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JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Vol. 277 No. 13, Pages 1052-1057. April 2, 1997.
CIRCUMCISION IN THE UNITED STATES
Prevalence, Prophylactic Effects, and Sexual Practice
Edward O. Laumann, PhD; Christopher M. Masi, MD; Ezra W. Zuckerman, MA
[abstract]
Objective. - To assess the prevalence of circumcision across
various social groups and examine the health and sexual outcomes
of circumcision.
Design. - An analysis of data from the National Health and Social
Life Survey.
Participants. - A national probability sample of 1410 American men
aged 18 to 59 years at the time of the survey. In addition, an
oversample of black and Hispanic minority groups is included in
comparative analyses.
Main Outcome Measures. - The contraction of sexually transmitted
diseases, the experience of sexual dysfunction, and experience
with a series of sexual practices.
Results. - We find no significant differences between circumcised
and uncircumcised men in their likelihood of contracting sexually
transmitted diseases. However uncircumcised men appear slightly
more likely to to experience sexual dysfunctions, especially later
in life. Finally, we find that circumcised men engage in a more
elaborated set of sexual practices. This pattern differs across
ethnic groups, suggesting the influence of social factors.
Conclusions. - The National Health and Social Life Survey evidence
indicates a slight benefit of circumcision but a negligible
association with most outcomes. These findings inform existing
debates on the utility of circumcision. The considerable impact
of circumcision status on sexual practice represents a new finding
that should further enrich such discussion. Our results support
the view that physicians and parents be informed of the potential
benefits and risks before circumcising newborns.
JAMA. 1997;277:1052-1057
AMERICAN MEDICAL ASSOCIATION
Physicians dedicated to the health of America
NEWS RELEASE – 3:00 PM CDT, April 1, 1997
BENEFITS OF CIRCUMCISION LIMITED
However, circumcised men report more varied sexual practices
CHICAGO - Aside from appearance, the differences between being
circumcised or uncircumcised are limited according to an article in
this week's issue of The Journal of the American Medical Association
(JAMA).
Edward O. Laumann, Ph. D., and colleagues from the University of
Chicago, Ill., analyzed data from the National Health and Social Life
Survey (NHSLS), a data source on the sexual, attitudinal, and
health-related experiences of Americans.
The authors write: "Overall, 77 percent of the 1,284 U.S.-born men
surveyed in the main NHSLS sample were circumcised, compared with 42
percent of the 115 non-U.S.-born men." They add that the proportion
of newborns that were circumcised reached 80 percent in the years
after World War II and climaxed in the mid 1960s. Men whose mothers
earned at least a high school diploma were 2.5 times more likely to be
circumcised than those whose mothers were less educated.
The researchers discovered: that circumcision provides no discernible
prophylactic benefit; that circumcision does not increase the
likelihood of contracting a sexually transmitted disease [CIRP
note: The study found no significant decrease either], that
circumcised men have slightly lower risk of experiencing sexual
dysfunction, especially in later life; and that circumcised men
displayed greater rates of experience of various sexual practices.
The difference in sexual practices were especially true among white
men in the areas of masturbation and heterosexual oral sex. The
researchers found that circumcised men were 1.4 times more likely to
masturbate at least once a month, and were nearly 1.4 times more
lifely to engage in heterosexual oral sex than uncircumcised men.
Ironically, circumcision, at one time, was thought to limit
masturbation, according to the researchers.
The authors write: "The NHSLS evidence indicates a slight benefit of
circumcision but at a negligible association with most outcomes.
These findings inform existing debates on the utility of circumcision.
The considerable impact of circumcision status on sexual practice
represents a new finding that should further enrich such discussion.
Our results support the view that physicians and parents be informed
of the potential benefits and risks before circumcising newborns."
The authors explain that nonreligious circumcision first gained
popularity in the United States in the 1870s as a practice that was
believed to promote hygiene and limit untraditional sexual practices.
While other English-speaking societies, including England, Canada,
Australia and New Zealand, adopted the practice at the turn of the
century, only the United States continues to have high rates on
non-religious circumcision today.
They add that the U.S. medical establishment endorsed neonatal
circumcision in the 1940s and 1950s. However, consensus regarding the
value of neonatal circumcision began to break down in the late 1960s
and early 1970s. In 1971 and 1975, the American Academy of Pediatrics
(AAP) Task Force on Circumcision concluded that valid medial
indications for routine neonatal circumcision did not exist. The AAP
counseled that the decision to perform this procedure, formerly a
choice about which parents deferred to the authority of physicians, be
made by parents who have been apprised of its risks.
#
For more information: contact the AMA's Scot Roskelley at 312/424-4431.
