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Sorrells ''et al.'' (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." According to Sorrells ''et al.'', the five penile areas most sensitive to fine-touch are located on the foreskin. <ref name="sorrells" /> This is disputed by Waskett and Morris, who argue that Sorrells' " 2 shows this applies only to their position 3, the orifice rim of the prepuce." However, they stated that after they used the ] method to correct for multiple comparisons, "this significance disappeared." <ref name="waskett2007" /> Sorrells ''et al.'' (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." According to Sorrells ''et al.'', the five penile areas most sensitive to fine-touch are located on the foreskin. <ref name="sorrells" /> This is disputed by Waskett and Morris, who argue that Sorrells' " 2 shows this applies only to their position 3, the orifice rim of the prepuce." However, they stated that after they used the ] method to correct for multiple comparisons, "this significance disappeared." <ref name="waskett2007" />


Boyle ''et al.'' (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref name="boyle" /> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well." Boyle ''et al.'' (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings&mdash;many of which are lost to circumcision."<ref name="boyle2002" /> They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."


Conversely, in a 2008 study, Krieger ''et al.'' stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name = "Krieger2008">{{cite journal Conversely, in a 2008 study, Krieger ''et al.'' stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."<ref name = "Krieger2008">{{cite journal
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==Female arousal== ==Female arousal==
O'Hara and O'Hara argue that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman's overall clitoral stimulation and helping her achieve orgasm more quickly and more often. Without the foreskin's gliding action, they suggest, it can be more difficult for a woman to achieve orgasm during intercourse. <ref>BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84, O'Hara and O'Hara argue that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman's overall clitoral stimulation and helping her achieve orgasm more quickly and more often. Without the foreskin's gliding action, they suggest, it can be more difficult for a woman to achieve orgasm during intercourse.<ref name= "OHara1999">{{cite journal
| last = O'Hara
⚫ January 1, 1999. "The effect of male circumcision on the sexual enjoyment of the female partner"
| first = K.
K. O'HARA and J. O'HARA </ref> Bailey et al. report that there is a preference by women for the circumcised man, mentioning that circumcised men enter the woman more easily and cause fewer traumas. <ref> AIDS Care. 2002 Feb;14(1):27-40. The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. Bailey RC, Muga R, Poulussen R, Abicht H. </ref>
| coauthors = J. O'Hara
| year = 1999
| month = January
⚫ | title = The effect of male circumcision on the sexual enjoyment of the female partner
| journal = BJU International
| volume = 83
| issue = Supplement 1
| pages = 79-84
| url = http://www3.interscience.wiley.com/cgi-bin/fulltext/119091407/PDFSTART
| format = PDF
| pmid = 10349418
}}</ref>


