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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

To Circumcise or Not, That is the Question

Allan Schwartz, LCSW, Ph.D. Updated: Mar 15th 2012

To Circumsize or Not, That is the QuestionMale circumcision is a topic that aroused a lot of controversy on Mental Help Net when articles were posted about health issues and circumcision. There were those who claimed that I, the writer, had some type of "hidden agenda" about this issue. Others simply rejected circumcision because they were convinced that it reduces sexual pleasure for all men, even those who had it when they were infants. Any research findings about the benefits of circumcision were rejected as coming from third world countries and, therefore, being irrelevant to the United States. Once more, at the risk of inciting controversy, I am reporting some of the latest findings about this.

During the last ten years there has been a slight decline, about 5%, in the numbers of American families who have their male infants circumcised. This has aroused some concern on the part of health officials in light of new evidence that circumcision protects against certain diseases. It is thought that the decline is due to the fact that Medicare and Medicaid will not reimburse if there are any complications associated with the procedure.

According to CBS News, a new study found that circumcision may protect men against prostate cancer. The CBS News report can be found at:

http://www.cbsnews.com/8301-504763_162-57395293-10391704/circumcision-tied-to-lower-prostate-cancer-risk/

The study is based on 3,400 men who had been circumcised before their first sexual intercourse. It was found that they had a 15% less of a chance of developing prostate cancer as compared to men who did not have the surgery. However, this is type of research is considered to be "observational" in nature and there must be solid proof linking prostate cancer prevention to circumcision.

Having said this, it is important to point out that there is solid evidence linking circumcision to a reduced rate of sexually transmitted diseases (STD), HIV and other types of inflammation and infection.

Evidently, circumcision prevents these disease in many men because it removes a space between the foreskin and penis that provides a pathway for STD and other sexual diseases.

The question that troubles many people, parents and adults, is whether or not to have circumcision performed. This is an intensely personal question for which no answer can be found that fits all people. As the CBS News article points out, there are risks and benefits to this. For example, some men who had the procedure done in their adulthood, sent Emails here stating that they experienced a loss of sexual pleasure as a result of the surgery.

As far as deciding for a new born baby about whether or not to have the foreskin removed, everyone must weigh the risks and benefits and decide according to what they think best for their child.

What are your views about this issue?

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

Reader Comments
Discuss this issue below or in our forums.

Dr Schwartz is regrettably mistaken about the foreskin - roger desmoulins - Mar 15th 2012

Very few parents have the medical or sexual sophisticataion to decide whether or not their sons should be circumcised.


In the 1970s, the circumcision rate was at least 90% overall. In the urban white middle class, it was more like 98%. The current overall rate is around 55%, and somewhat higher among the urban middle class. The rate is much lower west of the Rockies than east. The falling circ rate can be attributed in part to the growing fraction of babies born to immigrant and Latino parents.

If circumcision were healthier, that fact would be revealed by a straightforward comparison of urological and STD statistics, between the USA on one hand, and Europe and Japan. The available data point to much higher STD rates in the USA than in Japan and Europe. One reason for this may be that circumcised men are more reluctant to use condoms.

All medical procedures require studies of efficacy and of possible long term side effects. The claims that circumcision reduces STDs are based on subjects having widely differing levels of education and economic development. In particular, it is not valid to compare middle class circumcised men with poor intact men.

Finally, even though the USA has been circumcising babies since the 1880s, and routine infant circumcision has been extremely common since the 1940s, we know next to nothing about possible long term complications, with the possible exception of meatal stenosis. In particular, we do not know if circumcision affects the onset of premature ejaculation or erectile dysfunction in the adult. We do not know how many adult men are sexually damaged because too much skin was cut off in infancy. We do not know if circumcised men are more likely to perform intercourse in ways women find off-putting. There is some evidence from outside the USA that women find the intact penis more satisfying. Circumcision advocates implicitly devalue masturbation and foreplay with the fingers, and extol fellatio in its place by arguing that fellating an intact penis is disgusting (not true; a man should always wash his penis before fellatio). This is questionable.

 

his body, his choice - carrie - Mar 15th 2012

You wrote that there are risks and benefits to this procedure.  People on each side of the debate have facts and statistics to back them up.  The only thing to really consider then, is that it is "intensely personal".  All people regardless of gender, deserve to make their own decisions about their bodies.  Circumcision removes a healthy a functioning body part from an unconsenting PERSON.  In the U.S., girls are entitled legally to genital autonomy.  It is a human right.  His body, his choice.  Ask him when he's 18 - he'll say, "no".

The foreskin has many purposes - Jason - Mar 15th 2012

The human foreskin is highly innervated, and vascularized, sensitive erogenous tissue.It plays an important role in normal human sexual response and is necessary for normal copulatory behavior. An understanding of this role is now emerging in the scientific literature. Removal of the foreskin (circumcision) interferes with normal sexual function.

The foreskin provides mechanical functions to facilitate intromission and penetration. Several authorities observe that the penis enters the vagina without friction as the foreskin unfolds. Taves (2002) reported that excision of the foreskin by circumcision increases the force required to penetrate by ten-fold. Shen et al. reported 43.1 percent of men cirumcised as adults experience difficult penetration. After penetration, the foreskin provides a gliding action that greatly reduces friction, and vaginal dryness.

Elasticity. The foreskin has a layer of smooth muscle tissue called the peripenic muscle, which is part of the dartos muscle. The contraction and expansion of the muscle fibers in this layer give the foreskin great elasticity and are important in erogenous sensation.

Premature ejaculation. Lakshmanan & Prakash (1980) report that the foreskin impinges against the corona glandis during coitus. The foreskin, therefore, tends to protect the corona glandis from direct stimulation by the vagina of the female partner during coitus. The corona is the most highly innervated part of the glans penis. Zwang argues that removal of the foreskin allows direct stimulation of the corona glandis and this may cause premature ejaculation in some males. O'Hara & O'Hara (1999) report more premature ejaculation in circumcised male partners. The presence of the foreskin, therefore, may make it easier to avoid premature ejaculation, while its absence would make it more difficult to avoid premature ejaculation.

Inability to ejaculate or delayed ejaculation. While some circumcised males may suffer from a tendency toward premature ejaculation, others find that they have great difficulty in ejaculating. The nerves in the foreskin and ridged band are stimulated by stretching, amongst other movements. If those nerves are not present, Money (1983) argues that excision of these stretch receptors by circumcision may make ejaculation take longer. Some circumcised males may have to resort to prolonged and aggressive thrusting to achieve orgasm

 

Value to female partners. The foreskin has long been known to be valuable to the female partner. The presence of the foreskin is reported to be stimulating to the female. Women are more likely to experience vaginal dryness during sex with a circumcised partner. The unnatural dryness may make coitus painful and result in abrasions. The vaginal dryness may be mistakenly attributed to female arousal disorder.

 

cirp.org/library/sex function


We must also focus on the benefits of leaving our son's intact (genitally intact).

 

 

 

Preventative amputation is illogical - Ivana - Mar 15th 2012

So, whether circumcision has benefits or not is actually inconsequential. When else do we amputate healthy, functional body parts as a form of preventative medicine? NEVER! Why? Because it makes no sense at all to do so! Not to mention this is being done on uninformed, nonconsenting minors. If anyone wants to amputate body parts because they think it will help them, well then that decision should be theirs alone, when they are old enough to be fully informed of the risks and results! Not their parents, not some religion! Overall the intact penis is not infection prone, many other body parts are more prone to infection and we don't go chopping those off at birth. It makes no sense! RIC needs to be put to an end!

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