1. Evidence for Inherent Sexual Injury of Male Circumcision

    Dear Editor:

    Holms, writing in June 2004, laments that there is a “singular lack” of medical evidence regarding the harm of early circumcision on which to form an opinion regarding the ethical status of child circumcision.[1]

    We submit that that is not the case. We affirm there was enough evidence in 2004 regarding the inherent harm of circumcision on which to make a decision. We further submit that additional evidence has emerged in the past year to further support the sexual harm of child circumcision.

    Winkelmann, as early as 1959, showed that the prepuce is a “specific erogenous zone” with nerve endings arranged in rete ridges.[2] Moldwin & Valderrama (1989) reported “an extensive neuronal network within prepucial tissue.”[3] Taylor et al. (1996) further described the tissue that is excised by circumcision, finding that more than one-half of the skin and mucosa of the penis is excised by circumcision and, moreover, that this includes a highly innervated and vascularized circular band of ridged tissue, which he named the ridged band.[4] With so much sensory tissue extirpated, one would expect to find decreased sensory input to the central and autonomic nervous systems with adverse effects on sexual function.

    Demonstrated adverse effects of circumcision on erection and ejaculation supply proof of injury. A survey from South Korea (where circumcision has been practiced since the Korean War as a result of American cultural influence) found that men were twice as likely to report “diminished sexuality rather than improved sexuality.”[5] Coursey et al. report that the adverse effect of circumcision on erectile function is equivalent to that of anterior urethroplasty.[6] Fink et al. report a statistically significant reduction in erectile function after circumcision and a loss of sensitivity.[7] Shen et al. report weakened “erectile confidence” and prolonged intercourse after circumcision.[8] Senkul et al. report statistically significant increase in ejaculatory time after circumcision.[9] Masood et al. report degraded erectile function.[10]

    Circumcision also causes changes in sexual behaviour. Laumann et al. report higher incidence of oral sex, anal sex, and masturbation in circumcised men.[11] Dave et al. report circumcised males are more likely to have homosexual experience and partners from abroad.[12]

    Nineteenth century doctors were well aware of the sexual nature of the prepuce, therefore they promoted circumcision in hope of eliminating masturbation.[13]

    Coursey et al., Fink et al., and Masood et al. argue that men should be told of the probable adverse effect on sexual function as part of pre-circumcision informed consent counseling.[6] [7] [10]

    Although Holm attempts to draw a distinction between adult circumcision and childhood circumcision, [1] there is no reason to believe that the age at the time of circumcision has any effect on the reported sexual changes associated with extirpation of sensory tissue from the penis.

      George C. Denniston, MD, MPH
      George Hill, Bioethicist
    Executive Secretary

    Doctors Opposing Circumcision
    Suite 42
    2442 NW Market Street
    Seattle, Washington 98107-4137


    1. Holm S. Irreversible bodily interventions in children. J Med Ethics 2004;30:237. [Full Text]
    2. Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc 1959;34(2):39-47. [Full Text]
    3. Moldwin RM, Valderrama E. Immunochemical analysis of nerve distribution patterns within prepucial tissue. J Urol 1989;141(4) Part 2:499A.
    4. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5. [Medline]
    5. Pang MG, Kim DS. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int 2002;89:48-54. [Abstract]
    6. Coursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol 2001;166(6):2273-6. [Abstract]
    7. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: Effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002;167(5):2113-6. [Abstract]
    8. Shen Z, Chen S, Zhu C, et al. [Erectile function evaluation after adult circumcision]. Zhonghua Nan Ke Xue 2004;10(1):18-9. [Medline]
    9. Senkul T, Iseri C, Sen B. et al. Circumcision in adults: effect on sexual function. Urology 2004;63(1):155-8. [Abstract]
    10. Masood S, Patel HRH, Himpson RC, et al. Penile sensitivity after circumcision: Are we informing men correctly? Urol Int 2005;75:62-5. [Abstract]
    11. Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA 1997;277(13):1052-7. [Abstract]
    12. Dave SS, Johnson AM, Fenton KA, et al. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect 2003;79:499-500. [Full Text]
    13. Darby RJL. Medical history and medical practice: persistent myths about the foreskin. Med J Aust 2003;178 (4):178-9. [Full Text]

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