Circumcision in Adults: Effect on Sexual Function

To the Editor:

Senkul et al.¹ surveyed young men of military age in Turkey before and after elective circumcision. They reported, Adult circumcision does not adversely affect sexual function, although a significant increase in ejaculatory latency times was recorded. Unfortunately, older men, in whom problems may be more likely to occur, were not included in the study.

This survey was carried out in Turkey. Male circumcision is deeply woven into the fabric of Turkish society.² Turks consider that one is not a man until one is circumcised.² Culture is a confounding factor in studies regarding circumcision,³ and this study does not escape the influence of culture. Goldman⁴ reports:

Defending circumcision requires minimizing or dismissing the harm and producing overstated medical claims about protection from future harm. The ongoing denial requires the acceptance of false beliefs and misunderstandings of facts. Cultural conformity is a major force perpetuating non-religious circumcision, and to a greater degree, religious circumcision. The avoidance of guilt and the reluctance to acknowledge the mistake and all that that implies help to explain the tenacity with which the practice is defended.

The claim that adult circumcision does not adversely affect sexual function is a value judgment rooted in the culture of Turkey.¹ Other researchers may consider an increase in ejaculatory times to be adverse.

Other authors findings that circumcision does affect sexual function are helpful. Earlier work by Winkelmann⁵ showed that the foreskin is the site of the mucocutaneous region and that closely packed end organs extend from the distal end of the prepuce back to the hairy skin. Winkelmann characterized this as a specific erogenous zone. Taylor et al.⁶ subjected the prepuce to anatomic examination. They found a previously unknown structure, which they called the ridged band, of highly vascularized and innervated tissue just inside the tip of the prepuce and near the mucocutaneous boundary. Penile nerves provide sensory input to both the central and sympathetic nervous systems.⁷ Waldinger⁷ reports that an ejaculatory circuit exists in the central nervous system that controls ejaculation. Winkelmann⁵ observed, Certain pathologic states might be explicable on the basis of diminished or augmented cutaneous nerve supply. The excision of the ridged band nerve plexus by circumcision and consequent diminishment of sensory input would explain the increase in ejaculatory times reported by Senkul et al.¹

Senkul et al. failed to ask the crucial question, Is sexual pleasure increased or decreased by circumcision? Another study, carried out in a different culture (America) answers that question. Denniston⁸ carried out a survey of 38 adult males who were circumcised at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure.

There are ethical concerns regarding the nontherapeutic circumcision of minors.⁹ Elective circumcision should be restricted to adult males who, after being fully informed of the diminution of sensory input and pleasure associated with circumcision, personally give their informed consent.

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