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25th March 2007
Recent Medical Studies on Circumcision
Circumcision Removes the Most Sensitive Parts of the *****
A sensitivity study of the adult ***** in circumcised and uncircumcised men shows that the uncircumcised ***** is significantly more sensitive. The most sensitive location on the circumcised ***** is the circumcision scar on the ventral surface. Five locations on the uncircumcised ***** that are routinely removed at circumcision are significantly more sensitive than the most sensitive location on the circumcised *****.
In addition, the glans (head) of the circumcised ***** is less sensitive to fine touch than the glans of the uncircumcised *****. The tip of the foreskin is the most sensitive region of the uncircumcised *****, and it is significantly more sensitive than the most sensitive area of the circumcised *****. Circumcision removes the most sensitive parts of the *****.
This study presents the first extensive testing of fine touch pressure thresholds of the adult *****. The monofiliment testing instruments are calibrated and have been used to test female genital sensitivity.
Sorrells, M. et al., “Fine-Touch Pressure Thresholds in teh Adult *****,” BJU International 99 (2007): 864-869.
Circumcision Policy Influenced by Psychosocial Factors
The debate about the advisability of circumcision in English-speaking countries typically has focused on potential health factors. The position statements of committees from national medical organisations are expected to be evidence-based; however, the contentiousness of the ongoing debate suggests that other factors are involved. Various potential factors related to psychology, sociology, religion, and culture may also underlie policy decisions. These factors could affect the values and attitudes of medical committee members, the process of evaluating the medical literature, and the medical literature itself. Although medical professionals highly value rationality, it can be difficult to conduct a rational and objective evaluation of an emotional and controversial topic such as circumcision. A negotiated compromise between polarized committee factions could introduce additional psychosocial factors. These possibilities are speculative, not conclusive. It is recommended that an open discussion of psychosocial factors take place and that the potential biases of committee members be recognized.
Goldman, R., “Circumcision Policy: A Psychosocial Perspective,” Paediatrics & Child Health 9 (2004): 630-633.
Circumcision is Not Good Health Policy
A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically.
Van Howe, R., “A Cost-Utility Analysis of Neonatal Circumcision,” Medical Decision Making 24 (2004):584-601.
Circumcision Results in Significant Loss of Erogenous Tissue
A report published in the British Journal of Urology assessed the type and amount of tissue missing from the adult circumcised ***** by examining adult foreskins obtained at autopsy. Investigators found that circumcision removes about one-half of the erogenous tissue on the penile shaft. The foreskin, according to the study, protects the head of the ***** and is comprised of unique zones with several kinds of specialized nerves that are important to optimum sexual sensitivity.
Taylor, J. et al., "The Prepuce: Specialized Mucosa of the ***** and Its Loss to Circumcision," BJU 77 (1996): 291–295.
Circumcision Affects Sexual Behavior
A study published in the Journal of the American Medical Association found that circumcision provided no significant prophylactic benefit and that circumcised men were more likely to engage in various sexual practices. Specifically, circumcised men were significantly more likely to masturbate and to participate in heterosexual oral sex than uncircumcised men.
Laumann, E. et al., "Circumcision in the U.S.: Prevalence, Prophylactic Effects, and Sexual Practice," JAMA 277 (1997): 1052–1057.
Researchers Demonstrate Traumatic Effects of Circumcision
A team of Canadian researchers produced new evidence that circumcision has long-lasting traumatic effects. An article published in the international medical journal The Lancet reported the effect of infant circumcision on pain response during subsequent routine vaccination. The researchers tested 87 infants at 4 months or 6 months of age. The boys who had been circumcised were more sensitive to pain than the uncircumcised boys. Differences between groups were significant regarding facial action, crying time, and assessments of pain.
The authors believe that "neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant’s central neural processing of painful stimuli." They also write that "the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is therefore possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination."
Taddio, A. et al., "Effect of Neonatal Circumcision on Pain Response during Subsequent Routine Vaccination," The Lancet 349 (1997): 599–603.
