Debunking anti-circumcision pseudoscience

An annotated version of the National Coalition for Men's letter to the Bill and Melinda Gates Foundation

The National Coalition For Men (NCFM) published a letter to the Gates Foundation dated 14 July that argues against circumcision as an HIV-prevention measure in sub-Saharan Africa. The letter was written by Peter Adler and Steven Svoboda and submitted by the NCFM's president, Harry Crouch. Stephen Moreton has annotated the NCFM letter, pointing out its errors. This is a slightly edited version of the annotations he has sent to the Gates Foundation.

The Circumcision. Pot-metal glass and vitreous paint German (Cologne), 1460-70. Photo by Adam Fagen in the The Cloisters of the Metropolitan Museum of Art. (CC BY-NC-SA 2.0)

The NCFM text submitted by Harry Crouch is in italics. The annotations by Stephen Moreton are in bold.

Everyone should applaud how your Foundation is funding proven methods to slow the spread of HIVand AIDS in sub-Saharan Africa, including testing, teaching the so-called ABC's (Abstinence, Be Faithful, and Condoms), retroviral therapy, treating schistosomiasis (which causes vaginal bleeding) and STDs, and helping to lead the search for an HIV vaccine. It is time, however, for your Foundation to stop funding the scientically, morally, ethically, and legally unjustified program to circumcise 38 million African men as an HIV preventive strategy. After seven years and 6 million circumcisions, your program has failed.

On the contrary, it is working. See Auvert et al, 2013.

The mass male circumcision program is being justified based on four random controlled trials (RCTs) conducted in sub-Saharan Africa. The RCTs suffered from numerous ethical, scientific and methodological flaws that render the results meaningless. [1, 2]

Here the author ignores multiple debunkings of these criticisms. They have been answered in painstaking detail by authorities in the field, and to the satisfaction of all professional bodies involved. For examples of comprehensive debunkings see Halperin et al (2008) and Morris et al (2012). Tellingly, some of the articles cited in the open letter at this point attracted debunkings specific to those articles. Thus Green et al (2010) in ref. 2 was refuted by two separate letters to the editor: Banerjee et al (2011) and Wawer et al (2011); Boyle & Hill (which the author neglects to provide the full reference for) were refuted by Wamai et al (2011); and Van Howe & Storms (2011) in ref. 2 were refuted by Morris et al (2011). Ignoring criticisms, and citing discredited studies, is a pattern in Harry Crouch’s open letter, as we shall see.

Worse, one of the RCTs produced evidence that was quickly buried suggesting that circumcision may increase male to female transmission of HIV by 61%. [3]

The reference given (no. 3) merely refers the reader to the list of discredited studies above it, leaving the reader with the tedious task of searching through them to find the primary source. (Bad referencing is a problem with this open letter). Presumably it is Wawer et al (2009) who found that the female partners of recently circumcised HIV positive men had a higher risk of becoming positive themselves. This was because some men resumed sex before they had completely healed. So it is really an argument for educating men about the need to wait for complete healing before resuming sex, rather than an argument against circumcision per se.

Moreover, the African circumcision program may be completely unnecessary, as a Ugandan RCT [4] showed that intact men who wait at least ten minutes to clean their penis after sexual intercourse are 41% less likely to contract HIV than circumcised men. [5]

Here the author refers to a study which found that men who were quick to wash themselves after intercourse were more at risk than those who took their time and eventually merely wiped themselves with a cloth. Intactivists have enthusiastically seized on this curious finding and promoted it as an HIV-prevention strategy. This is premature as it is not proven why waiting and wiping should be of benefit. Speculations about enzymes in vaginal fluids have been made but the truth may be far more mundane. If a man has sex with a stranger, a prostitute, or someone else he considers to be at high risk of having HIV, then he will be far more likely to wash thoroughly and quickly as soon as proceedings have concluded. On the other hand, if he is with his regular partner, or someone he knows to be at low risk, he will be relaxed, and may take some time before merely reaching for a cloth and drying himself off. In short, the difference is simply a reflection of the accuracy of the men’s perception of risk (Ndebele et al, 2013). In light of this simple, prosaic explanation, it is reckless and irresponsible to promote “wait and wipe” as an HIV prevention strategy.

Thus, the program's targets could be achieved without a single circumcision and at minimal cost versus a projected cost for the current program of $16 billion. African men and women should have been informed of these facts critical to their health and safety.

As the author’s basis for this comment comprises discredited studies and an irresponsible instruction about waiting and wiping, it can be dismissed. What the author is presenting is not factual at all, but dangerously misleading pseudoscience.

Circumcision Offers Men Little or No Protection From HIV.

Circumcision results in about a 60% reduction in female to male transmission as indicated by three randomised controlled trials, rising with time to around 76% in the South African trial.

Some Africans are being told, and many will reasonably assume (why else are they being circumcised?) that circumcision will protect them from HIV, but that is false. Circumcision is no vaccine. Circumcised or not, men who have sex with HIV infected females risk becoming HIV positive. Africans should be informed as follows: "For highly exposed men, such as men living in southern Africa, the choice is either using condoms consistently, with extremely low risk of becoming infected, or being circumcised, with relatively high risk of becoming infected." [6]

Getting men to use condoms consistently has proved challenging despite massive condom promotion. Circumcision provides added protection for when condoms fail (as sometimes they do) and for those who don’t or won’t use them. The reference cited (no. 6) refers one to no. 5 above, which is a duplicate of no. 4, and is not the source of the quote. More sloppy referencing. Presumably it is intended to be Garenne (2006).

Even if circumcision did reduce the relative risk by 50%, Garenne concluded,“ a 50% reduction in risk [if true] is likely to have only a small demographic effect. "Observational studies of general populations have for the most part failed to show an association between circumcision status and HIV infection." [7]

Again the reference is wrong. In fact it comes from Van Howe and Storms (2011) in ref. 2 which, as explained previously, was discredited by Morris et al (2011).

Thus, the true protection that circumcision provides to men from HIV infection is negligible or nil. [8]

False, for reasons stated above.

Ironically, Circumcision Will Likely Increase HIV Infections Among African Men and Women. Experts have concluded that "circumcision programs will likely increase the number of HIV infections." [9]

The reference given here is to husband and wife Van Howe and Storms, although confusingly it says “Supra n.12” which means “note 12 above”, when 12 is actually below. It should be n.2. Such repeated careless referencing does not inspire confidence in the author’s academic skills. And, as Van Howe and Storms have no relevant research background in African HIV, but are in fact prominent intactivists, and Van Howe has a history of shoddy scholarship (see below), the description of them as “experts” is misleading. As stated before, the article in question has been debunked (Morris et al, 2011). Some of the co-authors of the debunking were involved in the African trials – real experts.

First, only 30%-35% of HIV in African men is attributable to sexual transmission, not 90% as experts initially claimed. [10] HIV in Africa is often blood borne, spread by contaminated needles.

Once again the author makes a bogus claim from a discredited source. In this instance he cites Gisselquist whose ideas about African HIV being mostly spread by vaccinations were thoroughly debunked in 2004 by the WHO (Schmid et al 2004). Gisselquist continues to be cited by anti-vaccination groups, HIV/AIDS deniers and, it seems, intactivists, but amongst the scientific community he has no credibility.

Circumcision surgery in Africa often causes HIV.

Having been regaled with discredited studies, and fringe sources like Gisselquist, we now have the other stock-in-trade of the pseudoscientist – the half-truth. Traditional African-style circumcision with a razor blade and no regard to hygiene, pain control or cosmetic outcome, can spread HIV. This has been known for years (e.g. Brewer et al 2007) and might explain why in some African countries (e.g. Lesotho, Cameroon & Tanzania) circumcision actually correlates with HIV (something intactivists never tell their audiences when they gleefully point to such countries).

The problem will [be] much worse when millions of Africans are circumcised in multiple, often unsterile venues on a rush basis by poorly trained workers.

Then see that they are trained and have the time and resources to do the job properly.

Second, volunteers, reasonably believing that they are completely or substantially protected from HIV, are less likely to use condoms, [11,12] and circumcised men are less likely to use condoms anyway.

This is the “risk compensation” argument. As usual the references cited are both discredited studies by the unreliable Robert Van Howe. No. 12 in particular became a textbook example – literally – of how NOT to do a meta-analysis (Borenstein 2009). Undeterred, Van Howe went on to do a second meta-analysis (on circumcision & HPV) that was so bad that when experts from the Catalan Institute of Oncology examined it they concluded it ought to be retracted from the literature (Castellsagué et al 2007). But Van Howe didn’t learn and when his third meta-analysis came out (on circumcision & STIs) it was again found to be so bad as to merit retraction (Morris et al 2014). Whenever Van Howe gets on his anti-circumcision hobby-horse he attracts criticisms. These episodes are just a sampling of the impressive tally of rebuttals and critiques he has clocked up over the years. And he was described earlier in Crouch’s open letter as an "expert"! Readers are advised to be deeply wary of anything bearing the name Van Howe.

Of course the notion of risk compensation has already been well examined and found not to be an issue when men are given proper counselling. Here are the studies demonstrating this which Crouch ignores: Mattson et al (2008), Reiss et al (2010), L’Engle et al (2014), Westercamp et al (2014).

Third, mass circumcision diverts resources from the proven methods of HIV prevention listed in the introduction. Thus, your mass male circumcision program will not only fail but will backfire.

Circumcision Is Also Painful, Risky, and Harmful. Africans report surprised at how painful circumcision is. Even if local anesthetics are used and given time to work, they are largely ineffective, and pain continues during the healing period.

This is just false as millions of men circumcised in this way know. Where is Crouch’s evidence?

Even the American Academy of Pediatrics ‘Task Force on Circumcision concedes that circumcision risks a long list of minor injuries, serious injuries (including hemorrhage, infection, deformed penis, and loss of all or part of the glans or of the entire penis) and death. In the United States, the risk of injury is estimated to be between 2% and 10%.

In the largest study yet (n = 1.4 million) the CDC have determined the risk of all complications, whether serious or not, from infant medical circumcision to be 0.5%, and about 10 to 20 times higher for those carried out later (Bcheraoui et al 2014).

