Male Circumcision Does Not Reduce Sexual Function, Sensitivity or Satisfaction

Brian J. Morris^1*, John N. Krieger²

¹School of Medical Sciences, University of Sydney, Sydney, Australia.
²Section of Urology, VA Puget Sound Health Care System, School of Medicine, University of Washington, Seattle, USA.

DOI: 10.4236/asm.2015.53007                

Abstract

We disagree with Boyle’s recent article questioning our systematic review in Journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we assigned to 7 of the 36 articles that met our inclusion criteria. These had been ranked for quality by the Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction.” This conclusion was supported by two randomized controlled trials, regarded as high-quality (1++) evidence and the majority of surveys and studies involving physiological measurements comparing uncircumcised and circumcised men. Here we explain why the 2 randomized controlled trials merit a 1++ ranking and why 4 reports that Boyle believes merit a higher ranking only meet the criteria set down for low quality (2?) evidence according to the SIGN system. We therefore stand by our conclusions. These are supported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of the histological correlates of male sexual sensation.

Keywords

Circumcision, Erectile Function, Sexual Satisfaction, Premature Ejaculation, Penile Sensitivity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Morris, B.J. and Krieger, J.N. (2013) Does Male Circumcision Affect Sexual Function, Sensitivity or Satisfaction? A Systematic Review. Journal of Sexual Medicine, 10, 2644-2657. http://dx.doi.org/10.1111/jsm.12293
[2]	Boyle, G.J. (2015) Does Circumcision Adversely Affect Sexual Sensation, Function, or Satisfaction? Critical Comment on Morris and Krieger (2013). Advances in Sexual Medicine, 5, 7-12. http://dx.doi.org/10.4236/asm.2015.52002
[3]	Tian, Y., Liu, W., Wang, J.Z., Wazir, R., Yue, X. and Wang, K.J. (2013) Effects of Circumcision on Male Sexual Functions: A Systematic Review and Meta-Analysis. Asian Journal of Andrology, 15, 662-666. http://dx.doi.org/10.1038/aja.2013.47
[4]	Boyle, G.J. and Bensley, G.A. (2001) Adverse Sexual and Psychological Effects of Male Infant Circumcision. Psychological Reports, 88, 1105-1106. http://dx.doi.org/10.2466/pr0.2001.88.3c.1105
[5]	Bollinger, D. and Van Howe, R.S. (2011) Alexithymia and Circumcision Trauma: A Preliminary Investigation. International Journal of Men’s Health, 10, 184-195. http://dx.doi.org/10.3149/jmh.1002.184
[6]	Cox, G., Krieger, J.N. and Morris, B.J. (2015) Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference? (Systematic Review). Sexual Medicine, 3, 76-85. http://onlinelibrary.wiley.com/doi/10.1002/sm2.67/full
[7]	Masood, S., Patel, H.R.H., Himpson, R.C., Palmer, J.H., Mufti, G.R. and Sheriff, M.K.M. (2005) Penile Sensitivity and Sexual Satisfaction after Circumcision: Are We Informing Men Correctly? Urologia Internationalis, 75, 62-66. http://dx.doi.org/10.1159/000085930
[8]	Dias, J., Freitas, R., Amorim, R., Espiridiao, P., Xambre, L. and Ferraz, L. (2014) Adult Circumcision and Male Sexual Health: A Retrospective Analysis. Andrologia, 46, 459-464. http://dx.doi.org/10.1111/and.12101
