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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.[1] Fink et al. found decreased penile sensitivity at the 92% certainty level.[2]
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."[3] Sorrells et al. criticised this early study for being poorly documented and not subject to peer review.[4] 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." [5]
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."[6]
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).[2] 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.[7] Other studies [8] 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.[9] Bleustein et al. (2005) divided 125 patients (62 uncircumcised men and 63 neonatally circumcised men) into groups based on their sexual dysfunction using the IIEF(International Index of Erectile Function). Twenty-nine were placed in the functional group, and 96 in the dysfunctional group. Quantitative somatosensory testing (including vibration, pressure, spatial perception, and warm and cold thermal thresholds) was used on the dorsal midline glans of the penis. In the dysfunctional group, circumcised men (49 +/- 16 years) were significantly younger (P <0.01) than uncircumcised men (56 +/- 13 years). When controlling for age, hypertension, and diabetes, there was no difference in sensitivity.[10]
Sorrells et al. (2007) measured the fine-touch pressure thresholds of 91 circumcised and 68 uncircumcised, adult male volunteers, They reported "[the] 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."[4] In a letter to BJU International, however, on the basis of the unadjusted data, Waskett and Morris stated "we find no significant differences [...], consistent with previous findings."[11] Young wrote a response disagreeing with Waskett and Morris's letter in a later issue.[12]
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."[13]
Foreskin sensitivity
Some recent researchers have asserted that the foreskin may be sexually responsive.[14][15][16][17] 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.[16] 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[citation needed] - 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.[18] This gliding action was also described by Lakshmanan (1980).[19]
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. [4] This is disputed by Waskett and Morris, who argue that Sorrells' "[table] 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." [11] Young responded to Waskett and Morriss's criticisms saying "Sorrells et al. compared 12 points that the two have in common, as well as five the circumcised penis does not have, and two (of scar tissue) that only the circumcised penis has. By disregarding those seven points (which they miscount) in their table, Waskett and Morris have removed the major source of difference and restored the major fault of the undocumented, unreviewed and vaguely described (but widely quoted) study by Masters and Johnson[3], that of ignoring the foreskin."[12]
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."[20] 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."[21]
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,[22] or decrease,[23] in erectile dysfunction among circumcised men, while other studies have shown little to no effect.[24][25][1][26][27]
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.[2]
Kim and Pang reported no significant difference in erection.[28]
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).[29]
Ejaculatory function
Waldinger et al. recruited 500 men (98 circumcised and 261 not-circumcised) from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States and studied their ejaculation times during sexual intercourse. They 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.[30] Commenting on the study, Sorrells et al. said "Turkish men, the vast majority of whom are circumcised, had the shortest Intravaginal ejaculation latency time (IELT)."[4]
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.[25]
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.[24]
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.[23]
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.[26]
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.[27]
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.[28]
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.[1]
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.[28]
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.[29] 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." [31]
Fink et al. did not find a change in sexual activity with adult circumcision (88% confidence).[2]
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,[28] Collins et al.,[25] and Senkul et al..[24]
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."[28]
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.[1]
Krieger et al. reported that in a trial in which 1,391 men were circumcised, more than 99% were "satisfied" with their circumcisions.[27]