In Africa, the risk of injury is much higher, estimated to be 17.7% clinically and 35.2% for traditional circumcisions. [13]

As usual Crouch does not tell the whole story. The clinical practitioners in the study had not the training or equipment to conduct circumcisions safely. Great efforts have since been put into developing safe methods and providing resources so it is misleading to base a complaint on one study of one district in one country which identified issues that have since been addressed. And to compare medical circumcision with traditional circumcision is absurd.

As the AAP conceded in its 2012 policy statement, the true extent of the risks associated with circumcision is unknown.

See Bcheraoui et al 2014.

Circumcision Diminishes Every Man's Sex Life. Circumcision removes one-half of the penile covering, the size of a postcard in an adult.

There is such variation in penile sizes and proportions it is not possible to give a “one size fits all” figure. Intactivists also count both inner and outer surfaces to make it seem larger.

The foreskin is replete with blood vessels and specialized nerves such as stretch receptors. The foreskin is, and circumcision removes, the most sensitive part of the penis. [14]

Here Crouch cites another dubious work by intactivists. Aside from the round of criticism (Waskett & Morris 2007), counter-criticism (Young 2007) and further criticism (Morris & Krieger 2013) it attracted, the study looked only at one kind of sensitivity – fine touch. But is this the right kind of sensitivity? Fine touch comes from nerve endings called Meissner’s corpuscles which are present in the foreskin, but even more so in the fingertips (Bhat et al 2008), and we do not consider fingertips erogenous. Pleasurable erotic sensations come from genital corpuscles which are concentrated around the glans, not the foreskin. So the whole study may be a red herring. It is certainly cherry-picked. Other studies find no difference between the circumcised and the uncircumcised. Like Bleustein et al (2005) who tested a broader range of sensation types (vibration, pressure, spatial perception and temperature) and found no difference between circumcised and uncircumcised. For every study the intactivists cherry-pick to suit their agenda, another can be found that contradicts it. Tellingly, the only meta-analysis to date, on the ten best studies, found that circumcision makes no difference to male sexual function (Tian et al 2013). An independent review found the same (Morris & Krieger 2013).

African men will be outraged to learn that circumcision not only has failed to protect them from HIV but has forever diminished their sex lives. Female partners of circumcised men also report reduced sexual satisfaction. [15]

More cherry-picking. There are studies which found that women report a preference for circumcised partners (e.g. Williamson & Williamson 1988) including a randomised controlled trial (table 2 in Krieger et al 2008).

Africans Are Being Misinformed, Coerced, and Exploited. African men are not being informed of the truth, that circumcision is painful, risky, and harmful; that in itself it gives little to no protection from HIV, and the surgery itself may infect them with HIV. Serious ethical violations are occurring as usually poor Africans are being offered valuable incentives to volunteer such as free medical care. [16] Boys as young as fifteen years old are being coerced, such as being offered team uniforms and equipment in exchange for being circumcised.

As usual the reference Crouch cites here (no. 16) is one that was comprehensively debunked, as mentioned earlier.

Quackdown Editor's note: There are unethical practitioners in all medical fields. These should be exposed, as has been done by this site in respect of Tara KLamp circumcisions. But broad generalisations about unethical practices are untrue.

Call For Action. Your Foundation’s mass circumcision program violates science, medical ethics, and the law. Your Foundation should immediately terminate its misplaced support of the African mass circumcision program. Your Foundation should also immediately initiate a comprehensive investigation into the program led by unbiased experts, ethicists, and of course Africans. Otherwise, the legacy of the Gates Foundation, and inevitably your personal legacy, will be that you and your Foundation funded one of the most harmful medical programs in human history, and also that you and your Foundation failed to stop it after being informed that it had failed.

Respectfully submitted,
Harry Crouch

Harry Crouch’s letter violates truth and reason. Although there is plenty of evidence in it for scholarly incompetence (such as the garbled referencing), the ignoring of detailed debunkings and the use of discredited studies, are so systematic from start to finish that it is difficult to see this as being due to mere ineptitude. The selectivity and use of fringe sources like Gisselquist add to the charge that Crouch’s open letter is agenda-driven anti-medical pseudoscience. I urge the Foundation to disregard it, and any future pressure from anti-circumcision groups, and to continue to back scientifically proven interventions, including circumcision, in the face of a deadly epidemic that has killed millions.

References in the NCFM (Harry Crouch) letter.

1 G.W. Dowsett and M. Couch, “Male circumcision and HIV prevention: is there really enough of the right kind of evidence?,” Reproductive Health Matters, 15, no. 29 (2007): 33-44; L.W. Green, R.G. McAllister, K.W. Peterson, and J.W. Travis, “Male circumcision is not the HIV ‘vaccine’ we have been waiting for!,” Future HIV Therapy, 2, no. 3 (2008):193-99; D. Sidler, J. Smith, and H. Rode, “Neonatal circumcision does not reduce HIV/AIDS infection rates,". South African Medical Journal, 98, no. 10 (2008):762-6.

2 Robert S. Van Howe and Michelle R. Storms, "How the circumcision solution in Africa will increase HIV infections", Journal of Public Health in Africa, Vol. 2, No. 1 (2011) ( ); Boyle & Hill, supra n.1; D.D. Brewer, J.J. Potterat, and S. Brody, “Male circumcision and HIV prevention,” Lancet, 369 (2007): 1597; L.W. Green, J.W. Travis, R.G. McAllister et al., “Male circumcision and HIV prevention: insufficient evidence and neglected external validity,” American Journal of Preventive Health, 39 (2010): 479-82.

3 Id.

4 F.E. Makumbi, R.H. Gray, M. Wawer et al., “Male post-coital penile cleansing and the risk of HIV acquisition in rural Rakai district, Uganda,” abstract from presentation at Fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, 2007, available at

5 F.E. Makumbi, R.H. Gray, M. Wawer et al., “Male post-coital penile cleansing and the risk of HIV acquisition in rural Rakai district, Uganda,” abstract from presentation at Fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, 2007, available at:

6 Id.

7 Id.

8 M. Garenne, A. Giamland, and C. Perrey, “Male Circumcision and HIV Control in Africa: Questioning Scientific Evidence and the Decision-making Process,” in T. Giles-Vernick and J.L.A. Webb Jr., eds., Global Health in Africa: Historical Perspectives on Disease Control (Athens, Ohio: Ohio University Press, 2013): 185-210, at 190 (“Garenne Male Circumcision and HIV Control”). ( ).

9 Van Howe & Storms, supra n.12.

10 Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int J STD AIDS 2003;14:162–73 ( ).

11 Van Howe & Storms, supra n.12.

12 Van Howe RS. "Circumcision and HIV infection: review of the literature and meta-analysis". Int J STD AIDS 1999;10:8–16.

13 Bailey RC, Egesah O, Rosenberg S. "Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya". Bull World Health Organ 2008; 86: 669-77.

14 Sorrells et al. "Fine-touch pressure thresholds in the adult penis", BJU Int. 2007 Apr;99(4):864-9 at .

15 Frisch et al, "Male circumcision and sexual function in men and women: a survey-based, crosssectional study in Denmark" (2011), at ; and "Effects of male circumcision on female arousal and orgasm", New Zealand Medical Journal, Vol. 116, No. 1181: 595-96, September 12, 2003.

16 Boyle & Hill, supra n.1.

References for the annotations

Auvert, B., Taljaard, D., Dino Rech, D., Lissouba, P., Singh, B., Bouscaillou, J., Peytavin, G., Mahiane, S.G., Sitta1, R., Puren, A., Lewis, D. (2013) Association of the ANRS-12126 Male Circumcision Project with HIV Levels among Men in a South African Township: Evaluation of Effectiveness using Cross-sectional Surveys. PLoS Med., 10(9), e1001509.

Banerjee, J., Klausner, J.D., Halperin, D.T., Wamai, R., Schoen, E.J., Moses, S., Morris, B.J., Bailis, S.A., Venter, F., Martinson, N., Coates, T.J., Gray, G., Bowa, K. (2011) Circumcision Denialism Unfounded and Unscientific. Am. J. Prev. Med., 40(3), e11-e12

Bcheraoui, C.E., Zhang, X., Cooper, C.S., Rose, C.E., Kilmarx, P.H., Chen, R.T. (2014) Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010. JAMA Pediatrics, E1-E10.

Bhat, G.M., Bhat, M.A., Kour, K., Shah, B.A. (2008) Density and Structural Variations of Meissner’s Corpuscle at Different Sites in Human Glabrous Skin. J. Anat. Soc. India., 57(1), 30-3.

Bleustein, C.B, Fogarty, J.D., Eckholdt, H., Arezzo, J.C., Melman, A. (2005) Effect of neonatal circumcision on penile neurologic sensation. Urology, 65(4), 774-7.

Borenstein, M., Hedges, L., Higgins, J.P.T., Rothstein, H.R. (2009) Introduction to Meta-Analysis, John Wiley and Sons, West Sussex.

Brewer, D.D., Potterat, J.J., Roberts, J.M., Brody, S. (2007) Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania. Ann. Epidemiol., 17(3), 217-26.

Castellsagué, X., Albero, G., Cleries, R., Bosch, F.X. (2007) HPV and circumcision: A biased, inaccurate and misleading meta-analysis, J Infect., 55, 91-3.

Garenne M (2006) Male Circumcision and HIV Control in Africa. PLoS Med 3(1), e78-e79.

Halperin, D.T. & 47 others (2008) Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics. Future HIV Therapy, 2(5), 399-405.

Jean, K., Lissouba, P., Taljaard, D., Taljaard, R., Singh, B., Bouscaillou, J., Peytavin, G., R. Sitta, R., Mahiane, S.G., D. Lewis, D., A. Puren, A., B. Auvert, B. (2014) "HIV incidence among women is associated with their partners' circumcision status in the township Orange Farm (South Africa) where the male circumcision roll-out is ongoing (ANRS-12126)". 20th International AIDS Conference; Abstract FRAE0105LB.

Krieger, J.N., Mehta, S.D., Bailey, R.C., Agot, K., Ndinya-Achola, J.O., Parker, C., Moses, S. (2008) Adult male circumcision: Effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med., 5, 2610-2622.

