To Circumcise or Not to Circumcise

A discussion of sexual arousal would not be complete without some mention of circumcision. To circumcise, or not to circumcise, has been a longstanding question dating back to biblical times. Male circumcision has long since been associated with cleanliness and a subject of popular media attention. Media attention aside, there has been a long debate regarding the "medical necessity" of male circumcision with some researchers claiming that male circumcision helps to protect men against sexually transmitted diseases and infections. A recent review of the literature has indicated that that while the rate of HIV infection among men who have sex with men is about 14% lower among the circumcised men versus the men who were uncircumcised, the difference is not statistically significant (Millett, Flores, Marks, Reed, & Herbst, 2008).

While the debate about the medical necessity of male circumcision continues, another debate has emerged about male circumcision and its impacts on sexual pleasure. Because most male circumcision procedures happen during infancy it is very difficult to determine how (if at all) sexuality is impacted by this procedure. Anecdotal reports from men who have undergone circumcision in adulthood suggest that male circumcision decreases penile sensitivity and sexual pleasure.

There are also other ways in which male circumcision can impact sexuality. As mentioned above there has been a bias in many cultures against uncircumcised men, perhaps due in part to the association between male circumcision and cleanliness. It is important to note that a circumcised penis does not necessarily equal a cleaner penis and that good hygiene practices are import for both the circumcised and the uncircumcised. The uncircumcised male (or the circumcised male) may feel insecure about the status of their penis. Over the last several years routine male circumcision has declined. This has created a balance between those who are circumcised versus those who are not. As we become more educated and this becomes a less frequent procedure perhaps we will also see a decrease in biases.

On August 27, 2012, the American Academy of Pediatrics released a policy statement on the issue. The abstract of that report states, "Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy's 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement."

To view the complete policy statement and accompanying documents, please visit http://pediatrics.aappublications.org/content/130/3/585.

The Canadian Paedtriac Society released a position policy statement in March 1996 that stated: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed.

Also in 1996, the Australian Association of Paediatric Surgeons, released their policy statement which says: The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available. Due to religious beliefs, Jewish children are circumcised by the seventh day of life, as a mark of dedication to God. [sic] Children born into the Muslim faith will likewise be circumcised for religious reasons, although the timing for the procedure is less clearly defined. There are Christian groups in other parts of the world, who insist on ritual religious circumcision, as well as tribal or cultural customs promoting male circumcision. We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.