To Circumcise or Not to Circumcise

A discussion of sexual arousal would not be complete without some mention of circumcision. To circumcise, or not to circumcise, has been a longstanding question dating back to biblical times. Male circumcision has long since been associated with cleanliness and a subject of popular media attention. In fact, the well known HBO series Sex and the City includes an episode where one the characters contemplates terminating a relationship because her partner is not circumcised. Media attention aside, there has been a long debate regarding the "medical necessity" of male circumcision with some researchers claiming that male circumcision helps to protect men against sexually transmitted diseases and infections. A recent review of the literature has indicated that that while the rate of HIV infection among men who have sex with men are about 14% lower among the circumcised men versus the men who were uncircumcised, the difference is not statistically significant (Millett, Flores, Marks, Reed, & Herbst, 2008).

While the debate about the medical necessity of male circumcision continues, another debate has emerged about male circumcision and its impacts on sexual pleasure. Because most male circumcision procedures occur during infancy it is very difficult to determine how (if at all) sexuality is impacted by this procedure. Anecdotal reports from men who have undergone circumcision in adulthood suggest that male circumcision decreases penile sensitivity and thus sexual pleasure. This aside, there are other ways in which male circumcision can impact sexuality. As mentioned above there has been a bias in our culture against uncircumcised men perhaps due in part to the association between male circumcision and cleanliness. It is important to note that a circumcised penis does not necessarily equal a cleaner penis and that good hygiene practices are import for both the circumcised and the uncircumcised. Thus, the uncircumcised male (or the circumcised male) may feel insecure about the status of their penis. Over the last several years routine male circumcision has declined creating a balance between those who are circumcised versus those who are not. As we become more educated and this becomes a less frequent procedure perhaps we will also see a decrease in biases.

On August 27, 2012, the American Academy of Pediatrics released a policy statement on the issue. The abstract of that report states, "Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement."

To view the complete policy statement and accompanying documents, please visit http://pediatrics.aappublications.org/content/130/3/585.