Circumcision Study Halted Due to Trauma
Researchers found circumcision so traumatic that they ended the study early rather than subject any more infants to the operation without anesthesia. Those infants circumcised without anesthesia experienced not only severe pain, but also an increased risk of choking and difficulty breathing. The findings were published in the Journal of the American Medical Association. Up to 96% of infants in some areas of the United States receive no anesthesia during circumcision. No anesthetic currently in use for circumcisions is effective during the most painful parts of the procedure.
Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision," JAMA 278 (1997): 2157–2162.
Circumcised ***** Requires More Care in Young Boys
The circumcised ***** requires more care than the intact ***** during the first three years of life, according to a report in the British Journal of Urology. The clinical findings of an American pediatrician showed that circumcised boys were significantly more likely to have skin adhesions, trapped debris, irritated urinary opening, and inflammation of the glans (head of the *****) than were boys with a foreskin. Furthermore, because there are large variations of appearance in circumcised boys, circumcision for cosmetic reasons should be discouraged.
Van Howe, R., "Variability in Penile Appearance and Penile Findings: A Prospective Study," BJU 80 (1997): 776–782.
Poll of Circumcised Men Reveals Harm
A poll of circumcised men published in the British Journal of Urology describes adverse outcomes on men’s health and well-being. Findings showed wide-ranging physical, sexual, and psychological consequences. Some respondents reported prominent scarring and excessive skin loss. Sexual consequences included progressive loss of sensitivity and sexual dysfunction. Emotional distress followed the realization that they were missing a functioning part of their *****. Low-self esteem, resentment, avoidance of intimacy, and depression were also noted.
Hammond, T., "A Preliminary Poll of Men Circumcised in Infancy or Childhood," BJU 83 (1999): suppl. 1: 85–92
Psychological Effects of Circumcision Studied
An article titled "The Psychological Impact of Circumcision" reports that circumcision results in behavioral changes in infants and long-term unrecognized psychological effects on men. The piece reviews the medical literature on infants’ responses to circumcision and concludes, "there is strong evidence that circumcision is overwhelmingly painful and traumatic." The article notes that infants exhibit behavioral changes after circumcision, and some men have strong feelings of anger, shame, distrust, and grief about having been circumcised. In addition, circumcision has been shown to disrupt the mother-infant bond, and some mothers report significant distress after allowing their son to be circumcised. Psychological factors perpetuate circumcision. According to the author, "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 misunderstanding of facts. These psychological factors affect professionals, members of religious groups, and parents involved in the practice."
Expressions from circumcised men are generally lacking because most circumcised men do not understand what circumcision is, emotional repression keeps feelings from awareness, or men may be aware of these feelings but afraid of disclosure.
Goldman, R., "The Psychological Impact of Circumcision," BJU 83 (1999): suppl. 1: 93–102
Serious Consequences of Circumcision Trauma in Adult Men Clinically Observed
Using four case examples that are typical among his clients, a practicing psychiatrist presents clinical findings regarding the serious and sometimes disabling long-term somatic, emotional, and psychological consequences of infant circumcision in adult men. These consequences resemble complex post-traumatic stress disorder and emerge during psychotherapy focused on the resolution of perinatal and developmental trauma. Adult symptoms associated with circumcision trauma include shyness, anger, fear, powerlessness, distrust, low self-esteem, relationship difficulties, and sexual shame. Long-term psychotherapy dealing with early trauma resolution appears to be effective in healing these consequences.
Rhinehart, J., "Neonatal Circumcision Revistited," Transactional Analysis Journal 29 (1999): 215-221
Anatomy and Function of the Foreskin Documented
A new article describes the foreskin (prepuce) as an integral, normal part of the genitals of mammals. It is specialized, protective, erogenous tissue. A description of the complex nerve structure of the ***** explains why anesthetics provide incomplete pain relief during circumcision. Cutting off the foreskin removes many fine-touch receptors from the ***** and results in thickening and desensitization of the glans outer layer. The complex anatomy and function of the foreskin dictate that circumcision should be avoided or deferred until the person can make an informed decision as an adult.
