The first cut
Do uncircumcised penises
have more fun? By R. Daniel Foster

Two years ago, Carl Redmond decided he wanted to be circumcised. The 36-year-old Seattle man had no medical reason for going under the knife. “I thought about it for years,” he says. “I just wanted to look like everyone else. It was a cosmetic decision. I thought it looked more normal.”

According to surveys, most parents decide to have their sons circumcised for much the same reasons. Indeed, there is no clear health incentive to perform routine circumcisions. That’s the policy statement of every medical society in the world, including the American Academy of Pediatrics. But in the United States, which has the highest rate of neonatal circumcision, the debate has yet to abate.

“In America, it’s still an ongoing controversy about whether circumcision is really necessary,” says Jack Sherman, M.D., associate chairman of pediatrics at Nassau County Medical Center in East Meadow, N.Y. “In 1971 and 1975, the AAP said it wasn’t necessary. Later, they amended their policy statement, citing studies about lowered penile cancer and first-year urinary-tract infections among circumcised males.”

The AAP’s 1999 policy statement, based on a review of 40 years of data, states that circumcision has potential medical benefits. “But they advise that parents not use that as their primary criterion when making a decision,” says Sherman. “That’s like not expressing an opinion at all.”

The AAP policy only clouds an already murky issue, according to Sherman. Until there are long-term studies with true, double-blind information, he says, parents will be left to deal with a host of ambiguities regarding the country’s most common surgery.

Boys in the hood

The primary risk associated with an intact penis is thought to be penile cancer, a rare condition affecting 10 in every million American men annually.

In the U.S. uncut men contract the disease at three times the rate of circumcised men, yet American Cancer Society officials cite lower penile-cancer rates in countries that do not practice circumcision.

Studies swing back and forth regarding a correlation between early urinary-tract infections and circumcision. They are similarly inconclusive about the foreskinned being more susceptible to STDs; the latest research, published in the Journal of the American Medical Association, found “no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.”

The perception that foreskin is unhygienic is a myth, says George C. Denniston, M.D., president of the Seattle-based Doctors Opposing Circumcision. “Foreskin protects against disease; it doesn’t cause disease. If foreskin is unhygienic, eyelids should be considered unhygienic.”

While circumcision as a religious rite has been around for thousands of years, the practice took hold in the U.S. in the late 1800s as a means of curbing sexual diseases and masturbation. (Ironically, a 1997 study published in JAMA showed that the trimmed self-indulge more than the untrimmed, and also engage in greater variety of sexual practices.) By the 1950s, circumcision assumed a class distinction, and by the 1970s, 80 percent of American male infants were circumcised. Today, that figure has dropped to 60 percent, with the lowest rate–34 percent–found on the West Coast. This still handily outdistances the international average of 15 percent.

The procedure is even being questioned among some non-Orthodox Jewish parents who are departing from the traditional bris, the ceremony of circumcision that initiates a baby into a covenant with God. Instead, they turn to Jewish laws that forbid the causing of pain to any living thing.

“It’s an ethical conflict,” says Ronald Goldman, author of Circumcision, the Hidden Trauma and director of the Circumcision Resource Center in Boston. “Many mothers I speak to have distress about what they witnessed even decades later.”

A 1989 AAP policy statement recognized the pain and trauma caused by the procedure and attendant behavioral changes among the young patients. Still, circumcision is the only surgery in America routinely performed without anesthesia. The AAP now recommends analgesic cream or shots of local anesthetic.

Fore score and 71 percent

So what goes missing during circumcision? Excised is about half the penile skin that grows to a postcard-size sheath in adults. Also removed is the mucosa, the foreskin’s supple underside that shields the head while producing an odorous, and possibly antibacterial, secretion called smegma.

What is also lost, insist the anticircumcisionists, is a significant amount of sexual sensitivity. In 1987, a Canadian researcher found 12 ridged bands inside the tip of the foreskin, dense with specialized nerve endings akin to those found on the ends of fingertips. The glans has similar receptors along the corona, or edge, though the head itself has poor sensitivity. During intercourse or masturbation, the bands touch the corona, sparking receptors on both surfaces.