; Vaginal dryness and female arousal : A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised. <ref> Gillian A Bensley, Gregory J Boyle. NEW ZEALAND MEDICAL JOURNAL, Volume 116, Number 1181: Pages 595-596, ; Vaginal dryness and female arousal : A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised.<ref>{{cite journal
| last = Bensley
| first = Gillian A.
| coauthors = Gregory J. Boyle
| year = 2003
| month = September
12 September 2003.
| title = Effects of male circumcision on female arousal and orgasm
ISSN 1175 8716
| journal = New Zealand medical journal
⚫ "Effects of male circumcision on female arousal and orgasm" </ref> Bensley ''et al.'' reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder. The authors hypothesized that the gliding action possibly involved intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication. They stated that the respondents were self-selected, and that larger sample sizes are needed<ref> PSYCHOLOGICAL REPORTS (Missoula), Volume 88, Pages 1105-1106. "ADVERSE SEXUAL AND PSYCHOLOGICAL EFFECTS
| volume = 116
OF MALE INFANT CIRCUMCISION"
| issue = 1181
GREGORY J. BOYLE AND GILLIAN A. BENSLEY </ref>. Boyle ''et al.'' state that self-selection is unreliable. <ref name="boyle"> Journal of Health Psychology
| pages = 595-596
An Interdisciplinary, International Journal
⚫ | url = http://www.cirp.org/library/sex_function/bensley1/
Volume 07 Issue 03 - Publication Date: 1 May 2002
| format =
"Male Circumcision:
| pmid = 14581975
Pain, Trauma and
⚫ }}</ref> Boyle & Bensley (2001) reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder. The authors hypothesized that the gliding action possibly involved intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication. They stated that the respondents were self-selected, and that larger sample sizes are needed.<ref>{{cite journal
Psychosexual Sequelae"
| last = Boyle
GREGORY J. BOYLE
| first = Gregory J.
RONALD GOLDMAN
| coauthors = Gillian A. Bensley
J. STEVEN SVOBODA
| year = 2001
⚫ EPHREM FERNANDEZ </ref>
| month = July
| title = Adverse Sexual and Psychological Effects of Male Infant Circumcision
| journal = Psychological reports
| volume = 88
| issue = 3,Part 2
| pages = 1105-1106
| url = http://www.cirp.org/library/psych/boyle5/
| format =
| pmid = 11597060
}}</ref> Boyle ''et al.'' state that self-selection is unreliable.<ref name="boyle2002">{{cite journal
| last = Boyle
| first = Gregory J.
| coauthors = Ronald Goldman, J. Steven Svoboda, Ephrem Fernandez
| year = 2002
| month = may
| title = Male circumcision: pain, trauma, and psycholosexual sequelae
| journal = Journal of health psychology
| volume = 7
| issue = 3
| pages = 329-343
| url = http://www.cirp.org/library/psych/boyle6/
| format =
| pmid =
}}</ref>


; Female visual arousal : Williamson ''et. al'' (1988) studied randomly selected young mothers in Iowa, where most men are circumcised, and found that 76% would prefer a circumcised penis for achieving sexual arousal through viewing it.<ref> J Sex Educ Ther 1988; 14: 8</ref> Williamson ''et al.'' conclude: "Not least among the considerations is the worth of sexual preference for male circumcision within the American culture as a valid reason for continuing the practice." ; Female visual arousal : Williamson ''et. al'' (1988) studied randomly selected young mothers in Iowa, where most men are circumcised, and found that 76% would prefer a circumcised penis for achieving sexual arousal through viewing it.<ref> J Sex Educ Ther 1988; 14: 8</ref> Williamson ''et al.'' conclude: "Not least among the considerations is the worth of sexual preference for male circumcision within the American culture as a valid reason for continuing the practice."

Revision as of 03:19, 17 October 2008

The sexual effects of male circumcision are not well understood and researchers' findings are often contested.

Penile sensitivity and sexual sensation

Results of studies of the effect on penile sensitivity have been mixed. In a British study of 150 men circumcised as adults for penile problems, Masood et al found that 38% reported improved penile sensation (99% confidence), 18% reported worse penile sensation, while the remainder (44%) reported no change. Fink et al. found decreased penile sensitivity at the 92% certainty level.

Glans sensitivity

A number of studies have looked at the question of whether sensitivity of the glans is affected by circumcision. Masters and Johnson (1966) reported: "Routine neurologic testing for both exteroceptive and light tactile discrimination were conducted on the ventral and dorsal surfaces of the penile body, with particular attention directed toward the glans. No clinically significant difference could be established between the circumcised and the uncircumcised glans during these examinations." In January 2007, The American Academy of Family Physicians (AAFP) stated "The effect of circumcision on penile sensation or sexual satisfaction is unknown. Because the epithelium of a circumcised glans becomes cornified, and because some feel nerve over-stimulation leads to desensitization, many believe that the glans of a circumcised penis is less sensitive. Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. An investigation of the exteroceptive and light tactile discrimination of the glans of circumcised and uncircumcised men found no difference on comparison. No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction."

Yang et al. (1998) concluded in their study into the innervation of the penile shaft and glans penis that: "The distinct pattern of innervation of the glans emphasizes the role of the glans as a sensory structure."

