The 1999 British Journal of Urology featured a study of American women who have experienced sex with both intact and circumcised partners. "The results of the survey are truly astonishing. Among other things, the vast majority of women indicated that they overwhelmingly prefer intercourse with a man with a natural penis (approximately 90%). More astonishing is the fact that many women actually rated circumcised intercourse a negative experience when compared to natural intercourse." The following is a summarization, excerpted from the report.




British Journal of Urology International, Volume 83, Supplement 1, Pages 79-84, January 1, 1999.

The effect of male circumcision on the sexual enjoyment of the female partner

K. O'HARA and J. O'HARA


Male circumcision, the most commonly performed surgery in the USA, removes 33 - 50% of the penile skin, as well as nearly all of the penile fine touch neuroreceptors. To date no study has investigated whether this dramatic alteration in the male genitalia affects the sexual pleasure experienced by the female partner or whether a woman can physically discern the difference between a penis with a foreskin. The impact that male circumcision has on the overall sexual experience for either partner is unknown.

The tip of the foreskin, and some or all of the frenulum, are routinely removed as part of circumcision. This tissue contains a high concentration of the nerve endings that sense fine touch. After circumcision, the surface of the glans thickens like a callus. The glans is innervated by free nerve endings that can only sense deep pressure and pain.

The 12th century physician and rabbi Moses Maimonides advocated male circumcision for its ability to curb a man's sexual appetite. Further, he implied that it could also affect a woman's sexuality, indicating that once a woman had taken a lover who was not circumcised, it was very hard for her to give him up. The impact of male circumcision on the sexual pleasure experienced by both males and females is largely unstudied. While the brain is often cited as the primary 'sexual' organ, what impact does surgical alteration of the male genitalia have for both partners? Based on anecdotal reports, a survey was developed to determine the effect of male circumcision on a woman's ability to achieve vaginal orgasm (both single and multiple), to maintain adequate vaginal secretions, to develop vaginal discomfort, to enjoy coitus and to develop an intimate relationship with her partner. This review presents the findings of a survey of women who have had sexual partners both with and without foreskins, and reports their experiences.

The survey included 40 questions; the results were analyzed for age, number of lifetime partners, preputial status of the most recent partner, preference for vaginal orgasms (as defined below) and their preference for a circumcised or intact penis. The survey defined 'vaginal orgasm' as 'an orgasm that occurs during intercourse, brought about by your partner's penis and pelvic movements and body contact, along with your own body's pelvic movements, with no simultaneous stimulation of the clitoris by the hands'. Premature ejaculation was defined as the man 'usually (50-100% of the time) has had his orgasm within 2-3 minutes after insertion'. The survey included three sets of responses for the respondents to rate their sexual experiences with their circumcised and unaltered male partners.

The survey is continuing and this article reports the preliminary results.

With their circumcised partners, women were more likely not to have a vaginal orgasm. Conversely, women were more likely to have a vaginal orgasm with an unaltered partner. Their circumcised partners were more likely to have premature ejaculation. Women were also more likely to state that they had had vaginal discomfort with a circumcised partner either often or occasionally as opposed to rarely or never [with an intact partner]. More women reported that they never achieved orgasm with circumcised partners than with their unaltered partners. Also, they were more likely to report never having had a multiple orgasm with their circumcised partners. They were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners.

During prolonged intercourse with their circumcised partners, women were less likely to 'really get into it' and more likely to 'want to get it over with'. On the other hand, with their unaltered partners, the reverse was true, they were less likely to 'want to get it over with' and considerably more likely to 'really get into it.'

When the women were divided into those older or younger than 40 years, the older women were more likely to rate their frequency of orgasm as higher with an unaltered partner. Women 29 years or younger were more likely to prefer orally induced orgasms, while women over 40 years preferred vaginally induced orgasms more than those aged <29 years.

Ratings of experiences with circumcised men compared with normal men (uncircumcised), overall (satisfaction) rating: 1.81 / 8.03 [ie: four and a half times more likely to consider the sexual experience satisfactory with an intact partner than with a circumcised partner].

