Male circumcision is a good thing

Post Reply New Topic

here is the discussion part after the numbers of the study you guys did not read apparently.

The glans in the circumcised male is less sensitive to fine-touch pressure than the glans of the uncircumcised male. The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive than the most sensitive location on the circumcised penis.

Despite the controversy over the long-term impact of male circumcision, no thorough, objective, quantitative studies measuring the long-term sensory consequences of infant circumcision have hitherto been reported. The present study provides the first extensive mapping of the fine-touch pressure thresholds of the adult penis. This information provides a baseline for future comparison studies and provides investigators with the testing locations that provide the most differentiation.

The Semmes-Weinstein monofilaments are individually calibrated to deliver a targeted force within a 5%sd. They have been used to test female genital sensitivity [17] and can be used to determine changes in sensitivity over time.

It is difficult to compare our data and results with those claimed by Masters and Johnson [1]; no method is documented, only their assertion of no difference in fine-touch reception on the glans. Nevertheless, their results, even if they were verifiable, are of little value to the question of the long-term sensory consequences of infant circumcision. First, the glans has virtually no fine-touch neuroreceptors [11–14]. Second, when determining the aggregate sensory impact of circumcision, the sensory effects of circumcision on the glans are of secondary significance, because the glans is not removed during circumcision. Instead of measuring changes in the glans after circumcision, it is more important to measure the sensory investment of the parts of the penis removed by circumcision.

In a subjective study with only a 44% response rate, Fink et al.[2] questioned men, using an unvalidated survey tool that they hoped would measure sexual function. Compared to before circumcision, men reported reduced erectile function (P = 0.01), decreased penile sensitivity (P = 0.08), no changes in sexual activity, and improved satisfaction after circumcision. The circumcisions were for ‘medical reasons’ in 88%. For a procedure that was expected to correct their problem, entirely favourable outcomes would be expected, but 38% reported a perceived problem or difficulty as a result of the procedure.

Collins et al.[3] studied 15 men who were circumcised as adults; all but one had a penile problem. The patients completed the Brief Male Sexual Function Inventory, an unvalidated measure of sexual function, before and at least 12 weeks after the procedure. Not surprisingly, this under-powered study failed to find any differences in sex drive, erection, ejaculation, problem assessment, or overall satisfaction. This is an intriguing finding because the men were circumcised expecting an improvement in sexual function and satisfaction.

In a study designed to measure the impact of anterior urethroplasty on erectile function, Coursey et al.[4] included a control group of men who were circumcised for ‘phimosis or other benign indication’. Of the 48 men circumcised, only 22 (46%) completed the survey. Using an internally validated survey, 27% reported worsening satisfaction with their erectile function after a procedure.

In a Turkish population of 42 men in their third decade undergoing circumcision, 39 of whom sought circumcision for religious reasons, the Brief Male Sexual Function Inventory, measured before and at least 12 weeks after the procedure, showed no difference in any of the five areas assessed by the instrument. However, the mean IELT was significantly longer after circumcision (P = 0.02) [5]. As noted earlier, Turkish men had the shortest mean IELT of the countries assessed [9].

In a study of 95 men undergoing circumcision in China, erectile function was measured before and after surgery. Eighteen patients reported mild erectile dysfunction before circumcision, while 28 reported from mild to moderate erectile dysfunction after circumcision (P = 0.001). Also reported were increased problems with weakened erectile confidence (P = 0.04), difficult insertion during coitus (P = 0.03), prolonged intercourse in 31 cases (P = 0.04), and improved satisfaction in only 34 patients (P = 0.04) [6].

In a study of 125 men drawn from a urology clinic, Bleustein et al.[7] found that uncircumcised men, both with and with no erectile dysfunction, had lower thresholds for pressure using the same device as used in the present study. The differences they found were no longer statistically significant when adjusted for age, diabetes, and hypertension. Their age difference (7 years) was greater than in the present population. Their population consisted of patients referred to a urologist; the present subjects were drawn from the general population, and diabetics were excluded. We did not enquire about hypertension nor measure blood pressure. Bleustein et al. only sampled two locations, the meatus and the dorsal glans halfway between the meatus and the corona, in circumcised men, with an additional sample in uncircumcised men at the ‘dorsal midline foreskin’ with the prepuce in its natural position over the glans. In uncircumcised men, there were no significant differences between the measurements taken at the glans with the foreskin retracted and those taken at the level of the glans with the foreskin in its normal position. The positions used in that study correlate to positions 9, 10 and 16 in the present study. In our mixed model, controlling for location of the measurement, age, wearing briefs, being Hispanic, and circumcision status, position 10 had a lower threshold than position 9 (−0.243 g, sem 0.079, P < 0.002). The present data indicated that the location on the uncircumcised penis measured by Bleustein et al. had one of the highest thresholds of the locations found only on the uncircumcised penis. We found that the age-adjusted thresholds were significantly lower in location 16 than either 9 or 10 (location 9, −0.75 g, sem 0.184, P < 0.001; location 10, −0.56 g, 0.17, P < 0.002).

