Sex: A Trim Off the Top

David Cornell, a urologist in Atlanta, has performed 1,000 adult cosmetic circumcisions in the last five years. What has he learned? "Guys and their penises are a strange pair." Cornell says he had no idea that having a foreskin would be such a big deal, but "for a lot of these guys it's been a real demon. Circumcision takes a big load off." According to Dave (names have been changed), "growing up, my brother and I definitely did not feel that we fit in properly with other guys—we had the 'elephant trunk.' I was always very ashamed of not being circumcised. My personal body image was very negative as a result." Brad told me his anxiety began in the boys' room at school in first grade. "I did not want to be different, so I would hide mine. This followed me through school, and I didn't play sports because I didn't want to undress in front of anyone."

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Today, infant circumcision rates are about 50 percent in the US, but 30 years ago it was closer to 90, and even higher in certain areas. So it's understandable that a lot of guys would have negative feelings about their foreskins, and track down doctors like Cornell. Many men told me they decided to be circumcised either to fit in or, perhaps because of what they're used to seeing around them, for aesthetic reasons; they just think it looks better. Dave told me "to put it bluntly, I feel that my masculinity is now unsheathed."

Surprisingly few of them mention sexual appeal or performance issues: They're not getting cut to please partners, or to enhance functionality in bed. But while sex isn't a main motivator, it is a concern. John told me that before the procedure, "I probably spent more time researching this than when I did my thesis at MIT." So what do guys considering a trim off the top need to know about sex after surgery?

Circumcision removes a third to a half of the skin on the penis, so one would expect a difference in sensitivity. According to one study, men who've been circumcised as adults have more difficulty achieving and maintaining erections than intact men do. And while another study found no difference in erections, it did find a significant delay in ejaculation among men who've had adult circumcisions—which can be either a burden or a blessing. A more recent study found that 65 percent of men circumcised as an adult reported a delay in ejaculation, but only 10 percent of them said that it improved their sex lives. And a large Korean study in 2007 found no differences in sex drive, erections, or ejaculation, but an overall decrease in masturbatory and sexual pleasure.

The results are certainly mixed. A study reported in 2008 surveyed 2210 guys circumcised in Uganda between the ages of 15 and 49, both before and after the procedure. The results showed no effect on sexual satisfaction. And a lab study published in 2007 comparing circumcised and uncircumcised men showed no difference in penile touch sensitivity, either while flaccid or aroused.

What's a woman's take? A study of female preferences found that the majority of women preferred cut penises, citing odor, cleanliness, and appearance. That study, however, is 20 years old and surveyed only a small sample of Midwesterners. According to a more recent paper, women reported that men without foreskins thrust harder and deeper during vaginal intercourse, while intact men are more gentle and use shorter strokes. During withdrawal, the sensitive foreskin bunches up against the sensitive glans, so the man doesn't pull out as far. Women also become dry more quickly with circumcised men. That's because the foreskin acts as a double sheath so the penis moves back and forth inside it rather than sliding against the vaginal wall, and the crown of the penis also acts as a scoop that pulls fluid out with it. Women said that with intact men they were more likely to have an orgasm and less likely to "want to get it over with." It should be noted, however, that some of the women in the study were recruited through anti-circumcision web sites.

In the end, whether the mechanics of sex decline (or improve) after circumcision may not matter as much as a guy's body image. If you feel ugly or dirty or smelly in a private manly way, your self-confidence will plummet, and intimacy will follow. So either make peace with your foreskin, or make piece with it.

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