L’Engle, K., Lanham, M., Loolpatit, M., Oguma, I. (2014) Understanding partial protection and HIV risk and behavior following voluntary medical male circumcision rollout in Kenya. Health Education Research. 29(1), 122-130.

Mattson, C.L., Campbell, R.T., Bailey, R.C., Agot, K., Ndinya-Achola, J.O., Moses, S. (2008) Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted Assessment of Men Enrolled in a Randomized Controlled Trial. PlusOne, 3(6), e2443.

Morris, B.J., Bailey, R.C., Klausner, J.D., Leibowitz, A., Wamai, R.G., Waskett, J.H., Banerjee, J., Halperin, D.T., Zoloth, L., Weiss, H.A., and Hankins, C.A. (2012) A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries. AIDS Care. 24(12), 1565-1575.

Morris, B.J., Hankins, C.A., Tobian, A.A.R., Krieger, J.N., Klausner, J.D. (2014) Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny. ISRN Urology, Article ID 684706.

Morris, B.J. and Krieger, J.N. (2013) Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction? – A Systematic Review. J. Sex. Med., 10(11), 2644-57.

Morris, B.J., Waskett, J.H., Gray, R.H., Halperin, D.T., Wamai, R., Auvert, B., Klausner, J.D. (2011) Exposé of misleading claims that male circumcision will increase HIV infections in Africa. J. Public Health in Africa, 2(e28), 117-122.

Ndebele, P., Ruzario,S., Gutsire-Zinyama, R. (2013) Point of View: Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa. Malawi Medical Journal, 25(4), 113-115.

Riess, T.H., Achieng’, M.M., Otieno, S., Ndinya-Achola, J.O., C. Bailey, R.C. (2010) ‘‘When I Was Circumcised I Was Taught Certain Things’’: Risk Compensation and Protective Sexual Behavior among Circumcised Men in Kisumu, Kenya. PlusOne. 5(8), e12366.

Schmid, G.P., Buvé, A., Mugyenyi, P., Garnett, G.P, Hayes, R.J., Williams, B.G., Calleja, J.G., De Cock, K.M., Whitworth, J.A., Kapiga, S.H., Ghys, P.D., Hankins, C., Zaba, B., Heimer, R., Boerma, J.T. (2004) Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. The Lancet, 363, 482-8.

Tian, Y., Liu, W., Wang, J.Z., Wazir, R., Yue, X. & Wang, K.J. 2013. Effects of circumcision on male sexual functions: a systematic review and meta-analysis. Asian J. Androl., 15, 662-6.

Wamai, R.G., Morris, B.J., Waskett, J.H., Green, E.C., Banerjee, J., Bailey, R.C., Klausner, J.D., Sokal, D.C. & Hankins, C.A. 2012. Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection. J Law Med., 20(1), 93-123.

Waskett, J.H., Morris, B.J. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 99(6), 1551-2.

Wawer, M.J., Gray, R.H., Serwadda, D., Kigozi, G., Nalugoda, F., Quinn, T.C. (2011) Male Circumcision As a Component of Human Immunodeficiency Virus Prevention. Am. J. Prev. Med. 40(3), e7-e8.

Wawer M.J., Makumbi F., Kigozi G., et al. (2009) Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. The Lancet, 374, 229–237.

Westercamp, N., Agot, K., Jaoko, W., Bailey, R.C. (2014) Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya. AIDS Behav. Epub ahead of print.

Williamson, M.L., Williamson, P.S. (1988) Women's preferences for penile circumcision in sexual partners. J Sex Educ Ther., 14(2), 8-12.

Young, H. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 100(3), 699.

Comments in chronological order (47 comments)

Frank Jones wrote on 17 August 2014 at 3:58 p.m.:

Another circumcision myth to be debunked is: "female circumcision has no health benefits".

Female circumcision also has been found to reduce HIV in female subjects by 50% to 60%. This protection can be achieved by amputating the inner labia lips and removing the mucus membrane from the outer labia lips. This can be done in a safe, clinical environment, and actually removes less flesh then male circumcision.

In sub-Saharan Africa, women constitute 60% of people living with HIV:

"Stallings et al. (2005) reported that, in Tanzanian women, the risk of HIV among women who had undergone FGC was roughly half that of women who had not; the association remained significant after adjusting for region, household wealth, age, lifetime partners, union status, and recent ulcer."

Note: when it's found that circumcising female genitals reduces HIV/AIDS it's called a "conundrum" rather that a wonderfully exciting "medical opportunity" to reduces HIV/AIDS.

"Georgia State University, Public Health Theses" — a USA University of international renown:

The Association between Female Genital Mutilation (FGM) and the Risk of HIV/AIDS in Kenyan Girls and Women (15-49 Years):

"RESULTS: This study shows an inverse association (OR=0.508; 95% CI: 0.376-0.687) between FGM and HIV/AIDS, after adjusting for confounding variables."

"DISCUSSION: The inverse association between FGM and HIV/AIDS established in this study suggests a possible protective effect of female circumcision against HIV/AIDS. This finding suggests therefore the need to authenticate this inverse association in different populations and also to determine the mechanisms for the observed association."

"This study investigated whether there is a direct association between FGM and HIV/AIDS. Surprisingly, the results indicated that the practice of FGM turned out to reduce the risk of HIV. While a positive association was hypothesized, a surprising inverse association between cases of female circumcision and positive HIV serostatus was obtained, hence indicating that FGM may have protective properties against the transmission of HIV."

"National Bureau of Statistics, Tanzania - 50% reduction in HIV/AIDS in women who have the mucus membranes of their genitals amputated:"

Stephen Moreton wrote on 17 August 2014 at 5:51 p.m.:

In response to Frank Jones: Doubtless amputating feet will protect against verrucas, but would come at a cost so high as to render it pointless. Maybe FGM can protect against HIV, but at what cost? Aside from the great variation in types of FGM, from removal of some skin to the most grotesque cliterodectomy and infibulation, with everything in between, making it difficult to make comparisons, would it win a cost-benefit analysis? In high HIV countries male circumcision wins such an analysis comfortably (arguably even in low HIV countries too). It imparts significant benefits at little risk to the patient, and with no adverse consequences to function and pleasure. Is this true of FGM? And is it even relevant to male circumcision? The merits or otherwise of FGM have no bearing on the theme of the NCFM's open letter on male circumcision and HIV. Whatever one's views on circumcision, that open letter is an appalling piece of misleading pseudoscience, and my criticisms of it stand independently of whether it is good, bad or indifferent to circumcise.

James wrote on 17 August 2014 at 6:59 p.m.:

Steve, what do you have against simply letting individuals decide what's best for them? Surely it's not escaped your notice that men in your country (for example) aren't having any difficulty avoiding HIV without resorting to having parts of their genitals removed; why the panic?

Frank Jones wrote on 17 August 2014 at 11:54 p.m.:

In response to Stephen Moreton:

In Poker there is something known as a "tell". This is a type of behaviour a player may exhibit, which reveals their underlying reasoning or motive.

Your reaction to the research on FGM and HIV/AIDs is a "tell": Why are you not excited about the possibilities of female circumcision leading to a reduction in HIV/AIDs? Why are you not calling for millions of dollars of research into female circumcision to hopefully discover the same amazing health benefits as male circumcision?

Don't you believe that men and women should have equality in healthcare? Don't you want to help the millions of women who will become infected with HIV/AIDs - but could be protected by female circumcision?

And of course, female circumcision is widely practiced in Africa, as much so as male circumcision. So there would be no problems with acceptance - especially with the same widespread education and incentive campaigns that have been devoted to male circumcision.

Research seems to show, that it is the amputation of the mucus membrane of the penis - the inner lining of the foreskin - that reduces the transmission of the HIV virus. So it would seem possible, that the amputation and removal of the mucus membranes of the female vulva would have the same effect.

As I said, we don't need to amputate the external glans clitoris, and we don't need to infibulate the women (sew-up the remnants of her outer labia lips). Hopefully, we just need to amputate the inner labia lips, and remove the mucus lining of the outer labia lips. All in a safe, clinical environment. This removes actually less flesh and nerve endings than male circumcision. And of course many western women have similar procedures on their genitals for mainly cosmetic reasons:

Frank Jones wrote on 17 August 2014 at 11:54 p.m.:

In response to Stephen Moreton:

You posed the question: "[male circumcision has] no adverse consequences to function and pleasure. Is this true of FGM?"

Well happily, much peer-reviewed medical research shows exactly that for levels of female circumcision often far in excess of what I am proposing:

Female Circumcision Does not Reduce Sexual Experiences:

"International Journal of Obstetrics and Gynaecology" — a peer reviewed journal of international renown:

Female genital cutting in this group of women did not attenuate sexual feelings:

"The Journal of Sexual Medicine"* — a peer reviewed journal of international renown:

Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C):

"The New Scientist" (references a medical journal)

Female Circumcision Does Not Reduce Sexual Activity:

"Journal of General Internal Medicine" — a peer reviewed journal of international renown:

Female "Circumcision" - African Women Confront American Medicine

Medical benefits of female circumcision: Dr. Haamid al-Ghawaabi [not research; but many of the same arguments are made for male circumcision]

"Pediatrics (AAP)" — a peer reviewed journal of international renown:

Genital Cutting Advocated By American Academy Of Pediatrics

Frank Jones wrote on 18 August 2014 at 12:06 a.m.:

You cite papers by:

Morris, B.J. Waskett, J.H.

You can find a comprehensive debunking of the "works" of Brian J. Morris here:


Brian D. Earp is a scientist and ethicist who holds degrees from Yale and Oxford universities. He has served as Guest Editor for the Journal of Medical Ethics.

Robert Darby is an independent scholar with a PhD from the University of New South Wales and is the author of numerous articles on the history and ethics of male and female genital surgeries.

And Waskett, J.H. is not a doctor or medical professional of any kind, nor does he have any type of degree. Waskett is a 34 year old computer software engineer, located in Radcliffe Manchester England.

