Late in the summer of 2005, I visited a nondescript medical office in San Francisco’s fog belt, lay down on an examination table and had eleven regions of my penis poked by various gauges of monofilament. It wasn’t quite what I’d envisioned when I’d signed up for the Penile Sensitivity Touch-Test Evaluation Study — “touch test” had conjured something a little sexier than a retired MD coming at me with medical-grade fishing line. But by the age of thirty-five, the human penis is nothing if not well schooled in disappointment, and so, for the good of science, I went through with the exam.
The science in this case concerned one of the most controversial and common medical procedures practiced in the West: circumcision of the penis. The study, published in the April 2007 BJU International (the former British Journal of Urology) under the title “Fine-Touch Pressure Thresholds in the Adult Penis,” is the latest research salvo in the war for the neonatal foreskin.
Pro-circumcision forces have been getting the upper hand
on the research front in recent months, brandishing high-profile studies associating male circumcision with significantly lower HIV-infection rates in Africa. And while the American Academy of Pediatrics continues to call the evidence “complex and conflicting,” several older studies claim a link between male circumcision and lower rates of specific sexually transmitted diseases, including HIV, syphilis, and cancer of the sexual and reproductive organs.
Anti-circumcision advocates cite methodological problems with the STD studies while raising a separate question about the ethics of discarding a body part to prevent its becoming infected. In order to establish what, exactly, a male person loses when he loses his foreskin, the study set out to compare sensation in the cut and the uncut organ. Its conclusion may seem obvious to those of us with only a lay interest in the penis, but it’s controversial, nonetheless: uncut dick feels more. A lot more.
“The study shows that the foreskin is the most sensitive portion of
the penis,” said study coauthor Robert Van Howe, a pediatrician at the Marquette General Health System in Marquette, Michigan. “It’s not like you’re chopping off plain old skin. The analogy would be like removing your lips, because the lips are more sensitive than the skin around them.”
The study, organized by the anti-circumcision advocacy group NOCIRC (National Organization of Circumcision Information Resource Centers), isn’t the first to compare the sensitivity of the cut and the uncut. Masters and Johnson found no difference between circumcised and uncircumcised men’s glans sensitivity, but they didn’t subject that finding to peer review. Another dozen studies cited in the BJU International report compared sexual function of cut and uncut men, and some looked — from an anatomical, rather than sensory, perspective — at the loss of sensory tissue in circumcision. But the study authors say they’ve achieved something new with their study: a comparative sensory mapping of the male organ.
This new cartography of the penis proffers nineteen zones. Missing from the circumcised male are eight of these penile destinations, four on the dorsal side (the outer prepuce, the orifice rim, the muco-cutaneous junction, the ridged band) and four on the ventral (frenulum near ridged band, frenulum at muco-cutaneous junction, orifice rim, and outer prepuce). Missing from the uncircumcised anatomy are two regions on this new map, and they’re both scars.
In the areas that cut and uncut men have in common, the study showed a sensitivity deficit of between two and thirty-three percent. In those areas peculiar to the intact penis, the deficit is by definition 100 percent. And it’s in those areas, the study concludes, where most of the sensory action is. Perhaps the most salient of the report’s findings is that “the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis.” If the penile map were of New York City, the equivalent cut would be Manhattan from Fourteenth Street to Battery Park.
Controversy in scientific research is hardly unique to the subject of male circumcision, but the procedure itself does pose unique challenges to the investigator. The first of these is determining who is actually circumcised. In some studies, researchers simply asked participants — or their female partners — if the penis in question was intact or not. But circumcision skeptics say asking doesn’t cut it. Bob Van Howe, co-author of a recent study showing that circumcision removes the most sensitive parts of the penis, cites research showing that both men and women are wrong about the circumcision status of the penis between five and thirty percent of the time. (I found this statistic implausible until I asked my mother whether my father — to whom she’d been married for eighteen years and with whom she’d had two children — was circumcised. She didn’t know.)