Kigozi et al. reported finding "no trend in satisfaction among circumcised men". The authors concluded that "[a]dult male circumcision does not adversely affect sexual satisfaction [...] in men".[26]
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.[22]
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.[24]
Collins et al. reported on a study of 15 adult circumcision patients. No statistically significant difference in BMSFI scores was observed.[25]
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.[2]
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.[32] 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.[33][verification needed]
- 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.[34] Boyle & Bensley (2001) reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder.[verification needed] The authors hypothesized that the gliding action possibly involved intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication.[verification needed] They stated that the respondents were self-selected, and that larger sample sizes are needed.[35] Boyle et al. (2002) state that self-selection is unreliable.[20]
- 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.[36] 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)[25] |
Prospective; adult circumcision patients |
Yes |
15 |
No difference |
No; p > 0.68 |
| Senkul (2004)[24] |
Prospective; adult circumcision patients |
Yes |
42 |
No difference |
No; p = 0.32 |
| Erectile function |
| Fink (2002)[2] |
Cross-sectional; adult circumcision patients |
Yes |
40 |
Worse after circumcision |
Yes; p = 0.01 |
| Collins (2002)[25] |
Prospective; adult circumcision patients |
Yes |
15 |
No difference |
No; p > 0.96 |
| Senkul (2004)[24] |
Prospective; adult circumcision patients |
Yes |
42 |
No difference |
No; p = 0.89 |
| Masood (2005)[1] |
Not stated; adult circumcision patients |
Yes |
88 |
No difference |
No; p = 0.40 |
| Shen (2004)[22] |
Not stated; adult circumcision patients |
Yes |
95 |
Worse after circumcision |
Yes; p = 0.001 |
| Laumann (1997)[29] |
National probability study |
Yes |
1410 |
Better in circumcised males |
Yes; p < 0.10 |
| Richters (2006)[23] |
Telephone survey |
Yes |
10,173 |
Better in circumcised males |
Yes; p=0.022 |
| Ejaculation |
| Collins (2002)[25] |
Prospective; adult circumcision patients |
Yes |
15 |
No difference |
No; p > 0.48 |
| Senkul (2004)[24] |
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)[22] |
Not stated; adult circumcision patients |
Yes |
95 |
Greater time to ejaculate after circumcision |
Yes; p=0.04 |
| Laumann (1997)[29] |
National probability study |
Yes |
1410 |
Circumcised men less likely to ejaculate prematurely |
Yes; p < 0.10 |
| Waldinger (2005)[30] |
Multinational, stopwatch assessment |
Yes |
500 |
No difference |
No |
| Richters (2006)[23] |
Telephone survey |
Yes |
10,173 |
Circumcised men more likely to ejaculate prematurely |
No; p = 0.11 |
| Penile sensation |
| Fink (2002)[2] |
Cross-sectional, adult circumcision patients |
Yes |
40 |
Worse after circumcision |
Almost; p = 0.08 |
| Masood (2005)[1] |
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)[37] |
Not stated; survey of males circumcised in adulthood |
No |
38 |
Better after circumcision in 58%, worse in 34% |
Not stated |
| Masters (1966)[3] |
Neurologic testing; subjects matched for age |
No |
70
(35 c, 35 uc)² |
No difference |
Not stated |
| Bleustein (2005)[10] |
Quantitative somatosensory testing |
Yes |
125
(63 c, 62 uc)² |
No difference when controlled for other variables |
No |
| Richters (2006)[23] |
Telephone survey |
Yes |
10,163 |
Better in circumcised males |
No; p = 0.192 |
| Overall satisfaction |
| Fink (2002)[2] |
Cross-sectional; adult circumcision patients |
Yes |
40 |
Better after circumcision |
Yes; p=0.04 |
| Collins (2002)[25] |
Prospective; adult circumcision patients |
Yes |
15 |
No difference |
No; p > 0.72 |
| Senkul (2004)[24] |
Prospective; adult circumcision patients |
Yes |
42 |
No difference |
No; p=0.46 |
| Masood (2005)[1] |
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)[22] |
Not stated; adult circumcision patients |
Yes |
95 |
Improved satisfaction in 34 cases |
Yes; p = 0.04 |
| Kigozi (2007)[26] |
Randomised trial; adult circumcision patients |
Yes |
4456 |
"no trend in satisfaction among circumcised men" |
No; p = 0.8 |
Notes:
- If stated, author's analysis is used. Otherwise, significance is considered to be p <= 0.05.
- c = circumcised; uc = uncircumcised.
See also
References
- ^ a b c d e f g Masood, S; Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK (2005). "Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly-". Urol Internationalalis 75(1): 62-6. PMID 16037710. http://www.cirp.org/library/sex_function/masood1/.
- ^ a b c d e f g h Fink, K.S.; C.C. Carson and R.F. DeVillis (May 2002). "Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction". Journal of Urology 167 (5): 2113-6. http://www.circs.org/library/fink/.
- ^ a b c Masters, W.H.; Johnson, V.E. (1966). Human Sexual Response. Toronto; New York: Bantam Books. ISBN 0-553-20429-7. http://www.circs.org/library/masters/index.html.