When women who preferred vaginal orgasm were compared with those preferring orally or manually induced orgasm, the former rated unaltered men higher, had more positive post-coital feelings with their unaltered partners, and rated these men higher overall. These women were more likely to prefer being on top during coitus to achieve vaginal orgasm. They were also more likely to have an unaltered man as their most recent partner.

The women who preferred circumcised partners were more likely to have had their first orgasm with a circumcised partner than those who preferred unaltered partners. Although these women preferred circumcised partners, they still found unaltered partners to evoke more vaginal fluid production, a lower vaginal discomfort rating and fewer complaints during intercourse than their circumcised partners. In women who preferred circumcised men, there was no difference in their comparison of circumcised and unaltered. These women had fewer unaltered partners, which suggests that their limited exposure to unaltered men may have a consequence of ... inability to detect a difference in orgasm frequency, coital duration, coital complaints or satisfaction.

When women were grouped based on the preputial status of their most recent partner, women with unaltered partners had a higher rate of orgasms with them. They were more likely to rate circumcised partners lower and unaltered partners higher. When only women whose most recent partner was circumcised, the results were consistent with the results from the entire study population.

These results show clearly that women preferred vaginal intercourse with an anatomically complete penis over that with a circumcised penis; there may be many reasons for this. When the anatomically complete penis thrusts in the vagina, it does not slide, but rather glides on its own 'bedding' of movable skin, in much the same way that a turtle's neck glides in and out of the folded layers of skin surrounding it. The underlying corpus cavernosa and corpus spongiosum slide within the penile skin, while the skin juxtaposed against the vaginal wall moves very little. This sheath-within-a-sheath alignment allows penile movement, and vaginal and penile stimulation, with minimal friction or loss of secretions. When the penile shaft is withdrawn slightly from the vagina, the foreskin bunches up behind the corona in a manner that allows the tip of the foreskin which contains the highest density of fine-touch neuroreceptors in the penis to contact the corona of the glans which has the highest concentration of fine-touch receptors on the glans. This intense stimulation discourages the penile shaft from further withdrawal, explaining the short thrusting style that women noted in their unaltered partners.


Comparison of responses for circumcised partners compared with normal partners

Question Set 1: During or after most intercourse, have you noticed yourself having any of the feelings listed below?


Odds Ratio

irritability
9.39
unappreciated
9.06
sexually violated
5.57
emotionally aggravated
7.51
a general 'out of sync' feeling
13.12
he cared very little about my sexual satisfaction
10.05
except for my vagina, he didn't seem to know I was there
10.10
bitchy, argumentative
4.16
guilty
4.52
we had two separate experiences (no feeling of sexual unison)
8.67
our thrusting rhythms were 'out of sync'
7.31
felt like I was being used as a masturbating object
4.16
incomplete as a woman

7.07

[notes added for clarification]





(ie: 9 times more likely to feel
irritable or unappreciated with a
circumcised partner compared to
an intact partner)

(ie: women were 10 times more
likely to feel that a circumcised
partner was only interested in himself during sex)
Question Set 2: During intercourse with most (circumcised/natural) men, do any of these thoughts generally cross your mind?


Odds Ratio

he seems to be distanced from what I'm feeling
10.22
my mind wanders to other things
7.22
he seems to be working too hard at it
34.19
he seems to have to work too hard at achieving his orgasm
7.68
I seem to be becoming disinterested
23.10
my vagina doesn't seem to be enjoying this
7.68
when he really gets pumping, I'm afraid it's going to start hurting me
17.62
we seem to be engaged in two separate experiences
4.08
I feel wide awake, 'on alert'
2.87
frustration
10.15
discomfort
11.41
a general feeling of discontentment

8.45

[notes added for clarification]





(ie: 34 times more likely to feel
circumcised partner is having to
work awfully hard compared to
the intact partner)

(ie: 23 times more likely to be
disinterested when the sex was
with a circumcised partner)

(ie: 11 times more likely to feel
discomfort with the circumcised
partner than the intact partner)
Question Set 3 How would you describe your general feelings after having sex with most (circumcised/natural) men?