Even after figuring out who’s cut and uncut, the researcher confronts epidemiologically significant cultural and religious questions that can turn painstakingly designed studies into the equivalent of a leaky condom. In Africa, as elsewhere, Muslim men are more likely to be circumcised and less likely to be HIV-positive. Is that because their circumcision is protecting them, or because of the way religion and ritual affect their sexual behavior and genital hygiene? In England, circumcision rates among older men are class-determined. Are HIV rates among the gentry low because they’re missing a prepuce, because of the sex practices of the English upper class, or because of the education and health care they can afford? In the U.S., Hispanics are less likely to be circumcised than African-Americans, and less likely to be HIV-positive. Again, is that a function of cultural affiliation and sexual behavior, or of foreskin?
In Africa, circumcision research faces even knottier challenges. One study published this year showed that sub-Saharan African adolescents and virgins were significantly more likely to infected with HIV if they were circumcised, probably because they were infected by the instruments used to circumcise them. But among circumcised adults, HIV rates were lower. Instead of indicating that foreskin was the culprit in spreading HIV, the study authors suggested, this lower HIV prevalence may simply be because a significant number of men who were circumcised as boys in Kenya, Lesotho and Tanzania didn’t survive their circumcisions long enough to be studied.
So is it any surprise that circumcision studies are so frequently at odds with each other? From the studies I’ve reviewed for this story, I could use peer-reviewed scientific evidence to support the notion that circumcision results in higher rates of infection with herpes type 2, or lower
rates of herpes type 2, or higher rates of infection but lower incidents of herpes outbreaks. I could argue that circumcision helps prevent HPV and anogenital and cervical cancer or that it has no effect. I could argue that the West has an obligation to help Africa get circumcised or that it has an obligation to leave African penises alone.
But even if the medical establishment arrived at an undisputed consensus, I’ll keep thinking about the well intentioned parents — and doctors — in the nineteenth century who circumcised millions of boys to protect them from hip dysplasia. Doesn’t that history give us a special obligation to be cautious?
Circumcision proponents say that amounts to tainting them by association with yesterday’s crackpots. "One can find absurd statements about almost anything if one searches for them," said Robert Bailey, professor of epidemiology at the School of Public Health at the University of Illinois at Chicago, and the principal investigator for the Kenya study. "There is a lunatic fringe advocating for or against nearly every medical treatment ever proposed."
But the nineteenth century argument linking circumcision, masturbation and epilepsy didn’t belong to the lunatic fringe. It belonged to the medical establishment. Respected researchers in major medical journals and textbooks urged doctors to amputate the foreskin of men and boys to prevent them from jerking off and contracting the debilitating disorders, physical and otherwise, that masturbation was thought to cause.
How will future generations judge today’s medical establishment on the question of circumcision? Surely scientific research today is more rigorous than it was in the nineteenth century. In the coming century, it will be more rigorous still. Personally, if I’m ever in the position of deciding whether an infant is going to have the most sensitive part of his penis cut off in exchange for potential health benefits later in life, the full range of what They have been telling us over the last 150 years is going to raise a red flag. n°
©2007 Paul Festa and Nerve.com
|ABOUT THE AUTHOR:|
Festa‘s essays appear in Nerve, Salon, the Best Sex Writing
anthologies for 2005, 2006 and 2008, and other publications. He is
the author of OH MY
GOD: Messiaen in the Ear of the Unbeliever, which is based on Apparition of the Eternal
Church, his award-winning and critically acclaimed film about the
music of Olivier Messiaen. A violinist, he has toured extensively,
given the U.S., Boston, New York, San Francisco and Los Angeles
premieres of Messiaen’s 1933 Fantaisie, and performed with the
Stephen Pelton Dance Theater and the North Bay Shakespeare Company. He
is the official historian of the Presidential Memorial Commission of
San Francisco, and is revising a novel. More info at paulfesta.com.