- ^ a b c d Sorrells, Morriss L.; James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox and Robert S. Van Howe (March 2007). "Fine-touch pressure thresholds in the adult penis" (PDF). BJU International 99 (4): 864-869. http://www3.interscience.wiley.com/cgi-bin/fulltext/118508429/PDFSTART.
- ^ "Circumcision: Position Paper on Neonatal Circumcision", American Academy of Family Physicians, 2007, http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html, retrieved on 30 January 2007.
- ^ Yang, CC; Bradley WE (July 1998). "Neuroanatomy of the penile portion of the human dorsal nerve of the penis". British Journal Urology 82 (1): 109-113. PMID 9698671. http://www.cirp.org/library/anatomy/yang1/.
- ^ Paick, JS; Jeong H, Park MS (December 1998). "Penile sensitivity in men with premature ejaculation" (PDF). International journal of impotence research 10 (4): 147-250. PMID 9884921. http://www.nature.com/ijir/journal/v10/n4/pdf/3900368a.pdf.
- ^ 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.
- ^ Szabo, Robert; Roger V. Short (June 2000). "How does male circumcision protect against HIV infection-" (PDF). BMJ 320 (7249): 1592-1594. doi:10.1136/bmj.320.7249.1592. PMID 10845974. http://bmj.bmjjournals.com/cgi/reprint/320/7249/1592. Retrieved on 9 July 2006.
- ^ a b Bleustein, Clifford B.; Fogarty JD, Eckholdt H, Arezzo JC, Melman A (April 2005). "Effect of neonatal circumcision on penile neurologic sensation". Urology 65(4): 773-7. PMID 15833526. http://linkinghub.elsevier.com/retrieve/pii/S0090-4295(04)01343-3.
- ^ a b Waskett, Jake H.; Brian J. Morris (May 2007). "Letter in response to Sorrells et al.: Fine touch pressure thresholds in the adult penis". BJU International 99 (6): 1551-1552. http://www3.interscience.wiley.com/cgi-bin/fulltext/118508593/HTMLSTART.
- ^ a b Young, Hugo (July 2007). "Letter in response to Waskett and Morris's letter:Fine touch pressure thresholds in the adult penis". BJU International 100 (3): 699. http://www3.interscience.wiley.com/cgi-bin/fulltext/118508003/HTMLSTART.
- ^ Payne, Kimberley; Thaler, Lea; Kukkonen, Tuuli; Carrier, Serge; and Binik, Yitzchak (May 2007). "Sensation and Sexual Arousal in Circumcised and Uncircumcised Men". Journal of sexual medicine 4 (3): 667-674. PMID 17419812. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1743-6109.2007.00471.x.
- ^ Winkelmann, R.K. (January 1956). "The cutaneous innervation of human newborn prepuce". Journal of investigative dermatology 26 (1): 53-67. PMID 13295637. http://www.cirp.org/library/anatomy/winkelmann2/.
- ^ Winkelmann, R.K. (January 1959). "The erogenous zones: their nerve supply and significance". Proceedings of the staff meetings of the mayo clinic 34 (2): 39-47. PMID 13645790. http://www.cirp.org/library/anatomy/winkelmann/.
- ^ a b Taylor, J.R.; A.P. Lockwood and A.J. Taylor (February 1996). "The prepuce: Specialized mucosa of the penis and its loss to circumcision". British journal of urology 77 (2): 291-295. PMID 8800902. http://www.cirp.org/library/anatomy/taylor/.
- ^ Taylor, J.R.; C.J. Cold (February 1999). "The prepuce" (PDF). British journal of urology 83 (Supplement 1): 34-44. http://www3.interscience.wiley.com/cgi-bin/fulltext/119091418/PDFSTART.
- ^ Taylor, J.R. (October 2000). "Back and forth (letter)". Pediatric news 34 (10): 50. http://www.cirp.org/library/anatomy/taylor2/.
- ^ Lakshmanan, S; S. Parkash (1980). "Human prepuce: some aspects of structure and function". Indian journal of surgery 44: 134-137. http://www.cirp.org/library/anatomy/lakshmanan/.