Frank Jones wrote on 18 August 2014 at 12:21 a.m.:

On further inspection of the "internets" I see you are already familiar with the arguments of Brian D. Earp :-)

Stephen Moreton wrote on 18 August 2014 at 9:03 p.m.:

Frank Jones: I have enough on my plate as it is without taking on yet another controversial topic. You obviously know far more than I about the merits of FGM, so I'll let you promote it. I really haven't the time for yet another cause. Besides I am not even in the business of promoting medical male circumcision either. If pushed I'd go with the AAP, and in high HIV countries the WHO etc., and leave it at that. I do not promote it (in the sense of actively encouraging people to circumcise), and I don't care if they do or don't, although I certainly support and defend its use in high-HIV countries. I am much more concerned about the damage being done by the anti-circumcision brigade, or "intactivists" as they call themselves. They abuse the science (and their opponents), they damage the psychological well-being of circumcised males by making them falsely believe they are sexually damaged, and they undermine an important public health initiative in the fight against HIV, thereby endangering lives. And that really annoys me. Intactivism is pernicious, so I attack it. My position is very much more anti-intactivist, than pro-circumcision. Hope that clarifies things. Yes I know about Brian Earp, having sparred with him on-line and exchanged some private e-mails. Unlike many intactivists he is quite gentlemanly to debate with, but still plays fast and loose with the evidence. I also know about his (and Darby's) misleading article in the Skeptic and have written and submitted a 1400 word rebuttal. It remains to be seen if the editor will take it. Like typical intactivists they rely heavily on ad hominems against Prof. Morris, they are selective with the literature, and misrepresent that which they do cite, and their silence on African HIV is extraordinary.

Stephen Moreton wrote on 18 August 2014 at 9:21 p.m.:

Frank Jones: Regarding your final comments about the qualifications of Earp, Darby and Waskett. Earp's scientific background (cognitive science & psychology) is as irrelevant as mine (chemistry & geology) and Darby's PhD is in history. And the authors of the open letter I was critiquing are both lawyers, not medics, or scientists of any sort. One of the authors they cite, George Hill (Vice-President of "Doctors Opposing Circumcision") is a retired airline pilot. I haven't the time to go through the rest. From what I've seen of Waskett's published works, as far as I can tell always co-authored with Morris and sometimes others, they display a better understanding of the topic, and knowledge of the literature, than his opponents. It says something about the credibility of intactivists that they can be shown up by a software engineer. As for Prof. Morris, he is a professor emeritus of medical science, with 350 publications to his name, and is familiar with medical literature, terminology and stats. No problem there then. Interestingly, I had someone try to trump me on qualifications once. A young-earth creationist. I prefer to let the evidence speak for itself. When people start complaining about qualifications or try to pull rank, instead of addressing the evidence, they are clearly on the run.

Frank Jones wrote on 18 August 2014 at 9:29 p.m.:

As you say yourself, people who don't support female circumcision in Africa and are anti-female circumcision:

"they damage the psychological well-being of circumcised females by making them falsely believe they are sexually damaged"

"they undermine an important public health initiative in the fight against HIV, thereby endangering lives."

"their silence on African HIV is extraordinary."

If as you claim it's good enough for males than why is it not good enough for females? At least male circumcision is available around the world, and is free-of-charge in Africa.

Surely your time would now be better spent pushing female circumcision as an "important public health initiative"?

Or is there something I'm missing?

Stephen Moreton wrote on 18 August 2014 at 9:42 p.m.:

James: I have no problem letting people decide what's best for them. But I have a big problem with others lying to people, and feeding them misinformation on important health matters, thereby making it harder for people to make informed decisions about what is best for them. As for HIV here in the U.K., 6360 people were newly diagnosed with the virus in 2011, 41 % of them apparently contracting it heterosexually. Disturbing though that is, it is minor compared to the dire situation in Africa where the epidemic has a head start of 80+ years. There are also big differences in sexual behaviours, including condom use, and likely genetic susceptibility (seems Africans are more susceptible). So whether circumcision is as much use here as it is in Africa is not as clear cut. Professional bodies dealing with the epidemic in Africa are unanimous that medical circumcision is very useful there so I go with that. Elsewhere there is no consensus, so I keep out of it. If pushed I'd go with the AAP, but I'm not really that bothered. As I explained to Frank Jones I am not in the business of promoting circumcision. Rather I am concerned with countering harmful misinformation being spread by a pernicious anti-medical, anti-science movement. Hope this helps.

Stephen Moreton wrote on 18 August 2014 at 9:52 p.m.:

Frank Jones: Yes you are missing something. I am not in the business of promoting, I am in the business of debunking. I also have very little free time. Just writing these posts tonight is taking up time I'd like to be spending on other things. Give me a million pounds so I do not have to work 8:30 till 5, five days a week and maybe then I'll have time to look into your intriguing insights into FGM. Until then my plate is full. Sorry, but I'll have to leave it to you.

Frank Jones wrote on 18 August 2014 at 10:05 p.m.:

Stephen Moreton:

Many thanks for your words of encouragement about my intriguing insights into female circumcision (it's not FGM I am proposing; no more than male circumcision is MGM).

It's great to know that you are excited about the merits of female circumcision becoming an important public health initiative in the fight against HIV, which as you say, is a dire situation in Africa.

And as I mentioned above: In sub-Saharan Africa, women constitute 60% of people living with HIV, so they are in desperate need of this important medical intervention which is so unfairly restricted to males at present.

Ian wrote on 18 August 2014 at 10:20 p.m.:

Why do you keep banging on about 'genital corpuscles'? There is no such thing as a unique nerve ending 'for sexual pleasure'; so-called 'genital corpuscles' (aka Krause end-bulbs) are found in the conjunctiva, oral mucosa, pharynx, etc. Stop peddling nonsense. Yes, the most sensitive part[s] of the penis are lost to circumcision, as Sorrells (2007) demonstrated; Morris (as per usual...) disliked the study, but didn't show anything wrong with it.

Ian wrote on 18 August 2014 at 10:32 p.m.:

If I contract HIV sexually, it's my own fault; I don't see any sense (or justice) in punishing children as a collective for the irresponsible behaviour of individuals. Given that some drink themselves to death, ought we then to ban alcohol? Let people make their mistakes; they'll be the ones paying for them, after all. And, yes, heterosexually-transmitted HIV is the very quintessence of a non-issue in the UK, as we all know. Kindly stop exploiting HIV/AIDS to perpetuate child abuse.

Hugh Young wrote on 19 August 2014 at 12:57 a.m.:

Your rebuttal relies heavily on the work of the same small band of circumcision advocates who did the original research claiming that circumcision has an effect on HIV acquisition, and the subsequent research claiming it has no effect on sexual functioning or pleasure, is safe, cost-effective, etc. If you removed the work of Robert Bailey, Stefan Bailis, Ronald Gray, Daniel Halperin, Godfrey Kigozi, Jeffrey Klausner, Brian Morris, Stephen Moses, Malcolm Potts, Thomas Quinn, David Serwadda, Dirk Taljaard, Aaron Tobian, Richard Wamai, Maria Wawer, Helen Weiss and Thomas Wiswell from the equation, the case for circumcision would collapse. Their studies - which frequently reference each other - are analysed and rebutted on the relevant pages of

You especially rely on the work of Brian Morris, who is a molecular biologist, has never seen a reason to circumcise he didn't like (including to prevent "bathroom splatter" and zipper injury), has done only paper research on circumcision (and none at all on the foreskin), and has a long track record of playing fast and loose with the facts, documented at

"We do not consider the fingertips erogenous"? Speak for yourself!

Sandra Collisson wrote on 19 August 2014 at 6:57 p.m.:

CONDOMS protect against HIV when used properly, and education needs to be done to show how necessary it is. Circumcision is completely redundant, even if it did work, which it does not. Here are the study's actual findings, showing that only ONE country showed any marked decrease in transmission. The rest of 18 did not. See page 109. "9.4 HIV Prevalence by Male Circumcision Findings from the 18 countries with data present a mixed picture of the association between male circumcision and HIV prevalence (Table 9.3). In eight of the countries (Burkina Faso, Cambodia, Côte d’Ivoire, Ethiopia, Ghana, India, Kenya, and Uganda), HIV prevalence is higher among men who are not circumcised, although the difference between circumcised and non-circumcised men is slight, except in Kenya, where the difference is substantial (HIV prevalence of 11.5 percent for non-circumcised men compared with 3.1 percent for circumcised men) (Figure 9.1). In 10 of the countries—Cameroon, Guinea, Haiti, Lesotho, Malawi, Niger, Rwanda, Senegal, Tanzania, and Zimbabwe—HIV prevalence is higher among circumcised men."

Stephen Moreton wrote on 19 August 2014 at 7:49 p.m.:

Frank Jones: What “words of encouragement”? And where do I say I am “excited” about the topic? I thought it was obvious by now. I view it as irrelevant. My criticisms of the NCFM open letter stand independently of the merits or shortcomings of what you call “female circumcision”. Likewise whether male circ. protects against HIV or not is independent of whether female procedures do, or not. If you want to take up this particular cause then by all means do, but I am not getting involved. I have too much on my plate already. Please do not attempt to attribute to me any stance on this issue other than default. Default is to leave alone. If one wishes to deviate from default then it has to be because it is in the patient’s best interests. That, in turn, should be determined by evidence. Right now all you have is a few studies. I have not the time or expertise to look into them but, as the relevant medical and health bodies (WHO, CDC etc.) are evidently unconvinced by them, they are insufficient to justify the procedure at present, and I am happy to go with the present medical consensus on the matter, i.e. default. Male circ. against African HIV, in contrast, is supported by dozens of epidemiological studies, 3 RCTs, several meta-analyses and several identified biological mechanisms. Consequently the consensus amongst the relevant bodies is that male circ. is an important tool against African HIV. So I go with that. Is this clear enough?

Stephen Moreton wrote on 19 August 2014 at 7:50 p.m.:

Ian: I mentioned genital corpuscles once, and this is “banging on”? If they are present around the eyes and oral mucosa then that may explain why some report erogenous sensations from those regions (people kiss, after all). Whilst the exact neurology of various types of sensation is, doubtless, complex genital corpuscles have long been known to be linked to erogenous sensation. This is not nonsense. If it is then you need to correct all those workers over the decades who have researched them. Most sensitive with respect to what? Pain? Temperature? Pressure? Vibration? Fine touch? Erogenous sensation? You need to specify. Sorrells only looked at one type of sensation (fine-touch) but that may be irrelevant. Bleustein looked at more and found no difference. You also ignore other studies that found no difference, and the meta-analysis by Tian et al. And actually Morris did find fault with Sorrells, and Hugh Young’s attempt at a response had its own faults, before you mention it.