[9]	Bossio, J.A., Pukall, C.F. and Steele, S. (2014) A Review of the Current State of the Male Circumcision Literature. Journal of Sexual Medicine, 11, 2847-2864. http://dx.doi.org/10.1111/jsm.12703
[10]	Morris, B.J. and Krieger, J.N. (2015) The Literature Supports Policies Promoting Neonatal Male Circumcision in North America. Journal of Sexual Medicine, 12, 1305. http://dx.doi.org/10.1111/jsm.12855
[11]	Boyle, G.J. and Hill, G. (2011) Sub-Saharan African Randomized Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns. Journal of Law and Medicine, 19, 316-333.
[12]	Wamai, R.G., Morris, B.J., Waskett, J.H., Green, E.C., Banerjee, J., Bailey, R.C., Klausner, J.D., Sokal, D.C. and Hankins, C.A. (2012) Criticisms of African Trials Fail to Withstand Scrutiny: Male Circumcision Does Prevent HIV Infection. Journal of Law and Medicine, 20, 93-123.
[13]	Van Howe, R.S. (2015) A CDC-Requested, Evidence-Based Critique of the Centers for Disease Control and Prevention 2014 Draft on Male Circumcision: How Ideology and Selective Science Lead to Superficial, Culturally-Biased Recommendations by the CDC.
[14]	Kigozi, G., Watya, S., Polis, C.B., Buwembo, D., Kiggundu, V., Wawer, M.J., Serwadda, D., Nalugoda, F., Kiwanuka, N., Bacon, M.C., Ssempijja, V., Makumbi, F. and Gray, R.H. (2008) The Effect of Male Circumcision on Sexual Satisfaction and Function, Results from a Randomized Trial of Male Circumcision for Human Immunodeficiency Virus Prevention, Rakai, Uganda. BJU International, 101, 65-70. http://dx.doi.org/10.1111/j.1464-410X.2007.07369.x
[15]	Mulhall, J., King, R., Glina, S. and Hvidsten, K. (2008) Importance of and Satisfaction with Sex among Men and Women Worldwide: Results of the Global Better Sex Survey. The Journal of Sexual Medicine, 5, 788-795. http://dx.doi.org/10.1111/j.1743-6109.2007.00765.x
[16]	Krieger, J.N., Mehta, S.D., Bailey, R.C., Agot, K., Ndinya-Achola, J.O., Parker, C. and Moses, S. (2008) Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya. The Journal of Sexual Medicine, 5, 2610-2622. http://dx.doi.org/10.1111/j.1743-6109.2008.00979.x
[17]	Morris, B.J., Waskett, J.H. and Gray, R.H. (2012) Does Sexual Function Survey in Denmark Offer Any Support for Male Circumcision Having an Adverse Effect? International Journal of Epidemiology, 41, 310-312. http://dx.doi.org/10.1093/ije/dyr180
[18]	Masters, W.H. and Johnson, V.E. (1966) Human Sexual Response. Little Brown, Boston.
[19]	Sorrells, M.L., Snyder, J.L., Reiss, M.D., Eden, C., Milos, M.F., Wilcox, N. and Van Howe, R.S. (2007) Fine-Touch Pressure Thresholds in the Adult Penis. BJU International, 99, 864-869. http://dx.doi.org/10.1111/j.1464-410X.2006.06685.x
[20]	Waskett, J.H. and Morris, B.J. (2007) Fine-Touch Pressure Thresholds in the Adult Penis. BJU International, 99, 1551-1552. http://dx.doi.org/10.1111/j.1464-410X.2007.06970_6.x
[21]	Young, H. (2007) Fine-Touch Pressure Thresholds in the Adult Penis. BJU International, 100, 699. http://dx.doi.org/10.1111/j.1464-410X.2007.07072_1.x
[22]	Podnar, S. (2012) Clinical Elicitation of the Penilo-Cavernosus Reflex in Circumcised Men. BJU International, 109, 582-585. http://dx.doi.org/10.1111/j.1464-410X.2011.10364.x