In a survey of men circumcised as adults for medical (93%) or elective (7%) reasons, Fink et al. reported that adult circumcision appears to result in decreased penile sensitivity (92% confidence). Fink grouped decreased sensitivity with ejaculation taking longer than the men desired. Only one question relating to ejaculation time had a significant result; the question directly addressing sensitivity had no significant difference. There is conflicting evidence whether this should be seen as evidence of decreased sensitivity or simply of delayed ejaculation. A study by Paick et al failed to find a correlation between increased vibrational sensitivity and premature ejaculation. Other studies and several other groups they cited showed that ejaculation can be significantly delayed using a local anesthetic cream to numb the glans and penile shaft.

An examination of 7 circumcised and 6 uncircumcised males found no difference in keratinization of the glans penis. Bleustein et al. (2003) tested the sensitivity of the glans penis, and found no difference between circumcised and uncircumcised men, confirming the earlier Masters and Johnson study. Bleustein later followed up with a larger study, with the same finding. These studies relied on laboratory tests of sensation thresholds to mechanical or thermal stimuli, rather than on subjective reports of sexual sensation.

Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers, They reported " glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity." Waskett and Morris, however, on the basis of the unadjusted data, stated "we find no significant differences , consistent with previous findings." Young wrote a response to Waskett and Morris's letter in a later issue.

Payne et al. (2007), in a study of the glans and shaft sensitivity of twenty circumcised and twenty uncircumcised men, reported that "No differences in genital sensitivity were found between the uncircumcised and circumcised groups."

Foreskin sensitivity

Some recent researchers have asserted that the foreskin may be sexually responsive. Opponents of circumcision have cited these studies, which report on the sensitivity or innervation of the foreskin, claiming a sexual role based upon the presence of nerve-endings in the foreskin sensitive to light touch, stroking and fluttering sensations.

Circumcision removes the ridged band at the end of the foreskin . Taylor (1996) observed that the ridged band had more Meissner's corpuscles — a kind of nerve ending that is concentrated in areas of greatest sensitivity — than the areas of the foreskin with smooth mucus membranes. Taylor postulated that the ridged band is sexually sensitive and plays a role in normal sexual function. He also suggested that the gliding action, possible only when there was enough loose skin on the shaft of the penis, serves to stimulate the ridged band through contact with the corona of the glans penis during vaginal intercourse. This gliding action was also described by Lakshmanan, (1980) .

Sorrells et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates" (removes) "the most sensitive parts of the penis." According to Sorrells et al., the five penile areas most sensitive to fine-touch are located on the foreskin. This is disputed by Waskett and Morris, who argue that Sorrells' " 2 shows this applies only to their position 3, the orifice rim of the prepuce." However, they stated that after they used the Bonferroni method to correct for multiple comparisons, "this significance disappeared."

Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well."

Conversely, in a 2008 study, Krieger et al. stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."

Erectile function

Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase, or decrease, in erectile dysfunction among circumcised men, while other studies have shown little to no effect.

Fink et al., in an American study of 123 men, found that medically necessitated circumcision resulted in worsened erectile function at the 99% confidence level.

Kim and Pang reported no significant difference in erection.

Laumann et al. reported that the likelihood of having difficulty in maintaining an erection was lower for circumcised men, but only at the 0.07 level (OR 0.66; 95% CI, 0.42-1.03).

Ejaculatory function

A multinational study of 500 couples, conducted by Waldinger et al., found that circumcised men took on average 6.7 minutes to ejaculate, compared with 6.0 minutes for uncircumcised men. This difference was not statistically significant. The comparison excluded Turkey, which was significantly different from the other countries studied.

Collins et al. conducted a prospective study of 15 adult circumcision patients, using the Brief Male Sexual Function Inventory (BMSFI). The authors did not find a statistically significant effect on ejaculation scores.

In a study of 42 Turkish men circumcised for religious reasons, Senkul et al. did not find a statistically significant difference in BMSFI ejaculation scores, but found a significant increase in the mean time to ejaculate. The authors suggested that delayed ejaculation may be seen as a benefit.

In a telephone survey of 10,173 Australian men, 22% of uncircumcised men and 26% of circumcised men reported reaching orgasm too quickly for at least one month in the previous year. The difference was not statistically significant.

Kigozi et al. reported that, in a randomised controlled trial of 4,456 men of whom 2,474 were selected to be circumcised, the authors did not find a statistically significant effect on premature ejaculation.