Stephen Moreton wrote on 19 August 2014 at 7:51 p.m.:

Ian: Who said anything about punishing anyone? And yes, there is an element of culpability in those who suffer illness as a result of reckless conduct, but ultimately we ALL pay for that. We foot the bill for over-stretched health services, and we suffer increased risk ourselves if infections become more prevalent in society. I don’t think that over 6000 people catching a life-threatening, expensive-to-treat infection every year is a non-issue. What a callous attitude you have. And who said anything about child-abuse? And remember, as I have made clear earlier, I am not in the business of promoting circ, but debunking pseudoscience. My criticisms of intactivism stand independently of whether it is good, bad or indifferent to circumcise, and I’m not saying that in the U.K. we should or shouldn’t. So you are attacking a straw man.

Stephen Moreton wrote on 19 August 2014 at 7:51 p.m.:

Hugh Young: Your criticism is as ad hominem as it is hypocritical. It is also increasingly becoming false. That the same names appear often in writings on the topic says nothing about the quality of those writings. And the charge can be thrown straight back at you. Look at the writings of intactivists. Again it is a small band of the same people: Darby, Hill, Svoboda, Earp, Hill, Boyle, Van Howe, Bollinger … Some have no medical credentials whatever, or even scientific background of any sort, and of those that do some have clocked up impressive tallies of rebuttals and critiques, and not just from Morris & Co. It was not Morris who showed that Van Howe’s first “meta-analysis” was an example of Simpson’s paradox, nor he who exposed Van Howe’s second meta-analysis as so bad it ought to be retracted from the literature. It was Morris et al who did this to Van Howe’s 3rd attempt at meta-analysis, but if you bother to read the actual criticisms and check them against the literature they are justified. I have seen enough nonsense on circumstitions to have lost confidence in anything it says and now regard it as being as useful and unbiased a source on circumcision as is on evolution. Its “rebuttals” would have more credibility if they were published in peer-reviewed journals. But when intactivists do get into the peer-reviewed literature they still write nonsense as shown by the debunkings they attract. As I said, with references, the critiques the NCFM open letter cites have been thoroughly debunked. One of those debunkings (Halperin et al) has 48 authors. Even taking out the ones you list still leaves plenty of others. And if you look at the literature, there are scores and scores of other authors publishing papers demonstrating benefits from circumcision, or lack of adverse effects. African names are increasingly common, even Chinese ones too. The evidence speaks for itself and researchers all over the world are finding it. I note that you do not address my actual criticisms of the NCFM open letter (that it is selective, ignores critiques and uses discredited sources) but instead resort to ad hominem. I have seen this repeatedly with you people. The evidence is against you, so you fall back on ad hominem. If fingertips were erogenous then all this typing should have got me really horny by now. It hasn’t. I’m bored and tired.

Stephen Moreton wrote on 19 August 2014 at 8:23 p.m.:

Sandra Collisson: You misuse, even quote-mine, USAID report 22. Turn to the next page and look at the footnote: “Note: HIV prevalence estimates for ‘not circumcised’ men for Guinea and Niger are based on small numbers of cases.” Look near the top of page 12 for another caveat: “some of the estimates presented in this report are based on small numbers of cases in survey samples, and should be interpreted with caution”. I see no caution in your post. Look at the actual data. As with Guinea & Niger, the sample size for Senegal (only 56 in the uncircumcised group) is far too small to tell if there is a relationship or not. The sample size for Haiti is also small enough to be influenced by a few households. Straight away one can dismiss 4 of the countries as having sample sizes too small to be of use. As for the remainder, aside from the issue of whether the data is reliable (self-reporting of circumcised status is not always so, especially when included may be partial circumcisions or other forms of cutting) the remaining countries include ones where circumcision is an initiation ritual, in unhygienic situations, and has been linked to HIV transmission. I explain this in my critique above and provide a reference (Brewer). As with the caveats about the small sample sizes you completely ignore all this. Why? Ironically this same argument was addressed on this blog in 2012 when another intactivist (Mark Lyndon) tried it on: He tried it again in Nature in 2013 and was given a thorough dressing down by a leading expert on the subject: I took him to task on it just a few weeks ago: but he did it again within a fortnight: He, Hugh Young, and others have been abusing this report for years and continue to do so even when their errors are explained to them. Little wonder I have come to regard intactivism with contempt, and some of its leading proponents as dishonest.

Frank Jones wrote on 19 August 2014 at 9:26 p.m.:

Stephen Moreton:

I'm shocked that you could find that such a great potential weapon against HIV/AIDS - namely female circumcision - is "irrelevant".

If you are truly so concerned about the fight against HIV/AIDS, and you believe in gender equality when it comes to healthcare, then at the very least, you should be supporting medical trials into female circumcision.

Why does that put "more on your plate"?

Just as you no-doubt support the medical trials into male circumcision that you are so knowledgeable about and hold in such high-esteem.

But as I said right from the start - it's all a "tell".

Ian wrote on 20 August 2014 at 2:11 a.m.:

I’ve read several of your posts and in each of them you trot out this nonsense about ‘genital’ corpuscles, state that ‘erogenous sensation’ is ‘mediated’ by these corpuscles, and posit that since the foreskin doesn’t have any, it can be concluded that the foreskin plays no role—much less an important one—in sexual response. Of course, this is an argument repeatedly made by a certain Professor Brian Morris; it’s an argument you accept uncritically purely for its salubriousness. Both of you cite a forty year-old histology textbook (Rhodin, 1974) in support of this contention and ignore more recent research (or even differing perspectives in texts of similar vintage); neither of you appear to have the faintest idea what you’re talking about. So-called ‘genital’ corpuscles are simply Krause end-bulbs (Chouchkov, 1978); they were given their name because investigators first described them in tissues taken from the genitals (Winkelmann, 1986). I repeat: there is no special nerve ending for ‘sexual pleasure’; even Luciani, writing as far back as 1917 (!) states that ‘[t]he name of genital corpuscles is morphologically a misnomer, because similar forms exist not only in the conjunctiva, but also in the joints.’ Of course the ‘genital’ corpuscles have ‘long been known to be linked to erogenous sensation’, simply because ‘genital’ corpuscles, by definition, are found in the glans penis and glans clitoris.

Yes, what we call the foreskin includes the parts of the penis most sensitive to touch. The Semmes-Weinstein aesthesiometer is designed to measure the sensitivity of cutaneous mechanoreceptors and by ‘fine touch’, Sorrells et al. simply mean ‘not crude touch’; the former refers to discriminative touch, the latter to non-discriminative touch. The notion that the sensitivity of the penis to touch ‘may be irrelevant’ to the question of sexual pleasure is patently ridiculous: sex feels as it does because of the genitals’ acute sensitivity to touch, not to pain or temperature (or light, or sound…). The primary stimulus for the sense of touch is pressure. Cold and Taylor (1999) quite pragmatically decided to group together all the various corpuscular receptors on the assumption that they all function as mechanoreceptors; as Halata and Munger (1986) point out, in the glans penis, the ratio of free nerve endings (typically nociceptors) to corpuscular receptors is approximately 10:1. The glans has very little touch sensitivity; Taylor referenced Le Gros Clark (1965) noting that the glans penis ‘is one of the few areas on the body that enjoys nothing beyond primitive sensory modalities’.

Ian wrote on 20 August 2014 at 2:13 a.m.:

The obscure Bhat (2008) paper you’ve referenced several times (though not here) is replete with flaws, several of which are shared with the work you excoriate in your classic ‘Sloppy scholarship and the anti-circumcision crusade’ (Moreton, 2013). The major problem for works such as Bhat’s, however, is that ‘there is no universally accepted method of quantifying the density of nerve fibers and corpuscles in the human skin’, as Shih et al (2013) elaborate, in reference to claims made about the allegedly impressive innervation of the clitoris.

Bleustein (2005), like Payne (2007), ignored the foreskin. If I compared ‘vulvar sensitivity’ in women with and without clitorises by taking my measurements at, say, the labia minora, I could similarly conclude that clitoridectomy fails to diminish ‘vulvar sensitivity’. Would such a paper make publication? As Sorrells wrote, ‘[w]hen determining the aggregate sensory impact of circumcision, the sensory effects of circumcision on the glans are of secondary significance, because the glans is not removed during circumcision. Instead of measuring changes in the glans after circumcision, it is more important to measure the sensory investment of the parts of the penis removed by circumcision.’ No, Morris did not ‘find fault’ with the Sorrells paper, he simply disliked it, as you do. One wonders why! Perhaps sexual pleasure is to the anti-intactivists what HIV is to the intactivists?

The Tian meta-analysis is worthless, not least because the studies it meta-analyses are worthless. I’m not going to pretend that there exist good epidemiologic studies to prove the deleterious sexual effects of male circumcision. There are none, though one can cherry-pick poor studies to support the claim that it’s harmful (Frisch, 2011), beneficial (Laumann, 1997), or neutral (Ferris, 2010). Similarly, no good studies attest to the damaging sexual effects of female circumcision, either: Catania (2007) reported superior sexual function in circumcised women; Ojumu (2006) found that ‘female circumcision was not associated with any sexual problem’; while El-Naser (2010) found evidence of harm. I’d simply argue that while no good studies demonstrate male or female circumcision to be harmful, no good studies demonstrate them to be harmless, either. In this respect, I’m at least being consistent, and honest. For those who regard female circumcision as mutilating, barbaric, etc. I wonder how they justify regarding the available research to prove the harmlessness of male circumcision whilst merely failing to prove the harmfulness of female circumcision. Unfortunately, sex research is typically dreadful, and this tendency is exploited by Morris and others like him. If sex researchers can’t prove that a woman’s having most of her genitals excised is associated with any significant sexual sequelae, then perhaps we should be a little cautious in our evaluations of other work they produce.

