Thursday, June 21, 2007

Would you like some loss of sensation with that lopping of your foreskin?

Male infant circumcision is the most common medical procedure performed in the US (although an article I ran across last week said rates were dropping, and most of that rate drop was due to the assimilation of folk from non-penis-disfiguring cultures). Matz and I spent way too many arguments (according to him, I always enjoyed them) in med school over whether circumcsion was Matz: a benign procedure, culturally significant, and good for hygiene, or Garrett: medical barbarism fueled by the inability of American parents to ask why they should be attacking their male children so they can "look like Dad."

So yeah, I don't like circumcision, and I want my foreskin back, despite the marginal improvements in hygiene suggested in a shoddy body of medical literature, although I'm intrigued by literature suggesting that circumcision may have some role in preventing HIV transmission in Africa.

One of the high points of our arguments was always whether circumcision created a differential in sexual pleasure between the lopped and the non-lopped. This study doesn't answer that question, but it's a great demonstration from which we can extrapolate future work:

Adult male volunteers were evaluated with a 19 point Semmes-Weinstein monofilament touch-test to map fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since test ejaculation, ethnicity, country of birth, and level of education.

Analysis of results showed the glans of the uncircumcised men had significantly lower thresholds than that of circumcised men (P = 0.040). There were also significant differences in pressure thresholds by location on the penis

This study suggests 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. It appears that circumcision ablates the most sensitive parts of the penis.
I repeat, this study does not adequately address the magnitude of sexual pleasure experienced either way. Circumcision occurs when the brain is still markedly plastic, and it's certainly reasonable to think that some rewiring could compensate for the loss of sensation caused by circumcision. But, the results do suggest that the anti-circumcision crowd may be correct: a foreskin is a terrible thing to waste.

During my third year pediatrics rotation, our attending (Matz and I were actually on the same service that month) brought us to the procedure room to assist in a circumcision. Matz was kind enough to speak up for me, that I had some moral cat in the fight, so as to save some face for me and make me not look like a disinterested medical student who didn't want to learn how to do "procedures." The attending asked me about my objection, and I remember replying earnestly that I didn't see any evidence for a benefit to performing the procedure, and I did see evidence for harm. Her reaction was markedly benevolent (she could have destroyed me for daring to openly question an attending's judgment), and assigned me to my greatest role as a medical student: she handed me a pacifier and a packet of sugar, and suggested I keep the little guy as happy as possible while she and the resident elegantly lopped off the poor little guy's foreskin.

Hopefully our lives never depend on our performance on a penile sensation microfilament test.


Kyle said...

But if radical Islamicists want to convert us at knifepoint, it won't be as bad as all that...

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