Krieger et al. reported on a randomised controlled trial of 2,784 participants, of whom 1,391 were randomised to be circumcised. 54.5% of circumcised men described their ease of reaching orgasm as "much more" at 24 months after randomisation.

In a study of 255 circumcised men and 118 uncircumcised men, Kim and Pang reported no statistically significant difference in ejaculation or ejaculation latency time between circumcised and uncircumcised participants.

In a study of 150 men circumcised for benign disease, Masood et al. reported that 13% reported improvement in premature ejaculation after circumcision, 33% reported that premature ejaculation became worse, and 53% reported no change.

Sexual practice and masturbation

In a study by Korean researchers of 255 men circumcised after the age of 20 and 18 who were not circumcised, Kim and Pang reported that masturbatory pleasure decreased in 48% of the respondents and increased in 8%. Masturbatory difficulty increased in 63% but was easier in 37%. They concluded that there was a decrease in masturbatory pleasure after circumcision.

Laumann et al. reported that circumcised men in their survey displayed a greater rates of experience of various sexual practices, including oral sex, anal sex, and masturbation. For example, among whites the "estimated ratio of the odds of masturbating at least once a month for circumcised men was 1.76 that for uncircumcised men." Dr. Laumann provides two explanations for the difference in sexual practices. "One is that uncircumcised men, a minority in this country, may feel a stigma that inhibits them. Another is that circumcision reduces sensitivity in the penis, leading circumcised men to try a range of sexual activities."

Fink et al. did not find a change in sexual activity with adult circumcision (88% confidence).

Sexual drive

Several studies have investigated the effect of circumcision on sexual drive. Studies that did not find a statistically significant difference include Kim and Pang, Collins et al., and Senkul et al..

Satisfaction

Kim and Pang found that 20% reported that their sex life was worse after circumcision and 6% reported that it had improved. They concluded that "there was a decrease ... sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings."

Masood et al., in their study mentioned earlier of men circumcised for benign disease, found that 61% reported satisfaction with the results, while 17% felt it made things worse, and 22% expressed neutral sentiments. 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. The authors of the study concluded that the satisfaction rate was a 'poor outcome,' given the pre-procedure penile disease state and recommended discussing with prospective patients the results of this study during the informed consent process.

Krieger et al. reported that in a trial in which 1,391 men were circumcised, more than 99% were "satisfied" with their circumcisions.

Kigozi et al. reported finding "no trend in satisfaction among circumcised men". The authors concluded that "dult male circumcision does not adversely affect sexual satisfaction in men".

Shen et al. reported that adult circumcision appeared to result in improved satisfaction in 34 cases (of 95 adults being circumcised), the association was statistically significant.

Senkul et al. reported that they did not find a statistically significant difference in BMSFI satisfaction scores in their study of 42 adult circumcision patients.

Collins et al. reported on a study of 15 adult circumcision patients. No statistically significant difference in BMSFI scores was observed.

Fink et al. reported improved satisfaction at the 96% confidence level. Half of the circumcised men reported benefits, while 38% reported harm. "Overall, 62% of men were satisfied with having been circumcised." Fink attributes the improved satisfaction to the respondee's aesthetic considerations and to a resolution of previous painful conditions.

Female arousal

O'Hara and O'Hara argue that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman's overall clitoral stimulation and helping her achieve orgasm more quickly and more often. Without the foreskin's gliding action, they suggest, it can be more difficult for a woman to achieve orgasm during intercourse.

Vaginal dryness and female arousal
A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised. Boyle & Bensley (2001) reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder. The authors hypothesized that the gliding action possibly involved intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication. They stated that the respondents were self-selected, and that larger sample sizes are needed. Boyle et al. state that self-selection is unreliable.
Female visual arousal
Williamson et. al (1988) studied randomly selected young mothers in Iowa, where most men are circumcised, and found that 76% would prefer a circumcised penis for achieving sexual arousal through viewing it. Williamson et al. conclude: "Not least among the considerations is the worth of sexual preference for male circumcision within the American culture as a valid reason for continuing the practice."