email: SCOT_ROSKELLEY@ama.assn.org AMA's web site:
http://www.ama-assn.org
Jeff Molter, Director
Department of Science News
515 North State Street
Chicago, Illinois 60610p
312 464-5374
312 464-5839 FAX
NATIONAL ORGANIZATION OF CIRCUMCISION INFORMATION RESOURCE CENTERS Post Office Box 2512, San Anselmo, California 94979-2512 Telephone 415-488-9883 Fax 415-488-9660 NEWS RELEASE – 3:00 PM CDT, April 1, 1997 Circumcision Increases Oral and Anal Sex and Masturbation Increases risk of sexually transmitted diseases San Anselmo, CA - Circumcised men engage in various forms of oral and anal sex and masturbation at greater rates than uncircumcised men, according to a report in the April 2, 1997 Journal of the American Medical Association. These findings come from Edward O. Laumann, Ph. D., and colleagues at the University of Chicago, who analyzed data from the National Health and Social Life Survey (NHSLS), a data source on the sexual, attitudinal, and health-related experiences of Americans. Ironically, circumcision was one thought to limit masturbation, however, the need for varied sexual practices by circumcised men is explained by Canadian researcher John Taylor in his report, "The prepuce: specialized mucosa of the penis and its loss to circumcision" (British Journal of Urology, February 1996). "Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa...Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis. "the prepuce provides a large and important platform for several nerves and nerve endings. The innervation of the outer skin of the prepuce is impressive; its sensitivity to light touch and pain are similar to that of the skin of the penis as a whole. The glans, by contrast, is insensitive to light touch, heat, cold and as far as the authors are aware, to pin-prick." Without the prepuce, men must resort to varied sexual practices to receive adequate stimulation for enjoyment and ejaculation. Examination of the slight increase of sexual dysfunction found among elderly white males must include consideration of alcohol and tobacco abuse among men in lower socio-economic groups who, prior to World War II, were less likely to be circumcised than their middle class contemporaries. While Laumann and his colleagues report that circumcision provides no discernible prophylactic benefit and may in fact increase the likelihood of contracting sexually transmitted diseases, Anna Taddio, et. al., reporting in the March 1, 1997, issue of The Lancet, have demonstrated that "[T]he long-term consequences of the surgery done without anaesthesia are likely to include post-traumatic stress as well as pain." Recognizing that dubious benefits and acknowledged harm of circumcision, the Australasian Association of Paediatric Surgeons in their 1996 position statement declared, "we do not support the removal of a normal part of the body, unless there are definite indications to justify the procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce." For more information, contact Marilyn Milos, R.N. at 415-488-9883 e-mail: nocirc@nbn.com web site: http://www.nocirc.org/
NOHARMM NEWS RELEASE – 3 p.m. Tuesday, April 1, 1997 Circumcision decreases sensitivity, increases disease risk Survey finds surgery alters sexual functioning, behaviors Results from a survey of 544 circumcised men reveal that progressive sensitivity loss is a widespread complaint among such males, especially as they age. The recently updated report, Awakenings: A Preliminary Poll of Circumcised Men, first published in 1994 by the National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM), found that over 60% of respondents aged 30 to 49 reported loss of sensation in the glans (penile head) and 55% needed extraordinary stimulation to achieve orgasm. Over 10% of circumcised men aged 20-29 reported similar sensitivity loss and the need for gross stimulation techniques. "The decrease in penile sensitivity caused by circumcision predisposes men to engage in behaviors offering more stimulation, such as masturbation and oral or anal sex," according to survey coordinator Tim Hammond. "Compromised sensitivity increases reliance on elaborate behaviors that can cause abrasion and bleeding, and reduces the likelihood of condom use, factors that increase one's risk for sexually transmitted diseases (STDs)." These findings agree with Edward O. Laumann's study, "Circumcision in the United States," published in the Journal of the American Medical Association (April 2), which found "circumcised men engage in a more elaborated set of sexual practices" and concluded "circumcision provides no discernible benefit and may in fact increase the likelihood of STD contraction." "Amputating the foreskin externalizes the glans," Hammond explains, "leaving its moist mucosal surface unprotected and subject to drying out and keratinization (callusing), which leads to decreased sensitivity. This could explain why heterosexual men who are circumcised resort to behaviors offering more stimulation than vaginal intercourse." According to Hammond, "Circumcised respondents complained that, without the foreskin's gliding and lubricating qualities during intercourse, sufficient stimulation for orgasm could only be achieved by prolonged or exaggerated thrusting. This caused pain, abrasion and bleeding for both the male and his partner." Genital abrasion and bleeding during sex are recognized risk factors for contracting sexually transmitted diseases, including AIDS. Hammond says he is not surprised that, among developed Western nations, the U.S. has one of the highest newborn circumcision rates and one of the highest rates of STDs. Supporting evidence that the foreskin may enhance sexual response was disclosed in research published in the British Journal of Urology in 1996. It revealed that the foreskin is densely nerve-laden and "provides a large and important platform for several nerves and nerve endings." In "The prepuce: specialized mucosa of the penis and its loss to circumcision," Canadian researcher Dr. John Taylor found that circumcision "removes preputial skin and mucosa, or 51% of the mean adult penile shaft" and "ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the penis." "Neurological dysfunction is just one way in which circumcision damages males," Hammond says. He notes, "Almost no research has been done to determine how this surgery affects men later in life. Genital alteration is the longest experiment in history. It has never been analyzed properly." "Until recently," Hammond added, "many circumcised men were unaware of the functional benefits of the foreskin or the ways in which circumcision adversely affects them." Recent men's body image surveys have found that more than 25% of circumcised men are dissatisfied with their lack of a foreskin. The studies by Hammond and Laumann acknowledge that the adverse effects of circumcision have spurred significant efforts to protect the genital integrity of infants and to reverse circumcision in adult men. While the American Medical Association (AMA) reported on the "results" section of the Laumann study, which found "no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases," it ignored the study's "conclusion" section, which clearly states that, "Circumcision may in fact increase the likelihood of STD contraction." The AMA rejected a request by Hammond and other circumcision experts to report the study's important conclusion that circumcised men may be at increased risk of contracting sexually transmitted diseases. For more information, contact: NOHARMM, PO Box 460795, San Francisco CA 94146-0795.
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