Male Circumcision and Sexual Function in Men and Women

A Survey-based, Cross-sectional Study in Denmark

Morten Frisch; Morten Lindholm; Morten Grønbæk

Disclosures

Int J Epidemiol. 2011;40(5):1367-1381. 

In This Article

Abstract and Introduction

Abstract

Background One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes.
Methods Participants in a national health survey (n  = 5552) provided information about their own (men) or their spouse's (women) circumcision status and details about their sex lives. Logistic regression-derived odds ratios (ORs) measured associations of circumcision status with sexual experiences and current difficulties with sexual desire, sexual needs fulfilment and sexual functioning.
Results Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, ORadj = 3.26; 95% confidence interval (CI) 1.42–7.47], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, ORadj = 2.09; 95% CI 1.05–4.16) and frequent sexual function difficulties overall (31 vs 22%, ORadj = 3.26; 95% CI 1.15–9.27), notably orgasm difficulties (19 vs 14%, ORadj = 2.66; 95% CI 1.07–6.66) and dyspareunia (12 vs 3%, ORadj = 8.45; 95% CI 3.01–23.74). Findings were stable in several robustness analyses, including one restricted to non-Jews and non-Moslems.
Conclusions Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted.

Introduction

For >60 years it has been known from unselected population-based studies that the tight foreskin of newborn boys, a natural state sometimes referred to as physiological phimosis, regresses spontaneously during childhood and puberty,[1] leaving a freely mobile foreskin by age 17 years in 99% of boys.[2] Yet, prevention of the rare cases of pathological phimosis remains a leading argument for proponents of routine circumcision. Other claimed benefits of circumcision, such as reduced risks of balanoposthitis, sexually transmitted infections and penile cancer, can be achieved without tissue loss through the maintenance of good penile hygiene combined with proper use of condoms, and whether circumcision reduces the risk of urinary tract infections in infancy has been questioned.[3,4] Despite the fact that no professional medical organization recommends routine circumcision, not even in the USA where most newborn boys undergo the operation,[5] it remains a widespread belief that circumcision provides superior penile hygiene and protects against urinary tract infections, phimosis, paraphimosis, balanoposthitis, venereal diseases and cancer.[6,7]

Considering the organ involved with its sensitive anatomical structures,[8] surprisingly few population-based studies have been carried out to evaluate circumcision's possible sexual consequences.[9–11] A number of methodologically questionable reports have led to claims of impaired, improved or unaltered sexual function in circumcised men and their female partners. We wanted to explore these issues further, using data from a national health survey in Denmark, a country with a low prevalence of male circumcision.[12] In light of the conflicting literature, we deliberately did not set up a series of specific a priori hypotheses for the study.

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