Summary of research findings

Study Design Peer reviewed Sample size Finding Significant¹
Sexual drive
Collins (2002) Prospective; adult circumcision patients Yes 15 No difference No; p > 0.68
Senkul (2004) Prospective; adult circumcision patients Yes 42 No difference No; p = 0.32
Erectile function
Fink (2002) Cross-sectional; adult circumcision patients Yes 40 Worse after circumcision Yes; p = 0.01
Collins (2002) Prospective; adult circumcision patients Yes 15 No difference No; p > 0.96
Senkul (2004) Prospective; adult circumcision patients Yes 42 No difference No; p = 0.89
Masood (2005) Not stated; adult circumcision patients Yes 88 No difference No; p = 0.40
Shen (2004) Not stated; adult circumcision patients Yes 95 Worse after circumcision Yes; p = 0.001
Laumann (1997) National probability study Yes 1410 Better in circumcised males Yes; p < 0.10
Richters (2006) Telephone survey Yes 10,173 Better in circumcised males Yes; p=0.022
Ejaculation
Collins (2002) Prospective; adult circumcision patients Yes 15 No difference No; p > 0.48
Senkul (2004) Prospective; adult circumcision patients Yes 42 No difference in BMSFI (Brief Male Sexual Function Inventory)
Greater time to ejaculate after circumcision 		No; p = 0.85
Yes; p = 0.02
Shen (2004) Not stated; adult circumcision patients Yes 95 Greater time to ejaculate after circumcision Yes; p=0.04
Laumann (1997) National probability study Yes 1410 Circumcised men less likely to ejaculate prematurely Yes; p < 0.10
Waldinger (2005) Multinational, stopwatch assessment Yes 500 No difference No
Richters (2006) Telephone survey Yes 10,173 Circumcised men more likely to ejaculate prematurely No; p = 0.11
Penile sensation
Fink (2002) Cross-sectional, adult circumcision patients Yes 40 Worse after circumcision Almost; p = 0.08
Masood (2005) Not stated; adult circumcision patients Yes 88 Better after circumcision in 38%, worse in 18% Yes; p = 0.01
Denniston (2004), cited by Denniston (2004) Not stated; survey of males circumcised in adulthood No 38 Better after circumcision in 58%, worse in 34% Not stated
Masters (1966) Neurologic testing; subjects matched for age No 70
(35 c, 35 uc)²		 No difference Not stated
Bleustein (2003) Quantitative somatosensory testing No 79
(36 c, 43 uc)²		 No difference when controlled for other variables No; p = 0.08
Bleustein (2005) Quantitative somatosensory testing Yes 125
(63 c, 62 uc)²		 No difference when controlled for other variables No
Richters (2006) Telephone survey Yes 10,163 Better in circumcised males No; p = 0.192
Overall satisfaction
Fink (2002) Cross-sectional; adult circumcision patients Yes 40 Better after circumcision Yes; p=0.04
Collins (2002) Prospective; adult circumcision patients Yes 15 No difference No; p > 0.72
Senkul (2004) Prospective; adult circumcision patients Yes 42 No difference No; p=0.46
Masood (2005) Not stated; adult circumcision patients Yes 88 "Sixty-one percent were satisfied with the circumcision (p = 0.04) ... Fourteen patients (17%) were not satisfied with the circumcision, but only one patient in this group had any obvious post-operative complications (bleeding)." Not stated
Shen (2004) Not stated; adult circumcision patients Yes 95 Improved satisfaction in 34 cases Yes; p = 0.04
Kigozi (2007) Randomised trial; adult circumcision patients Yes 4456 "no trend in satisfaction among circumcised men" No; p = 0.8

Notes:

  1. If stated, author's analysis is used. Otherwise, significance is considered to be p <= 0.05.
  2. c = circumcised; uc = uncircumcised.