Ian wrote on 20 August 2014 at 2:16 a.m.:

Just as with HIV, we pay for people killing themselves with alcohol. You didn’t address why it would be wrong to inflict one form of collective punishment (banning alcohol) to prevent individual self harm (alcohol poisoning) but perfectly fine to mutilate the genitals of masses of children on the (likely erroneous) assumption that, for so doing, one of chose children, as a grown adult, might, perhaps, avoid (or delay) contracting an infection he could have avoided easily enough by, say, using a rubber. You have a ‘callous attitude’ to child abuse, and you’re utterly transparent: you don’t care about HIV or ‘public health’ or anything else: you simply fear that acknowledging circumcision as a violation of children will ‘damage the self-esteem of circumcised males by needlessly making them feel they are damaged, and are missing an important part of their anatomy’ and ‘distress parents by deceiving them into believing they have harmed their sons.’ Circumcised men are damaged, and they're missing a wonderful part of their anatomy. Parents who've circumcised their children are guilty of abusing them. Circumcision is properly considered as a 'harmful traditional practice', and it's about time we put a stop to it.

Katherine wrote on 20 August 2014 at 4:24 a.m.:

"If fingertips were erogenous then all this typing should have got me really horny by now. It hasn’t."

  • The penis and the fingertips are mapped to different parts of the brain via different branches of different nerves. It's hard to tell whether you were joking, though. Why don't you think that stimulating the 'genital' corpuscles in your conjunctiva or joints is going to get you off?

"One of those debunkings (Halperin et al) has 48 authors."

  • Surely you mean 'signees'?

Stephen Moreton wrote on 21 August 2014 at 10:57 p.m.:

Ian: “So-called ‘genital’ corpuscles are simply Krause end-bulbs”. They are a variety of Krause bulbs, but those in the genitals are different, being described as “mulberry-like”. Chouchkov may not have considered this enough to constitute a qualitative difference with other Krause bulbs, but others do describe them as different. Whatever, those labelled “genital corpuscles” are linked to sexual sensations in both genders: Rhodin 1974: “The tactile stimulation of the genital corpuscles activates the axolemma of the nerve endings and initiate afferent nerve impulses. As a response, this leads to … the sexual sensations and motor phenomena that form the orgasm and precede or accompany ejaculation.” C. Lombard Kelly, (1961) Sexual Feeling in Married Men and Women. Pocketbooks: “The head of the clitoris is also composed of erectile tissue, and it possesses a very sensitive epithelium or surface covering, supplied with special nerve endings called genital corpuscles, which are peculiarly adapted for sensory stimulation that under proper mental conditions terminates in the sexual orgasm.” You complain that Rhodin is 40 years old, but Chouchov is only 4 years younger, and I have seen older works cited by intactivists. Sorry, I was unaware that human anatomy had changed in the interim. Here are some recent sources: Bergman et al, on-line Atlas of Microscopic Anatomy, 1995-2014: “GENITAL CORPUSCLE… Stimulation of these receptors leads to erection and ejaculation of semen.” Di Marino & Lepidi, H. (2014) “Anatomic Study of the Clitoris and the Bulbo Clitoral Organ”, Springer, p. 92: “The presence of genital corpuscles on the hood, the clitoral prepuce, the labia minora, the vestibule and even, such as recalled by K.E. Kranz, in the labia majora and the mons pubis (mons veneris) shows that the clitoris is not the only excitable organ but that it remains the most capable of generating erogenous sensation.” A footnote attributes orgasms experienced by some women during activities like riding a bicycle, as due to the “extreme abundance of genital corpuscles”. Photo captions describe them as “corpuscles of pleasure”. And in your own intactivist scriptures: “both the penile and clitoral prepuce are richly innervated, specific erogenous tissue with specialised encapsulated (corpuscular) sensory receptors, such as Meissner's corpuscles, Pacinian corpuscles, genital corpuscles, Krause end bulbs, Ruffini corpuscles, and mucocutaneous corpuscles.” (Note genital corpuscles are named in addition to Krause end bulbs, as if separate entities; the claim that they are present in the prepuce is not well supported by the references given). So, pardon me if I got it wrong when saying that sexual sensations are associated with genital corpuscles. I was repeating what is in medical literature. I should have realised that medical literature is not as reliable as opinions of intactivists posted on internet comments threads. Silly me.

Ian wrote on 22 August 2014 at 4:26 a.m.:

Yes, nomenclature here is complicated—structures of identical or trivially different morphologies have been given an abundance of names according to their location or the investigator who was first (or second…) to describe them; many perceived differences in form can in fact be attributed to histological artefacts. The consensus seems to be that the ‘genital’ corpuscle is, like the Meissner corpuscle, a mechanoreceptor: Winkelmann, writing in 1986, states that ‘[w]hen more physiological studies are done, I believe they will show that these end organs and the Meissner corpuscles are comparable rapidly adapting mechanoreceptors’ and this opinion is shared by later researchers. The point here is simply that there is no reason to believe that the end bulbs or ‘genital’ corpuscles of the glans are any more specialised (or important) in sexual response than any of the other sensory receptors in the penis. Furthermore, the perception that the glans is particularly sensitive (at least to anything but pain) is not only unsupported but in fact undermined by the quality histological research on the penis we have—research to which Taylor and Cold have made an important contribution, irrespective of whether it irks you. I’ll quote at length from the excellent review by Munger and Ide (1988):

  • [Free nerve endings] are present in great abundance in the human glans penis as described by HALATA and MUNGER (1986). Not only are large numbers of FNEs present in the dermis but the large corpuscles (Fig. 2) thought to be specific for the glans penis and clitoris consist of a skein of FNEs using the criteria described by KRUGER et al. (1981). The epithelium of the human glans penis does not contain the sensory receptors characteristic of glabrous palmar, plantar or labial skin (HALATA and MUNGER, 1983) as described in detail below. Even more remarkable is the fact that their conclusion that the glans sensory nerves are almost exclusively FNEs is consistent with the sensory perception of the human glans as described by VON FREY (1894a, b) and confirmed in great detail by RIVERS and HEAD (1908). The glans is simply insensitive to light touch with a threshold in actual force resembling that of a callus on the sole of the foot. Stated another way to make the point that the glans is unique: the threshold for touch is actually the pain threshold. This remarkable fact was part of the basis for RIVERS and HEAD (1908) concluding that the glans was only capable of perceiving protopathic sensations.

Ian wrote on 22 August 2014 at 4:29 a.m.:

  • The opposite is true for glabrous digital skin where the touch threshold is extremely low and the pain threshold high (HALATA and MUNGER, 1986). The absence of Meissner corpuscles and Merkel terminals in the glans can also be correlated with the thermal responses of the glans. VON FREY (1894a, b) as well as RIVERS and HEAD (1908) all noted the unusual responses of the glans to cold stimuli, and as reviewed by HALATA and MUNGER (1986) this also consistent with the pattern of FNEs in this unusual cutaneous surface. They also note that developmentally the glans is not covered with epidermis typical of the general body surface, but rather develops as the result of an in growth from the epidermis that secondarily splits to free the prepuce from the surface of the glans. Thus the glans is not covered with a typical skin surface and is an exception to the general pattern of cutaneous innervation.

As I said, ‘genital’ corpuscles would have to be ‘linked to sexual sensations’ by sheer virtue of their being located—by definition—in (and only in) the genitals. (You might note that the term ‘genital corpuscle’ is not so often employed in research papers today, and is usually found in textbooks (typically translations) and popular works in fields like psychoanalysis and sexology.) Rhodin’s claim could equally be made of all the other sensory receptors in the penis; he doesn’t reference evidence (experimental or otherwise) that ‘genital’ corpuscles are uniquely specialised for or important to sexual response—he doesn’t do so because there is no such evidence, however often the claim may have been made. Your other references are even less impressive: all authors thoughtlessly parrot unsubstantiated speculation. The Di Marino and Lepidi text is particularly laughable; an orgasm a woman experiences while riding a bicycle could equally easily be attributed to all the other innervation of her genitals, after all. Given that you’ve elsewhere lambasted intactivists for making unsupported claims about the number of nerve endings in the foreskin, I’m amused to note that Di Marino and Lepidi perpetuate the even more popular myth that the clitoris contains ‘8,000 nerve endings’, a ‘factoid’ utterly without an evidentiary basis.

Anyway, you’ve repeatedly made erroneous and misleading claims about the nature and importance of ‘genital’ corpuscles in an effort to devalue the foreskin and trivialise the harms of circumcision. I do wish you’d stop it.

Stephen Moreton wrote on 23 August 2014 at 9:04 a.m.:

Ian: There is nothing in your latest posts that shows that genital corpuscles are NOT associated with erotic sensations. At most you can argue that the evidence they are is circumstantial – they occur in areas associated with such sensations, i.e. the genitals (arguably also nipples and lips). In view of this, and that medical texts as recent as this year link them to pleasure, it is premature to accuse me of making “erroneous and misleading claims” about them. I am not infallible, but I may well be right, and if there is an error it is not yet established, and is not mine. I could qualify future mentions with “erotic sensations are thought to be associated with genital corpuscles”, which is true and acknowledges a degree of uncertainty, although it may be too late to amend an article currently in press (I’ll ask the editor). Hope this helps. I only need to put my hand in my pants to confirm that it is the glans that is the source of erotic sensations, whatever nerve endings are involved. My foreskin was never so enjoyable. This fits with Schober’s 2009 study in which men ranked the glans first (especially the underside, where there is a concentration of genital corps). Those with foreskins (only 11) ranked them the least erogenous part of the penis. I’d like to see this work repeated with a larger sample size. It also leads to a thought experiment you can try. Suppose you had a pathology that required amputation (e.g. cancer). Which would you rather lose, your foreskin or your glans? Please provide the full bibliographic details for Winklemann 1986. Thanks.

