Circumcised as adults: Jim Ryan MD

The positive reports of persons circumcised as adults must be qualified for a number of reasons:

Those circumcised as adults for religious reasons are likely to see this ritual as a very positive experience and be reluctant to report any negative results. This would be reinforced if their partner shared their common religious perspective, which is likely in most cases (e.g. male Jewish or Muslim converts).
Those circumcised for medical reasons will all have had some medical problem affecting their penises. The abnormal medical condition may have been painful in itself or made sex painful before treatment. Thus sex may truly be more pleasurable for them after treatment than it was before. In any case, their comparisons of before vs. after circumcision must be recognized for what they are, comparisons of a diseased state vs. a desensitized state. Unfortunately, many men circumcised for medical reasons may find the latter an improvement. Non-surgical treatment of the underlying condition, however, may well have been able to correct the problem, enhancing their sexual pleasure without the loss of sensitivity resulting from circumcision.
No matter what the reports may be about the results of adult circumcision, it is incorrect to generalize this experience to infant circumcision. Routine Infant Circumcision (RIC) is different and may be more harmful to adult sensation for a number of reasons:
- RIC is performed on a small infant penis, usually with tools that preclude precision. Frequently it results in excess tissue removal and other complications which are avoidable when adult circumcision is performed. Adult circumcision is performed on a much larger penis, usually using a scalpel and sutures, permitting the doctor to save more tissue if he so chooses.
- RIC requires that the foreskin be torn from the tissue of the glans to which it still adheres, further damaging this sensitive structure. When an adult is circumcised, the foreskin has already separated from the glans. The loss of sensitivity to an adult may therefore be less.
- RIC leave the glans and residual foreskin exposed to urine and feces during the diaper period, further reducing any remaining sensitivity. Even with equivalent tissue loss, a man subjected to RIC may have less sensitivity than one circumcised as an adult.
- RIC may result in decades of exposure of the glans and residual foreskin to clothing and other trauma before sexual intercourse begins. If an adult is circumcised, he is starting at least with a more sensitive penis, although this may diminish over the years after circumcision as the tissue toughens.
- RIC usually removes all of the sensitive frenulum and leaves only a small band of the sensitive inner foreskin above the glans. A man circumcised as an adult has the option of saving these tissues. Some of the satisfied respondents who were circumcised as adults may therefore have much more sensitive penises than their brothers subjected to RIC. [Unfortunately, a circumcision which leaves only a small band of inner foreskin above the glans is considered by many men to be cosmetically more attractive than one where an ugly scar is located half way up the shaft of the penis, although this would clearly result in less impairment of sensitivity. Urologists, who perform most non-infant circumcisions, therefore tend to leave minimal residual foreskin.]
The only unbiased comparison of before vs. after adult circumcision would need to be made by healthy men who voluntarily chose to be circumcised for non-religious and non-medical reasons, were sexually active before the surgery, and continued comparable sex lives after the operation. I have heard no reports of such men preferring the circumcised condition. In fact, I have not personally encountered any men during my 23 years of medical practice who have had themselves circumcised other than for religious or medical reasons. Perhaps there are good reasons why so few healthy men elect to be circumcised! And I would guess that many men who choose circumcision for medical reasons would have chosen non-surgical treatment has they been advised by the surgeon that there were other alternatives.
Even if healthy men who chose circumcision as adults for non-religious and non-medical reasons could be found, their reports might still be suspect. Men who have chosen to be circumcised for whatever reason will be fully aware that they cannot go back and may be reluctant to admit to themselves (much less publicly) that they made a mistake, especially about such a sensitive (no pun intended) question. For the same reason, the reports of those who are willing to acknowledge a loss should be given additional credibility. Having undergone the pain of circumcision, they are now willing to take the painful choice of acknowledging their loss.

Basically, I don't think it is possible to find subjects who can make a valid positive evaluation of the effects of adult circumcision. On the other hand, there are no parallel reasons to dismiss the reports of men who report a loss after circumcision. I believe that all reports of improved sensitivity are suspect. We know that 50% or more of the skin of the penis is removed including most of the inner surface of the foreskin and most if not all of the frenulum. These are the tissues where most of the sexually sensitive nerve endings are found (See Taylor's report in the February 1996 British Journal of Urology). It makes no sense that removal of most of the highly sexually sensitive parts of the penis would enhance pleasure. All before vs. after comparisons must be viewed in this light. Enhanced pleasure after circumcision makes about as much sense as claims of improved manual dexterity after the fingertips havebeen amputated.

The fact that many circumcised men claim to be satisfied is irrelevant. Most have been subjected to RIC and have never known anything else. And the reports of those who may have been circumcised as adults are suspect for the reasons outlined above. It is useful to note that women in countries which practice Female Genital Mutilation (which often involves amputation of most of a woman's external genital organs) are reported to be satisfied with their status and to be the ones who are the strongest advocates of subjecting their daughters to this ritual.

Jim Ryan, MD

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