Cold, C. and Taylor, J., "The Prepuce," BJU 83 (1999): suppl. 1: 34–44.
Male Circumcision Affects Female Sexual Enjoyment
A survey of women who have had sexual experience with circumcised and anatomically complete partners showed that the anatomically complete ***** was preferred over the circumcised *****. Without the foreskin to provide a movable sleeve of skin, intercourse with a circumcised ***** resulted in female discomfort from increased friction, abrasion, and loss of natural secretions. Respondents overwhelmingly concurred that the mechanics of coitus were different for the two groups of men. Unaltered men tended to thrust more gently with shorter strokes.
O’Hara, K. and O’Hara, J., "The Effect of Male Circumcision on the Sexual Enjoyment of the Female Partner," BJU 83 (1999): suppl. 1: 79–84
Male Circumcision and Psychosexual Effects Investigated
Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual, and psychological consequences, too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation, and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors.
Boyle, G., Goldman, R., Svoboda, J.S., and Fernandez, E., "Male Circumcision: Pain, Trauma, and Psychosexual Sequelae," Journal of Health Psychology 7 (2002): 329-343.
Surveys Reveal Adverse Sexual and Psychological Effects of Circumcision
A survey of the 35 female and 42 gay sexual partners of circumcised and genitally intact men, and a separate survey of 53 circumcised and genitally intact men, and a separate survey of 30 genitally intact men themselves indicated that circumcised men experienced significantly reduced sexual sensation along with associated long-lasting negative emotional consequences.
Boyle, G. and Bensley, G., "Adverse Sexual and Psychological Effects of Male Infant Circumcision,". Psychological Reports 88 (2001): 1105-1106.
Foreskin Reduces the Force Required for Penetration and Increases Comfort
Masters and Johnson observed that the foreskin unrolled with intercourse. However, they overlooked a prior observation that intromission (i.e., penetration) was thereby made easier. To evaluate this observation an artificial introitus was mounted on scales. Repeated measurements showed a 10-fold reduction of force on entry with an initially unretracted foreskin as compared to entry with a retracted foreskin. For the foreskin to reduce the force required it must cover most of the glans when the ***** is erect.
Taves, D., "The Intromission Function of the Foreskin," Med Hypotheses 59 (2002): 180.
Survey of Men Circumcised as Adults Shows Mixed Results
Men circumcised as adults were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Over 80% of these men were circumcised to treat a medical problem. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function, decreased penile sensitivity, no change in sexual activity, and improved satisfaction. Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. Note: Results may be affected by the fact that there was no sample of normal, healthy, intact men for comparison.
Fink, K., Carson, C., DeVellis, R., "Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction," J Urol 167 (2002): 2113-2116.
Survey Finds Circumcision Contributes to Vaginal Dryness
The impact of male circumcision on vaginal dryness during coitus was investigated. We conducted a survey of 35 female sexual partners aged 18 to 69 years who had experienced sexual intercourse with both circumcised and genitally intact men. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men.
Bensley, G. and Boyle, G., "Effects of Male Circumcision on Female Arousal and Orgasm," N Z Med J 116 (2003): 595-596.
Early Adverse Experiences May Lead to Abnormal Brain Development and Behavior
Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. The brain of the newborn infant is particularly vulnerability to early adverse experiences, leading to abnormal development and behavior. Although several investigations have correlated newborn complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral types depending on the timing and nature of the adverse experience. The mechanisms mediating such changes in the newborn brain have remained largely unexplored. Maternal separation, sensory isolation (understimulation), and exposure to extreme or repetitive pain (overstimulation) may cause altered brain development. (Circumcision is described as an intervention with long-term neurobehavioral effects.) These changes promote two distinct behavioral types characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical importance of these mechanisms lies in the prevention of early adverse experiences and effective treatment of newborn pain and stress.
Anand, K. and Scalzo, F., "Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol Neonate 77 (2000): 69-82. |