See also

References

  1. ^ Masood, S (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?". Urol Internationalalis. 75(1): 62–6. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  2. ^ Fink, KS (2002). "Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction". Journal of Urology. 167 (5): 2113–6. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  3. ^ Masters WH, Johnson VE (1966) Human Sexual Response. Boston: Little, Brown & Co, 189–91
  4. "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. Retrieved 2007-01-30.
  5. Yang & Bradley. Neuroanatomy of the penile portion of the human dorsal nerve of the penis. British journal of urology, 1998 July
  6. Paick, Jeong & Park. Penile sensitivity in men with premature ejaculation. International journal of impotence research, 10(4):247-50, December 1998.
  7. A. Koos Slob, Antien van Berkel, Jacob J. van der Werff ten Bosch. Premature Ejaculation Treated by Local Penile Anaesthesia in an Uncontrolled Clinical Replication Study. Journal of Sex Research, August, 2000.
  8. Szabo & Short. How does male circumcision protect against HIV infection?. BMJ 2000;320:1592-1594 ( 10 June )
  9. ^ Bleustein, Clifford B. (April 26-May 1, 2003). "Effects of Circumcision on Male Penile Sensitivity". American Urological Association 98th Annual Meeting. Chicago, Illinois. {{cite conference}}: Check date values in: |date= (help); Unknown parameter |booktitle= ignored (|book-title= suggested) (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  10. ^ Bleustein, Clifford B. (2005). "Effect of neonatal circumcision on penile neurologic sensation". Urology. 65(4): 773–7. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  11. ^ Sorrells, Morriss L. (2007). "Fine-touch pressure thresholds in the adult penis" (PDF). BJU International. 99 (4): 864–869. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help); line feed character in |coauthors= at position 68 (help)
  12. ^ Waskett, Jake H. (2007). "Letter in response to Sorrells et al.: Fine touch pressure thresholds in the adult penis". BJU International. 99 (6): 1551–1552. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  13. Young, Hugo (2007). "Letter in response to Waskett and Morris's letter:Fine touch pressure thresholds in the adult penis". BJU International. 100 (3): 699. {{cite journal}}: Unknown parameter |month= ignored (help)
  14. Payne, Kimberley; Thaler, Lea; Kukkonen, Tuuli; Carrier, Serge; and Binik, Yitzchak. Sensation and Sexual Arousal in Circumcised and Uncircumcised Men. The Journal of Sexual Medicine. May 2007. Volume 4 issue 3. pp667-674
  15. JOURNAL OF INVESTIGATIVE DERMATOLOGY, Volume 26 Number 1: Pages 53-67, January 1956. THE CUTANEOUS INNERVATION OF HUMAN NEWBORN PREPUCE R. K. Winkelmann, M. D
  16. PROCEEDINGS OF THE STAFF MEETINGS OF THE MAYO CLINIC, Volume 34, Number 2: Pages 39-47, Rochester, Minnesota, January 21, 1959. THE EROGENOUS ZONES: THEIR NERVE SUPPLY AND SIGNIFICANCE R. K. Winkelmann, M. D., Section of Dermatology
  17. ^ BRITISH JOURNAL OF UROLOGY, Volume 77, Pages 291-295, February 1996. "The prepuce: Specialized mucosa of the penis and its loss to circumcision". J.R. Taylor, A.P. Lockwood and A.J. Taylor
  18. John R. Taylor, M.B. PEDIATRICS NEWS, Volume 34 Number 10: Page 50, October 2000. Letter: "Back and Forth"
  19. INDIAN JOURNAL OF SURGERY 1980; Volume 44: Pages 134-137. "Human prepuce: some aspects of structure and function" S. Lakshmanan* S. Parkash
  20. ^ Boyle, Gregory J. (2002). "Male circumcision: pain, trauma, and psycholosexual sequelae". Journal of health psychology. 7 (3): 329–343. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  21. Krieger, JN (2008). "Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya". The journal of sexual medicine. Epub ahead of print. PMID 18761593. {{cite journal}}: Cite has empty unknown parameters: |laydate=, |laysummary=, and |laysource= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  22. ^ Shen, Z (2004). "Erectile function evaluation after adult circumcision". Zhonghua Nan Ke Xue. 10(1): 18–9. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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  31. Study Is Adding to Doubts About Circumcision By SUSAN GILBERT Published: April 2, 1997. New York Times.
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  34. Boyle, Gregory J. (2001). "Adverse Sexual and Psychological Effects of Male Infant Circumcision". Psychological reports. 88 (3, Part 2): 1105–1106. PMID 11597060. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
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