The Mail Online says: “It's official: Circumcision doesn’t affect sexual pleasure”. The story follows publication of a study reviewing the scientific literature to find out whether there is any difference in sexual performance and satisfaction between circumcised and uncircumcised men.
An Australian systematic review concludes that the controversial practice has no adverse effect on sexual function or sensitivity.
Thirty-six studies were identified, most were observational studies, though two large randomised controlled trials (RCTs) from African countries were identified. Overall the review finds no evidence for any differences between circumcised and uncircumcised men in terms of sexual function or sexual pleasure.
While the review considered a large body of evidence, there are some factors that may be influencing the findings.
For example, many studies were surveys, and the recruitment process for them is not described. It could be the case that men who have a satisfying sex life may be more willing to participate and answer questions on sexual performance and satisfaction that those who aren’t.
Also, most of the responses in the study are subjective, and what one person considers to be a sexual problem or sexual satisfaction, another might not. There may also be differences in the culture and ethnicity of the participants of certain studies, meaning that their findings cannot be so easily transferred elsewhere.
Overall, this is a useful review combining the results of the global literature to investigate how sexual function and pleasure may or may not differ between circumcised and uncircumcised men.
Ultimately the decision of whether to undergo circumcision or not remains a personal matter that will be influenced by health-related or cultural factors.
Where did the story come from?
The study was carried out by two researchers from the University of Sydney, Australia and the University of Washington School of Medicine, Seattle, US, and was published in the Journal of Sexual Medicine. No sources of financial support are reported.
What kind of research was this?
This was a systematic review aiming to see what effects on pleasure or function are documented in the global literature of circumcision. Male circumcision is a common procedure that may be carried out for reasons of health, aesthetics, tradition or religion.
Various studies have suggested that circumcision may have several health benefits, including reducing risk of infections and possibly even cancers of the genitourinary system. However, it has often been debated whether circumcision has any effect on male sexual function or pleasure.
The Mail Online's reporting is representative of the findings of this research, but its claim that “it’s official” is unsupported and is sadly indicative of a misunderstanding of how science works. Very few things are “official” in medicine or in science generally, with most issues still up for debate and further research.
What did the research involve?
The researchers conducted a search of various literature databases using keywords related to sexual function (including performance, erectile dysfunction, premature ejaculation, orgasm difficulties or pain during sex), sensitivity and sensation of the penis, and self-reported satisfaction (sensation of pleasure or orgasm intensity). They conducted this search first, then searched for the same terms in combination with the keyword circumcision to ensure they didn’t miss any relevant studies. They also looked through reference lists of retrieved articles.
Eligible studies were observational studies (cohort, case control or cross sectional). Studies were rated using a recognised quality-grading system, and the lowest quality studies were excluded. This included case reports, discussion, and opinion pieces. They also excluded studies related to procedural aspects of circumcision.
What were the basic results?
The inclusion criteria were met by 36 studies, which reported data for 40,473 men, including 19,542 not circumcised and 20,931 circumcised. Just under half of those circumcised had had the procedure carried out in infancy. Over half the studies had collected data on premature ejaculation, erectile dysfunction, or sexual satisfaction or pleasure, while around a quarter had collected information on time to ejaculation, pain during sex, orgasm difficulties or sensitivity.
The research is discussed by study. The 36 studies only included two randomised controlled trials (RCTs) – though this is not especially surprising as most adult men would not volunteer to be randomly assigned to be circumcised or not, unless there was a pressing health reason to do so.
One RCT was from Kenya, it including included 2,784 men, used a behavioural questionnaire to examine sexual performance or satisfaction between those randomised to be circumcised and those not, and found no significant differences between the groups. The second, from Uganda, included around 4,500 men and again found no differences in sexual performance or satisfaction between those randomised to be circumcised and not.
In observational studies, a US Health and Social Life Survey of almost 1,500 men found that erectile dysfunction was more common among uncircumcised men, while an Australian telephone survey found reports of fewer sexual difficulties among circumcised men.
Other surveys, including those looking solely at men who have sex with men, found no differences in sexual problems or libido between circumcised and uncircumcised men. Overall, as would be expected, most erectile problems among circumcised and uncircumcised men became more common with increasing age.
Other surveys found that circumcised men were happier with the appearance of their bodies, and masturbated more frequently. However, another survey found that men after circumcision were more likely to find masturbation more difficult or that it gave less pleasure, than being more favourable.
Another study of 500 couples found no difference in the average time to ejaculation during sex in circumcised and uncircumcised men. Another survey of men in Sydney found that premature ejaculation was significantly less common in men circumcised in later life.
Other reviews that combined the results of individual studies found no difference between circumcised and uncircumcised men in difficulties with orgasm, pain during sex, or sexual desire.
How did the researchers interpret the results?
The researchers conclude that “the highest-quality studies suggest that male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction”.
This review combines the results of 36 studies reporting differences in sexual performance and satisfaction between circumcised and uncircumcised men. Most were observational studies, though two large RCTs from Kenya and Uganda were identified. The findings of the studies are discussed, and the review finds no evidence for any overall differences between circumcised and uncircumcised men in terms of sexual function or sexual pleasure.
The review gathers together a large body of evidence, though the included studies will vary in their populations and methods of assessment. There are some factors that may be influencing the findings. For example, many studies were surveys, and recruitment for them is not described. It could be the case that men who have a satisfying sex life may be more willing to participate and answer questions on sexual performance and satisfaction that those who aren’t.
Also, most of the responses in the study are subjective, and what one person considers to be a sexual problem or sexual satisfaction, another might not.
There also may be differences in the culture and ethnicity of the participants of certain studies, meaning that their findings cannot be so easily transferred elsewhere.
Overall though, this is a useful review combining the results of the global literature to investigate how sexual function and pleasure may or may not differ between circumcised and uncircumcised men.
Routine male circumcision performed for purely health-related reasons shortly after birth, remains a controversial issue.
Supporters of the practice make the case that it can reduce the risk of males contracting urinary tract infections and sexually transmitted infections such as HIV.
Opponents argue that routinely circumcising baby boys on health-related grounds violates the principle of consent to treatment. They say that circumcision should only be performed when a boy is old enough to make an informed decision about whether he wishes to be circumcised.
It is a debate that is likely to continue for many years to come. Ultimately the decision of whether to circumcise or not remains a personal matter that will be influenced by health-related factors, or for cultural reasons.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Mail Online, 6 December 2013
Links to the science
The Journal of Sexual Medicine. Published online August 12 2013