Stephen Moreton wrote on 23 August 2014 at 9:12 a.m.:

Ian: Glad you acknowledged earlier that one can cherry-pick studies that show circumcision has negative, positive or neutral effects. I’ve made the same point elsewhere too. Only you seem to miss the point here. If circumcision was even just half as bad as intactivists claim then it should be a disaster for sexual functions. We are endlessly regaled with the wonders of the prepuce, its ridged band, gliding, zillions of magical nerve ends, stimulatory and lubricating functions etc. All backed up with glowing anecdotes from men who have restored theirs’ (such is the power of the placebo, we don’t we hear from those who got circ’d again – as some have). If foreskins were so important then circ should be immediate and dramatic in its effect and ALL studies would find it. That, instead, we find a mixed assortment, with those that do find effects finding only slight ones (like Frisch who had to do some statistical jiggery-pokery to squeeze out a tiny difference) suggests that whatever effect circ has, whether for good or bad, is so slight it is lost in the statistical noise. You are also too dismissive of Tian et al. Whilst they do call for more research, their meta-analysis was of the ten best studies to date, and still they found no significant difference. As I said, if there was even half the damage done as claimed by intactivists then Tian et al would have found it. Intactivists greatly exaggerate the supposed merits of the foreskin in an attempt to distress circumcised males and get them angry and motivated, and to make parents feel guilty about circumcising their sons, or to scare them off doing it. This is dishonest, and psychologically damaging for those deceived, and I do wish intactivists would stop it.

Ian wrote on 23 August 2014 at 10:31 p.m.:

The Winkelmann paper is from Yaksh’s edited volume ‘Spinal Afferent Processing’ (1986).

Like I said, the end bulb that received the name ‘genital corpuscle’ (by sheer virtue of its being first described in glans and clitoral tissue) is believed to be a mechanoreceptor—again, that’s why Taylor and Cold grouped ‘genital’ corpuscles with other such receptors, for simplicity’s sake. Again, there is no evidence—experimental or otherwise—that the mechanoreceptors of the glans are any more responsive or important in mediating erogenous sensations than those found elsewhere in the penis, including most notably the abundance in the ridged band of the foreskin. On the contrary, as referenced above, we have quality histological evidence that ‘[t]he glans is simply insensitive to light touch with a threshold in actual force resembling that of a callus on the sole of the foot … [its] threshold for touch is actually the pain threshold. This remarkable fact was part of the basis for RIVERS and HEAD (1908) concluding that the glans was only capable of perceiving protopathic sensations’ (Munger and Ide, 1988). Indeed, as has already been pointed out, the ratio of free nerve endings (nociceptors, sensitive to pain) to corpuscular receptors (mechanoreceptors) in the glans is approximately 10:1 (Halata and Munger, 1985). Furthermore, whether you like it or not, the Sorrells paper, in investigating the responsiveness of penile cutaneous mechanoreceptors, demonstrated that several of the locations they tested on the foreskin were dramatically more sensitive than those of the glans. However counterintuitive it may be, we ought to keep our minds open to the possibility that the acute sensitivity men describe as emanating from the glans is in fact pain.

For the last time: there is no special nerve ending ‘for sexual pleasure’. You’re cherry-picking locations like the nipples and lips (which in fact are packed with Meissner corpuscles) as ‘proof’ of the magical erogeneity of Krause bulbs, but you keep on refusing to notice that they function in no such capacity in the conjunctiva or the joints. The fact that ‘medical texts as recent as this year’ repeat this error is neither here nor there: the fact remains that there is no evidence for it, and one assumes that the authors are simply senselessly parroting what they’ve read elsewhere. In the future, saying that ‘erotic sensations are thought to be associated with cutaneous mechanoreceptors’ would be accurate, if uninteresting (and unpartisan). Why not just drop this ‘genital’ corpuscle stuff, altogether? You say that ‘if there is an error it is not yet established’ but this is faulty reasoning: you apparently demand evidence that the Krause bulbs in the glans are not uniquely specialised for and important to sexual pleasure, and yet you never demanded evidence to establish the belief in the first place—and none was ever provided.

Ian wrote on 23 August 2014 at 10:34 p.m.:

There’s an obvious double standard here: you want to trivialise the foreskin and exaggerate the importance of the glans, so you’ll assume the mechanoreceptors in the former are worthless (until I convince you otherwise) while the mechanoreceptors in the latter are incomparably important (until I convince you otherwise). Something tells me I’ll never be successful, and not because I’m wrong.

I’m sorry that you didn’t enjoy your foreskin very much. I derive very nearly all erogenous sensation from mine, I’m very fond of it, and there are many other body parts I would enthusiastically consent to lose before submitting to circumcision. I think that circumcision with neither need nor consent is severely abusive.

The Schober paper you’ve repeatedly referenced is extremely problematic. People can be (and often are) confused about how their bodies work; I see no reason to regard the genitals as an exception to this rule. I’m very well aware that most men regard the glans as the most erotogenically important part of the penis—no prizes for pointing that out—but I think they’re mistaken for doing so, and I think the source of this confusion is twofold:

  • First, uncircumcised men invariably masturbate by playing the foreskin up and down over the glans and shaft and seem to be under the impression that the pleasurable sensations they experience while doing so can be attributed to the glans being stimulated by the foreskin. I believe this is wrong, and men masturbating in this manner are in fact using the glans to stimulate the foreskin. During sexual activity the glans is unlikely to be stimulated in isolation of the rest of the distal penis, thus the uselessness of the glans for erogenous sensation is disguised by virtue of its always being stimulated in concert with the foreskin. Thus men credit the glans for what they in fact owe to the foreskin. Interestingly, the ‘underside’ of the circumcised penis (i.e., the ventral aspect of the distal end) is popularly referred to, erroneously, as ‘the frenulum’, and this is the only site of the circumcised penis where any scrap of the foreskin’s ridged band remains. I believe that it’s this residual tissue—obviously not the glans—that circumcised men are stimulating when they masturbate, much as uncircumcised men do, by clasping the penile skin and stretching it up and down, albeit in their case in a necessarily abbreviated manner. While some circumcised men have enough slack while erect to create for themselves a similar illusion (that the skin sheath is being used to stimulate the glans) many are too tightly circumcised to be able to stimulate the glans even indirectly. Thus why tightly circumcised men fail to disabuse themselves of the perception that the glans is particularly vital is one of the more inexplicable aspects of male sexuality.

Ian wrote on 23 August 2014 at 10:36 p.m.:

  • Second, the glans, as referenced above, is packed with nociceptors. Elsewhere on the body with few exceptions (bruises, wounds, etc.) the sensation of pain is often attributable (and attributed) to excessive intensity of stimulation. For example, a massage can go from feeling pleasant to unpleasant (or vice versa) depending on the amount of pressure being applied; in other words, the quality of the sensation is altered as the quantity of the stimulus changes. When a man stimulates his glans (and only his glans) directly (and only directly) he will likely experience it as rather uncomfortable; most men seem to attribute this discomfort to ‘too much of a good thing’, or over stimulation, when, in fact, that’s really the only sensation the glans is capable of providing: it’s numbness or it’s pain, with nothing in between.

Your thought experiment is interesting, but perhaps a better way of testing the question would be to ask if I would rather my glans or my foreskin, as a sequela of some sort of nerve damage, be rendered utterly insensate. Would I rather lose the feeling from my glans, or my foreskin? I can unhesitatingly say that I would far rather lose the sensation from my glans. I don’t think your experiment quite tests the hypothesis in the way you probably wish, as without the glans or some sort of replacement implant, the foreskin, without the scaffolding of the glans, is (1) unlikely to work properly either during masturbation or coitus, and (2) highly susceptible to injury.

Note that, theoretically, these hypotheses (yours and mine) can be tested scientifically, but no one has yet to do so. Asking people how they think their genitals work can provide evidence only of how individuals perceive their genitals to work, not of how their genitals actually work; the perceived and the actual are often different, after all. Carefully controlled experiments using, say, anaesthesia, could help us to scientifically assess the relative erogenous value of various genital regions. I’m sure research like this will come along, eventually. But as I’ve pointed out, not only does the extant histological literature not support the view of the glans as an especially touch-sensitive part of the body, it in fact fatally undermines it.

Ian wrote on 23 August 2014 at 10:37 p.m.:

Your comment, ‘if foreskins were so important then circ should be immediate and dramatic in its effect and ALL studies would find it’ contains a perfect non sequitur; when you say that ‘if there was even half the damage done as claimed by intactivists then Tian et al would have found it’ you completely miss the point I made in reference to the research on the sexual effects of female circumcision, including the forms judged by most of us to be very extreme (e.g., pharaonic circumcision): ‘[i]f sex researchers can’t prove that a woman’s having most of her genitals excised is associated with any significant sexual sequelae, then perhaps we should be a little cautious in our evaluations of other work they produce.’ Presumably you do think that female circumcision is sexually damaging—more so than male circumcision, at least. Why then don’t all the studies (or even more than one or two of them) provide evidence of this? Your claim—that even the most terrible of studies would provide evidence of harm, were there any—is patently not borne out by the research we have on female circumcision. Using your logic, a circumcised woman, sceptical of arguments that she should abandon the practice because of its sexual impact, could just as easily argue that the failure of studies to consistently (or even more than once or twice) document harm is as much proof as is needed that the practice is harmless. Again, you’re taking the absence of proof of harm as proof of harmlessness. That’s extremely bad reasoning, and unless I’m mistaken in assuming that you regard, say, clitoridectomy as mutilating, you’re being inconsistent.

Stephen Moreton wrote on 25 August 2014 at 12:41 p.m.:

Ian: Right now I am too busy to reply in detail to your latest essays, and the speculations, poor reasoning and several egregious errors they contain, (maybe I'll manage a response in a few days - please check again later in the week) but meantime please provide the full bibliographic details for Ojumu 2006. Thanks. I am also surprised that you would "enthusiastically" consent to lose various body parts before your foreskin. I'll be charitable and assume it was merely a poor choice of words. Even when I consented to lose my foreskin 21 years ago, it was not without trepidation (and relief afterwards that it turned out just fine). Through medical necessity, rather than choice, I have also lost 5 teeth and a chunk of flesh from my left calf muscle (in fact I nearly lost the lower leg, and would have but for modern surgical techniques). I am in no hurry to lose any more.

Ian wrote on 25 August 2014 at 7:01 p.m.:

No, not a poor choice of words—there are many parts I’d be positively happy to lose if the only alternative were circumcision.