- ^ a b Boyle, Gregory J.; Ronald Goldman, J. Steven Svoboda, Ephrem Fernandez (may 2002). "Male circumcision: pain, trauma, and psycholosexual sequelae". Journal of health psychology 7 (3): 329-343. http://www.cirp.org/library/psych/boyle6/.
- ^ Krieger, JN; Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S (August 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.
- ^ a b c d e Shen, Z; Chen S, Zhu C, Wan Q, Chen Z (January 2004). "Erectile function evaluation after adult circumcision". Zhonghua Nan Ke Xue 10 (1): 18-9. PMID 14979200.
- ^ a b c d e Richters, J; Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK (2006). "Circumcision in Australia: prevalence and effects on sexual health". International Journal of Sexually Transmissible Diseases and AIDS 17: 547-554. PMID 16925903. http://www.cirp.org/library/general/richters1/.
- ^ a b c d e f g h Senkul, T; C. Iseri, B. Sen, K. Karademir, F. Saracoglu and D. Erden (2004). "Circumcision in Adults: Effect on Sexual Function". Urology 63(1): 155-8. http://www.circs.org/library/senkul/.
- ^ a b c d e f g h Collins, S; Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P (2002). "Effects of circumcision on male sexual function: debunking a myth-". Journal of Urology 167: 2111-2112. http://www.circs.org/library/collins/.
- ^ a b c d Kigozi, G; Watya S, Polis CB, Buwembo D, Kiggundu V, Wawer MJ, Serwadda D, Nalugoda F, Kiwanuka N, Bacon MC, Ssempijja V, Makumbi F, Gray RH. (January 2007). "The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda" (PDF). BJU International 101 (1): 65-70. PMID 18086100. http://www3.interscience.wiley.com/cgi-bin/fulltext/119420541/PDFSTART.
- ^ a b c Krieger JN, Mehta SD, Bailey RC, et al (August 2008). "Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya". The journal of sexual medicine. doi:10.1111/j.1743-6109.2008.00979.x. PMID 18761593.
- ^ a b c d e Kim, DaiSik; Myung-Geol Pang (March 2007). "The effect of male circumcision on sexuality" (PDF). BJU International 99 (3): 619 - 622. PMID 17155977. http://www3.interscience.wiley.com/cgi-bin/fulltext/118508378/PDFSTART.
- ^ a b c d Laumann, E.O.; C.M. Masi and E.W. Zuckerman (1997). "Circumcision in the United States: prevalence, prophylactic effects, and sexual practice". JAMA 277 (13): 1052-7. http://www.circs.org/library/laumann/.
- ^ a b Waldinger, M.D.; Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "Circumcision in the United States: prevalence, prophylactic effects, and sexual practice". Journal of Sexual Medicine 2 (4): 492-497. http://www3.interscience.wiley.com/journal/118719267/abstract.
- ^ Study Is Adding to Doubts About Circumcision By SUSAN GILBERT Published: April 2, 1997. New York Times. [1]
- ^ O'Hara, K.; J. O'Hara (January 1999). "The effect of male circumcision on the sexual enjoyment of the female partner" (PDF). BJU International 83 (Supplement 1): 79-84. PMID 10349418. http://www3.interscience.wiley.com/cgi-bin/fulltext/119091407/PDFSTART.
- ^ 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. [2]
- ^ Bensley, Gillian A.; Gregory J. Boyle (September 2003). "Effects of male circumcision on female arousal and orgasm". New Zealand medical journal 116 (1181): 595-596. PMID 14581975. http://www.nzma.org.nz/journal/116-1181/595/.
- ^ Boyle, Gregory J.; Gillian A. Bensley (July 2001). "Adverse Sexual and Psychological Effects of Male Infant Circumcision". Psychological reports 88 (3,Part 2): 1105-1106. PMID 11597060. http://www.cirp.org/library/psych/boyle5/.
- ^ Williamson ML, Williamson PS. Women's Preferences for Penile Circumcision in Sexual Partners. J Sex Educ Ther 1988; 14: 8
- ^ Denniston, G.C; Hill G (2006). "Circumcision in adults: effect on sexual function". Urology 64 (6): 1267. http://www.cirp.org/library/sex_function/denniston3/.
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