“During circumcision, the majority of the dartos muscle is removed; [this is] a thin band up along the shaft and in the foreskin that’s heat-sensitive,” says Christopher Cold, M.D., a pathologist with the Marshfield Clinic in Marshfield, Wis. Cold says that similar “vibratory and pressure receptors” exist in the foreskin and along the clitoris. Touch receptors are also dense along a male’s frenulum, which, like the underside of the tongue, attaches the foreskin to the head.

“The entire penis is designed as a sensory platform for sexual pleasure, just as the vulva is in females,” says Cold. “Just as you can’t draw the exact line where the G spot is in women, I don’t think it’s possible to point to one portion of the penis and claim it’s more important than the rest.”

The best indicator of foreskin as “specialized erogenous tissue,” says Cold, is to ask adult males who’ve had it removed. Redmond, who was circumcised two years ago, says his sexual pleasure decreased “about 200 percent.” Others rate their sensitivity loss at about half.

Some urologist report otherwise. “We’ve done hundreds of circumcisions on adult men over the past 20 years and never had one complaint about lack of sensitivity,” says Larry Lipshultz, M.D., professor of urology and chief of the division of male reproductive medicine and surgery at Baylor College of Medicine in Houston. “I was a doctor in the U.S. Army in 1973, and we did a whole lot of circumcisions on adults. They were away from their wives or girlfriends and wanted it done. None of them complained.”

A more radical résumé for the foreskin comes from Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers in Forest Knolls, Calif. “Women fake orgasm,” she says, “because men are circumcised.”

Milos cites a 1999 study published in the British Journal of Urology which documented that women were more likely to have an orgasm (and less likely to experience vaginal discomfort) with an uncircumcised partner. The study concluded that the uncircumcised penis glides within its sheath of moveable skin with minimal friction. Because of this, uncut men use shorter thrusts than cut partners, who drive more deeply to launch an orgasm. The shorter thrusts of uncircumcised men, according to 71 percent of the respondents, allowed more contact with the mons pubis and clitoris, creating more orgasms for the women.

Home remedy

While most men consider their circumcision status a done deal, others are determined to get back what they say was stolen from them. A few choose restoration surgery, which is expensive and unpredictable. Skin grafts are often used, but there can be problems with decreased blood supply to the grafted skin.

More commonly, skin is stretched over the glans and taped in place around the waist or down the leg. Small weights and straps are also used. Full coverage of the glans takes up to three years, a tedious process that requires daily taping and re-taping. Although the skin is stretched, new skin is actually grown, much like a child’s skin extends as he ages. Once the skin has generated, it doesn’t recede. (For a squirmingly detailed account of “homegrown” foreskin restoration–complete with before, during and after pictures–check out www.4skin.com)

Wayne Griffiths didn’t break out the tapes and weights until he was 57. After two years, his glans was consistently covered with skin. “It doesn’t bring back what was cut off,” says Griffiths, who lives in Concord, Calif., “but the dead, keratinized cells on the glans and the inner skin that built up have sloughed off. The increase in sensitivity has been absolutely delightful. I no longer have to thrust and thrust and thrust to have an orgasm.”

Griffiths’ main complaint about circumcision is that infants have no choice in the matter. The surgery is the first major decision parents make for their sons–involving the look and performance of the most outward symbol of what will make them men. The AAP now says that doctors should allow parents to make an “informed choice” and hospitals should provide an unbiased overview of the surgery–an expectation that some consider optimistic. Meanwhile, parents continue to opt for circumcision, as Carl Redmond did, because it seems “normal” to them. A loaded word, to be sure, when talking about a man’s penis, no matter how you cut it.

When it comes to his penis, Los Angeles freelance writer R. Daniel Foster prefers aerobics to weight training.