Thursday, June 7, 2012

Circumcision: the sensitive sensitivity and pleasure issue

One of the big debates about circumcision is whether it has any effect on the sexual life of the circumcised. Every time that the subject is discussed in any forum, a big emotional debate occurs, from those who say they have never missed having a foreskin and wouldn't want one, to those who blame circumcision for Erectile Dysfunction.

I was just reading today, and someone with a somewhat scientific profile argued that while the health benefits are not completely proved, the effects on sensitivity and sexual life have even less prove. I was thinking about it...

Different studies render different results. The doctors of yore where adamant on reducing the sensuality of men: "To obtain the best results one must cut away enough skin and mucous membrane to rather put it on the stretch when erections come later. There must be no play in the skin" (E.J.Spratling, Masturbation in the Adult, Medical Record, vol. 24. (1895): pp. 442-443.) and "Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often." R.W. Cockshut. Circumcision. British Medical Journal, Vol.2 (1935): p.764., and yet today's doctors assert that circumcision "has no adverse effect on sexual function, sensitivity, penile sensation or satisfaction and may enhance the male sexual experience" (http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415)

A different study concluded that: "Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised." http://www.ncbi.nlm.nih.gov/pubmed/11956453

Some argue that women (American women at least) prefer circumcised men, while others argue that the circumcised penis causes chaffing of the inner walls of the vagina and remove the natural lubrication, making sex painful.

The problem is that there is no real way to measure sensitivity and satisfaction. Some like it rough, some like it gentle. There is no way to connect a "pleasurometer" to a person's brain and see how it measures. I contend that in studies over men circumcised as adults, there are variables that are not controlled and they possibly lack mid to long term follow up. Let's see some of the issues:

Circumcision is not a one size fits all procedure. Every person faces this decision based on different circumstances and with different expectations. I am basing my observations here in anecdotal evidence taken from online forums, so this is not a scientific study, just a personal disertation.

Some men decide to get circumcised as adults because of existing conditions of the penis that made sex painful or even impossible: phimosis, paraphimosis, recurrent infections. In these cases, the ability to resume and normalize the patient's sexual life is an obvious advantage, regardless of a potential loss of sensitivity. Being able to have sex is better than not being able to have any.

Other men arrived at circumcision with not a lot of thought, and for reasons that could have been treated differently: a patient with "shrinking foreskin" who didn't attempt any alternative treatment. A guy that was convinced of doing it for aesthetic reasons. Both were quick to assert that they should have studied things better and that getting circumcised had been the worse mistake of their lives. One of them said that his wife hated the way his penis felt after circumcision. A video testimonial of another man says that the doctor never mentioned the potential lose of sensitivity, and proceeds to state that the loss was huge. He said it was like walking outside on a sunny day with blue sky and not be able to feel the heat on the skin.

Some people who were circumcised as babies are perfectly happy and would even circumcise their own children. Some hate their parents for having them circumcised. For example some have so little skin that erection is painful always.

Tabulating the degree of satisfaction or enjoyment of sex would require studies that are impossible to perform in the real world. To study the effect of circumcision in men, it would be impossible to produce blind studies, as obviously every man will know his own circumcision status. To study the effect of the circumcised or uncircumcised penis in women during sex we would need to conduct blind studies where all the other variables were removed: basically women would need to have sex with different partners without seeing the partners, without any additional touch or word, in order to compare exclusively the feeling of the penis inside their bodies.

What the previous anecdotes show, in addition to the existing studies, is that circumcision changes the sexual experience of men. This change might be positive, or it might be negative. Things are just never the same. It also shows that the percentage of people who believe that their circumcision had a positive effect is not that different from the number of people who think they had a negative effect. There is no big majority. There is no average. Every case is different.

However, what is undeniable is the physical change of the penis. An intact penis has slack skin that offers a gliding effect: skin can move freely up and down the shaft during sex or masturbation. The glans is shiny and soft with a strong color. In circumcised men, the skin is tight, to the point that there is little play or no play at all during erection. The glans, over time, becomes hard and dry because it's exposed to constant friction. There is no need for complex studies: we can compare a few penis of men circumcised when they were babies with the penis of a few intact men. The physical differences in the penis are obvious in plain sight. I say this without judgment. Whether one or the other feels better for his owner, or for his partner, is a different issue, but the difference exists.

The man who gets circumcised as an adult experiences an evolution over time. Initially the glans is very sensitive, as it is not used to being exposed. This can be uncomfortable at the beginning. With time, the glans becomes keratinized. This is the way the body reacts to being constantly exposed, by desensitizing itself. This may be an advantage as it may give more endurance to the man, or it may be negative as it may make orgasm more difficult to achieve. It's all matter of perspective and expectations.

When one chooses to get circumcised, one has to consider carefully his own motivation and expectations. Satisfaction depends greatly upon the reasons, circumstances, and previous experiences.

Where all this leads is to the dilemma of circumcising babies. As adults, we might have lived through different circumstances and we might find the need or not to undergo surgery. The problem with babies is: they haven't lived yet; they don't have previous experiences; they don't have motivation or reasons to get circumcised, and we can't really discuss the issue with them and receive their feedback.

If we choose to circumcise them, they are going to have to live with it all their lives. They may like it or they may not, but they won't be able to change it.

I've heard people say: "I don't know anyone who is circumcised and unhappy about it". Well, I am. And I've seen forums full of people like me, who had no choice in the matter.

If we leave the babies intact, they may one day develop a condition that requires circumcision, or they may not. They may decide that they want to be circumcised for aesthetic reasons, or not. If it's really important for them, they might choose the surgery. Or they may be afraid of the pain, the healing process and decide against it. Or they may not find any reason to do it at all. Whatever the case, it will be their choice. If they do it and they don't like it, it was their mistake. If they do it and they enjoy it, it was their call. If they don't do it, again it is their choice.

Considering the mixed results in terms of satisfaction, who would like to take actions that are not reversible and will affect the adult life of our babies with unpredictable results?

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