[23]	Blaivas, J.G., Zayed, A.A. and Labib, K.B. (1981) The Bulbocavernosus Reflex in Urology: A Prospective Study of 299 Patients. The Journal of Urology, 126, 197-199.
[24]	Morris, B.J. and Waskett, J.H. (2012) Claims That Circumcision Increases Alexithymia and Erectile Dysfunction are Unfounded. International Journal of Men’s Health, 11, 177-181. http://dx.doi.org/10.3149/jmh.1102.177
[25]	Taylor, G.J., Bagby, R.M. and Parker, J.D.A. (1997) Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge University Press, Cambridge. http://dx.doi.org/10.1017/CBO9780511526831
[26]	Parker, J.D.A., Bagby, R.M., Taylor, G.J., Endler, N.S. and Schmitz, P. (1993) Factorial Validity of the 20-Item Toronto Alexithymia Scale. European Journal of Personality, 7, 221-232. http://dx.doi.org/10.1002/per.2410070403
[27]	Mattila, A.K., Salminen, J.K., Nummi, T. and Joukamaa, M. (2006) Age Is Strongly Associated with Alexithymia in the General Population. Journal of Psychosomatic Research, 61, 629-635. http://dx.doi.org/10.1016/j.jpsychores.2006.04.013
[28]	Mason, O., Tyson, M., Jones, C. and Potts, S. (2005) Alexithymia: Its Prevalence and Correlates in a British Undergraduate Sample. Psychology and Psychotherapy: Theory, Research and Practice, 78, 113-125. http://dx.doi.org/10.1348/147608304X21374
[29]	Bronselaer, G.A., Schober, J.M., Meyer-Bahlburg, H.F., T’sjoen, G., Vlietinck, R. and Hoebeke, P.B. (2013) Male Circumcision Decreases Penile Sensitivity as Measured in a Large Cohort. BJU International, 111, 820-827. http://dx.doi.org/10.1111/j.1464-410X.2012.11761.x
[30]	Morris, B.J., Krieger, J.N. and Kigozi, G. (2013) Male Circumcision Decreases Penile Sensitivity as Measured in a Large Cohort. BJU International, 111, E269-E270. http://dx.doi.org/10.1111/bju.12128_9
[31]	Ruzic, A. and Lambaerts, T. (2011) Mannelijke circumcisie vermindert genitale gevoeligheid als gemeten door zelf-evaluatie in een grote cohort. Master in de Geneeskunde, Academiejaar 2010-2011 (Promotor: Prof. Dr. Piet Hoebeke; Begeleider: Guy Bronselaer), Faculteit Geneenskunde En Gezondeidswetenschappen, Universiteit Gent, Ghent, 39. http://lib.ugent.be/fulltxt/RUG01/001/787/887/RUG01-001787887_2012_0001_AC.pdf
[32]	Hoschke, B., Fenske, S., Brookman-May, S., Spivak, I., Gilfrich, C., Fritsche, H.M., Wolff, I. and May, M. (2013) Male Circumcision Is Not Associated with an Increased Prevalence of Erectile Dysfunction: Results of the Cottbus 10,000-Men Survey. Der Urologe, 52, 562-569. (In German) http://dx.doi.org/10.1007/s00120-012-3112-2
[33]	Mao, L.M., Templeton, D.J., Crawford, J., Imrie, J., Prestage, G.P., Grulich, A.E., Donovan, B., Kaldor, J.M. and Kippax, S.C. (2008) Does Circumcision Make a Difference to the Sexual Experience of Gay Men? Findings from the Health in Men (HIM) Cohort. The Journal of Sexual Medicine, 5, 2557-2561. http://dx.doi.org/10.1111/j.1743-6109.2008.00845.x
[34]	Payne, K., Thaler, L., Kukkonen, T., Carrier, S. and Binik, Y. (2007) Sensation and Sexual Arousal in Circumcised and Uncircumcised Men. The Journal of Sexual Medicine, 4, 667-674. http://dx.doi.org/10.1111/j.1743-6109.2007.00471.x
[35]	Walter, G. and Streimer, J. (1990) Genital Self-Mutilation: Attempted Foreskin Reconstruction. The British Journal of Psychiatry, 156, 125-127. http://dx.doi.org/10.1192/bjp.156.1.125