The studies detailed above share several important flaws: (i) a low response rate to opportunities to complete surveys (it is speculative as to how the half who did not complete these surveys would have responded); (ii) the lack of agreed upon, externally validated instruments to measure erectile function; (iii) small population sizes that limit the study power; (iv) the subjective nature of instruments used; (v) short follow-up times; and (vi) the patients in the studies were not genitally healthy.

The last three items deserve special comment. Self-reporting is notoriously unreliable, and all but one of the reported studies relied on patient testimony rather than objective measurements. Patients are highly susceptible to suggestions or inferences that surgery or treatments used to correct a problem will, in fact, correct that problem. Also, otherwise healthy men who seek circumcision for other than medical reasons are predisposed to reporting a favourable outcome. Furthermore, surveys with subjective measures are dependent on the respondent’s state of health. When asked to rate quality of life of various impaired health states, healthy individuals will rate the quality lower than will a person in that particular health state. In these studies, it would be expected that the men rate their genital performance higher when in the genitally impaired condition than if they were not genitally impaired.

The short follow-up might have precluded changes in genital response and sensitivity that take longer to develop. Likewise, the acute changes from surgery and scar remodelling are known to take up to 12 months to resolve [18]. Finally, except for the Turkish study, the men in these studies had penile pathology. Consequently, improvements in this population would be expected regardless of the intervention, due to what is commonly referred to as the ‘floor effect’ (more room for improvement than deterioration). Consequently, the worsening in so many subjects is remarkable. It could be concluded that circumcision might be an invalid intervention for these medical conditions.

The present subjects, while drawn from the general population, were men who showed the initiative to participate. This might introduce a population and selection bias, but the objective nature of the measure should not have been affected. In the USA, uncircumcised men are demographically different from circumcised men. They tend to be younger and from certain ethnic backgrounds. They might also be from families with either higher or lower parental education levels, depending on the decade of their birth [19,20]. Younger men might have been less willing to participate in the study due to their increased modesty. As there are many more circumcised than uncircumcised men in the USA, recruiting equal numbers of subjects from each group was challenging.

The measurement of fine touch using pressure thresholds might be limited. Fine touch transmitted through Meissner’s corpuscles might be dynamic, using a network of nerve endings. For example, the fingertips, which have a high density of Meissner’s corpuscles, are able to interpret Braille when moving over raised dots, not merely by pressing on them. Consequently, a static measurement of pressure threshold can miss much of what the Meissner’s corpuscles are capable of transmitting. An instrument that measures the sensitivity to light brushing or that can discriminate surface texture when rubbing might be needed to measure this dynamic sensation.

The differences in age, based on circumcision status, were expected. In their study, Bleustein et al.[7] found that uncircumcised men were a mean of 7 years older. Based on the fluctuations of circumcision rates over the past century, we expected genital integrity to be more prominent among older men and among men in their twenties. Because the confidence, sufficient to volunteer for mapping of genitalia, might not come until the later twenties, this population might have been under-represented in our study.

Additional study with vibratory, hot and cold thresholds on a wider variety of positions on the penis is needed. Furthermore, development of a reliable method of measuring dynamic sensation is needed to identify, elucidate and quantify the sensory capacity of the various nerve endings in all parts of the penis, and to provide a greater understanding of the dynamic sensory interplay between the various parts of the uncircumcised penis during sexual activity. Finally, prospective real-time stopwatch assessments of the IELT at coitus in men, investigated in the laboratory by the Semmes-Weinstein touch test, would provide additional objective information of their sexual and particularly ejaculatory performance. Long-term monitoring of numerous factors of sexual pattern, including sexual pattern films, would provide additional information. Ideally, such investigations could be undertaken on adult subjects before and after elective circumcision, and in whom there is no preoperative pathology.

In conclusion, circumcision removes the most sensitive parts of the penis and decreases the fine-touch pressure sensitivity of glans penis. The most sensitive regions in the uncircumcised penis are those parts ablated by circumcision. When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.

I know this isn't the best source, but here's an article that says otherwise: http://www.psychologytoday.com/blog/mor ... e-and-stds

Just something for you guys to chew on.

The pleasure loss in circumcised women is much greater than in circumcised men, to the point that women feel hardly any pleasure from sex. Besides, the intent of female circumcision is that loss of pleasure and female oppression in general instead of religious, cultural, or even medical reasons as it is in men.

On nerve density and sensitivity vs pleasure... if circumcised men lose 50% nerve sensitivity, that doesn't mean that they lose 50% of pleasure. But it DOES play a role, I'd put my money on the fact that circumcised men feel somewhat less pleasure than uncircumcised ones. Those nerves must count for something.

Visagrunt's position is pretty reasonable actually, although I do have this small concern:

If someone is not circumcised and wishes he were, he can do something about it.
If someone is not circumcised and wishes he weren't, it's all good.
If someone is circumcised and wishes he were, it's all good
If someone is circumcised and wishes he weren't, then tough luck, that foreskin is not coming back.

It brings me some moral concerns on freedom of choice too; the loss of a functional body part should be the decision of the owner of such body part. Although I do wonder, why do the benefits of circumcision you've talked about only apply when it's done at an early age?