 Danish men and women who had had partner sex within the last year, providing data not only about the sexual consequences of circumcision for men, but also on any affects their circumcision may have had for their sex partners’ sexual function and fulfillment.

The Results

Circumcised and uncircumcised men in the study were found to have comparable sexual histories, equal levels of sexual activity and partner-related sexual activity, and a similar appreciation for “having a good sex life.”  Circumcised and uncircumcised men were also equally likely to report episodes of low or lacking sexual desire, or incomplete sexual needs fulfillment within the last year. Likewise, there was no difference in the prevalence of premature ejaculation, erectile difficulties and occasional orgasm difficulties between the two groups. Contrary to popular belief, the study also found that frequent or occasional episodes of dyspareunia (painful sex) were equally distributed between both groups of respondents.

According to the findings, circumcised men were more likely to report frequent orgasm difficulties. In fact, circumcised men were found to be three times more likely to experience frequent orgasm difficulties than uncircumcised men. These odds hold even when the researchers controlled for religious affiliation (including Jewish and Muslim participants) and age of circumcision. In the context of the psychological and physical data gathered on the participants, the researchers’ findings suggest that reduced penile sensitivity may be a factor in explaining this difference in orgasm difficulties.

It is important to note here that whether or not circumcision results in reduced penile sensitivity is a hotly debated topic, with numerous studies supporting either side of the argument. Further study is warranted in order to determine stronger statistical trends before any pronouncements can be made on this centuries-old debate (and certainly not by me!)

Finally, the study found that male circumcision was negatively affecting the sexual function of study participants’ female partners as well. The majority of women, both those with circumcised and uncircumcised partners, reported episodes of low or lacking sexual desire in the past year. However, women with circumcised partners experienced incomplete fulfillment of sexual needs consistently more often than women with uncircumcised partners.  Additionally, overall frequent sexual function difficulties, frequent orgasm difficulties and frequent episodes of dyspareunia were more commonly reported by women with circumcised partners.

It is widely believed that circumcision can prevent urinary tract infections, phimosis and paraphimosis (conditions in which the foreskin becomes trapped over or behind the glans), balanoposthitis (swelling of the foreskin and glans), STIs, and cancer. However, the Danish researchers argue that all of these benefits can be achieved without removing the foreskin—through proper penile hygiene and the consistent use of condoms.

Like all research, the results from this study should be approached with caution.  Denmark is a country in which circumcision is not a common cultural practice, and the majority of males are not circumcised. Because it is not the socio-cultural norm, perceived notions of otherness or abnormality may have affected the study results. In other words, some of the men in the study and their female partners might be reporting sexual difficulties solely because they believe that the male partner’s circumcised penis is unusual, dysfunctional, or aesthetically displeasing; not because the circumcision itself has physically disrupted the couples’ sexual pleasure or fulfillment. Further research must be conducted in countries with differing socio-cultural norms surrounding the practice of circumcision.

Burke Denning is an MPH student at Indiana University, and is currently interning at the Kinsey Institute. Her studies are centered around the promotion of holistic sexual health and education that seeks to improve quality of life, and expands beyond the prevention and treatment of disease, dysfunction and unintended pregnancy.