Odds Ratio

a feeling of relaxation
0.19
a feeling of being at peace with myself and my surroundings
0.22
a sense of human warmth and closeness to my partner
0.19
mutual satisfaction
0.18
a sense of completeness and wholeness as a woman
0.25
a wonderful positive-feeling afterglow
0.24
'gee, that was really great'
0.25
'what a lover'
0.10
[notes added for clarification]





(ie: women almost never felt
these positive feelings after
sex with circumcised men,
compared to intact men)

(ie: women were far more
UNLIKELY to describe feeling
relaxed, at peace, intimate,
wonderful, after sex with a
circumcised partner)




As stated, circumcision removes 33-50% of the penile skin. With this skin missing, there is less tissue for the swollen corpus cavernosa and corpus spongiosum to slide against. Instead the skin of the circumcised penis rubs against the vaginal wall, increasing friction, abrasion and the need for artificial lubrication. Because of the tight penile skin, the corona of the glans, which is configured as a one-way valve pulls the vaginal secretions from the vagina when the shaft is withdrawn. Unlike the anatomically complete penis, there is no sensory input to limit withdrawal. Because the vast majority of the fine-touch receptors are missing from the circumcised penis, their role as ejaculatory triggers is also absent. The loss of these receptors creates an imbalance between the deep pressure sensed in the glans, corpus cavernosa and corpus spongiosum and the missing fine touch. To compensate for the imbalance, to achieve orgasm, the circumcised man must stimulate the glans, corpus cavernosa, and corpus spongiosum by thrusting deeply in and out of the vagina. As a result, coitus with a circumcised partner reduces the amount of vaginal secretions in the vagina, and decreases continual stimulation of the mons pubis and clitoris.

Respondents overwhelmingly concurred that the mechanics of coitus was different for the two groups of men. Of the women, 73% reported that circumcised men tend to thrust harder and deeper, using elongated strokes, while unaltered men by comparison tended to thrust more gently, to have shorter thrusts, and tended to be in contact with the mons pubis and clitoris more, according to 71% of the respondents.

The responses in Sets 1, 2 and 3 are more a measure of intimacy than physical differences in thrusting patterns. While some of the respondents commented that they thought the differences were in the men, not the type of penis, the consistency with which women felt more intimate with their unaltered partners is striking. Some respondents reported that the foreskin improved their sexual satisfaction, which improved the quality of the relationship. In addition to the observations of Maimonides in the 12th century, one survey found that marital longevity was increased when the male had a foreskin.

In asking women to evaluate their experience based on all of their lifetime sexual partners, there may be an element of recall bias, but the circumcision status of the most current sexual partner did not alter the findings. Women who preferred vaginal orgasms had a strong preference for unaltered partners. Women who preferred circumcised partners were half as likely to prefer vaginal orgasms, but there were too few women preferring circumcised partners to make any valid statistical claims. This would suggest that the foreskin makes the most positive impact during vaginal intercourse.

Another weakness of the survey is its preoccupation with vaginal intercourse. Several respondents commented that the foreskin also makes a difference in foreplay and fellatio. Although this was not directly measured, some respondents commented that unaltered men appeared to enjoy coitus more than their circumcised counterparts. The lower rates of fellatio, masturbation and anal sex among unaltered men suggests that unaltered men may find coitus more satisfying.

Clearly, the anatomically complete penis offers a more rewarding experience for the female partner during coitus. While this study has some obvious methodological flaws, all the differences cannot be attributed to them. It would be useful to examine the role of the foreskin in other sexual activities. Because these findings are of interest, the negative effect of circumcision on the sexual enjoyment of the female partner needs to be part of any discussions providing 'informed consent' before circumcision.


Copyright 1999, K. O'HARA and J. O'HARA
Copyright 1999, British Journal of Urology International




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