Tempting though it is to stick around to learn of the ‘speculations, poor reasoning, and several egregious errors’ my modest comments contain, I’m not particularly interested in continuing this exchange; I’m going away tomorrow and really don’t want to have to keep checking back, especially as your habit seems to be to ignore the real substance of my arguments to instead focus on trivial details. Once more, though, I’ll politely request that you retire this ‘genital’ corpuscle stuff from your obviously very well-stocked anti-anti-circumcision arsenal.

There was an error in my spelling, as the author's name is actually Ojomo, not Ojumo. The paper's title is ‘Sexual problems among married Nigerian women’ and it appeared in the International Journal of Impotence Research in 2007.

You might also be interested in

  • Catania et al. ‘Pleasure and orgasm in women with female genital mutilation/cutting (FGM/C)’
  • Okonofua et al. ‘The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria’
  • Stewart et al. ‘Determinants of coital frequency among married women in Central African Republic: the role of female genital cutting’
  • Morison et al. ‘The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey’
  • Veale and Daniels, ‘Cosmetic clitoridectomy in a 33-year-old woman’

Note that much of this research, as with male circumcision, is quite poor.

Stephen Moreton wrote on 25 August 2014 at 8:31 p.m.:

Ian: At the risk you will not return, but in hope that you do I’ll reply briefly. Unlike male circ there is a meta-analysis on FGM that found it has a negative effect on sexual pleasure and function: So overall the studies do indicate harm. That a few don’t reflects that they are poor (you admit this) or that FGM is very variable in type and perhaps the milder forms really don’t make much difference. You miss my point that if intactivists were even half right about the wonders of the prepuce then all studies should show it. They (including you) really hype it up whilst diminishing the merits of the glans. If the best sensations came from the foreskin and few from the glans then the former’s loss would be dramatic in its effect. You can’t seem to grasp this. Your speculations about masturbation are just that – speculations - and incorrect. Uncut men do not “invariably masturbate by playing the foreskin up and down over the glans”. Some can’t (their foreskin retracts and stays thus upon erection) others keep the foreskin pulled back. And many (?most) cut men (me included) have no frenulum at all and, therefore, no residual ridged band. Where it was is very pleasant (and has a high concentration of genital corps). Whether cut or not it’s stimulation of the glans that generates erotic sensation. Accept this and there is no mystery “why tightly circumcised men fail to disabuse themselves of the perception that the glans is particularly vital”. I agree that your idea of selective anaesthesia experiments is a good one. As for genital corps, you have made a case that the evidence for their erotogenicity is circumstantial, but you are wrong to say there is no evidence. Their consistent association with erotic areas, in particular the glans (which you deny is erotogenic) and clitoris is evidence. And as it is mechanical stimulation that creates erotic sensation it is likely that the relevant nerves will be mechanoreceptors. It is not enough to point to similar nerve ends in non-erotic areas. They are similar but not identical, despite Chouchkov, and there is still the matter of where they map to in the brain. I will try to remember to qualify future references with “thought to be” but I have an article in the sceptical press for which it may be too late (I’ll ask the editor).

Ian wrote on 26 August 2014 at 3:21 a.m.:

This’ll be another lengthy essay. You’ve made so many objectionable remarks that I don’t think brevity is really an option here. You’ll have to forgive me for ‘fisking’ you; I just think it’ll save me time.

  • ‘Unlike male circ there is a meta-analysis on FGM that found it has a negative effect on sexual pleasure and function ... So overall the studies do indicate harm.’

Yes, and the paper is worthless. I actually scrutinised it just minutes after it was published, and it’s really a shockingly bad piece of work—so terrible that I’ve very seriously considered submitting a detailed criticism to the journal’s editors. The most blatant problem is in its biased set of inclusion criteria. Catania (2007) is acknowledged but doesn’t make it past the group stages to their final fifteen, presumably because one inclusion criterion was that ‘the women needed to be part of a community in which FGM/C was a customary practice’, and Catania et al. used Italian uncircumcised women as the control group. This is a senseless stipulation, however, as uncircumcised women can be argued—by definition—to come from ‘communities’ (whatever that means) in which female circumcision is not ‘a customary practice’—they’re not circumcised, after all. Many of the included studies use control groups of uncircumcised women from different ethnic groups, socioeconomic strata, locations (e.g., rural versus urban), and religious backgrounds; thus there are simply no legitimate grounds on which to exclude the Catania paper while including so many of the others. In addition, Catania et al., in contrast to virtually all other researchers, can at least claim to have employed a widely used, validated questionnaire (the Female Sexual Function Index) in their work.

Studies reporting results the authors don’t like (i.e., that female circumcision has either beneficial or nugatory sexual effects) are inexplicably missing. For example, the Ojomo (2007) paper meets the inclusion criteria (to my eye, at least) and isn’t even acknowledged, much less included in the analysis. The authors grade the various papers for quality and it’s with some amusement that I note that of the fifteen included papers, only Morison (2001) and Stewart (2002) are rated as high quality, and neither reported any evidence of harm!

Ian wrote on 26 August 2014 at 3:23 a.m.:

In support of their claim that female circumcision is a cause of dyspareunia, only Elnashar (2007) reported a statistically significant increase in circumcised women—in one of the smallest included studies, rated as low quality by the authors. The only high quality paper (Morison, 2001) found no association, and nor did the largest (Okonofua, 2002). The claim that ‘no sexual desire’ is a problem more prevalent amongst circumcised women is based on just two studies (of which only one attained statistical significance), both of which have perilously small sample sizes. (The authors also appear oblivious to the fact that in certain cultures it may be regarded as something of a taboo for a woman to admit to feeling sexual desire; one wonders whether such cultures are more or less likely to circumcise girls...) Similarly, the assertion that ‘sexual satisfaction’ is significantly diminished in circumcised women is based on just two small studies of which only one reported a statistically significant difference.

In short, the paper is a work of advocacy, not scientific research. The authors are guilty of many of the sins that appear to so rattle you when you allege anti-male circumcision activists to have committed them. Whilst I share the authors’ opposition to female circumcision, as with male circumcision, I don’t think we should be kidding ourselves about the strength of the epidemiologic evidence we can wield in support of our positions, whatever our positions may be.

  • ‘That a few [studies] don’t [provide evidence that female circumcision is harmful] reflects that they are poor (you admit this) or that FGM is very variable in type and perhaps the milder forms really don’t make much difference. You miss my point that if intactivists were even half right about the wonders of the prepuce then all studies should show it.’

First, I’m not in a position to ‘admit’ anything; it’s simply my opinion that none of the papers as yet available to us provide very good evidence of the sexual effects of male (or female) circumcision—whatever they may be. Others are free to disagree, of course, though one has to take care not to simply cherry-pick. It is my assumption that ablating impressively innervated genital tissue is likely to have deleterious sexual effects, but I’m not convinced that epidemiologic evidence as yet exists to support (or undermine) this position; if you want to argue that papers supporting this or that position are methodologically superior (or inferior) to those undermining this or that position, you’re free to do so, although I’d urge you not to, as I’m sure that neither of us wish to be dragged kicking and screaming down that particular rabbit hole. I will however say that I don’t see any reason to regard the Catania paper, for example, as any worse than any of the studies reporting harm; in some respects the paper is quite obviously superior.

Ian wrote on 26 August 2014 at 3:25 a.m.:

Incidentally, Catania et al. studied women with the most extreme and invasive variety of circumcision, and, as I mentioned, Berg’s review rated the studies showing no harm to be of the highest quality—which I don’t think is saying much.

Your argument that ‘all studies should show’ proof of sexual harm ‘if intactivists were even half right’ is completely illogical; as I said before, it’s a non sequitur. Again, assuming you regard any of the varieties of female circumcision as harmful, the mere existence of the Catania paper utterly demolishes your argument. By arguing that, were circumcision harmful, ‘all studies’ would provide evidence of this harm, you obviously preclude the possibility that any study, whatever its design, could fail to do so. It’s an indefensible (and confused) argument, which is why I was so surprised to see you make it in the first place, much less stand by it. Perhaps you’re here guilty of being a little ideologically rigid.

  • ‘If the best sensations came from the foreskin and few from the glans then the former’s loss would be dramatic in its effect. You can’t seem to grasp this.’

I do think the loss of the foreskin is dramatic in its effect; I think virtually all erogenous sensation men feel is owed to the tissue lost to circumcision. Furthermore, I don’t even think the glans is the most erogenous tissue circumcised men are left with; I take as a hint at this the fact that so many masturbate without even touching it. I think the scrap of what remains of the foreskin’s ridged band is pretty much all circumcised men have to get by on. Circumcised men are pretty much just masturbating as the uncircumcised do, only with a fraction of the equipment.

Ian wrote on 26 August 2014 at 3:27 a.m.:

  • ‘many (?most) cut men (me included) have no frenulum at all and, therefore, no residual ridged band. Where it was is very pleasant (and has a high concentration of genital corps).’

You appear to have misunderstood me. I was very careful to note that the region I was referring to is only ‘erroneously’ referred to as the frenulum; I do know that it’s not strictly the actual frenulum. Typically the term ‘frenulum’ in popular writings on sex (i.e., not medical textbooks) is employed as a sort of shorthand when the author wishes simply to refer to the sensitive ‘zone’ on the ventral aspect of the penis at the distal end. Unless you had an extremely unusual circumcision, you would have some of this ridged band remaining. Because of the way the way the penis is shaped there is always an excess residue of preputial mucosa on the ventral as opposed to dorsal side; the ridged band begins where the actual frenulum is, then loops all the way around the inside of the foreskin before joining itself on the other side. Unless you were given a full preputial mucosectomy—and I’ve never heard of such a procedure being performed in the absence of a recalcitrant dermatosis like lichen sclerosus—with the shaft skin stitched on to the edge of the glans or a millimetre or two from it, you’ll still have some of this tissue remaining; you couldn’t have got it anywhere else, after all.

  • ‘Your speculations about masturbation are just that – speculations - and incorrect. Uncut men do not “invariably masturbate by playing the foreskin up and down over the glans”. Some can’t (their foreskin retracts and stays thus upon erection) others keep the foreskin pulled back.’

First, while my attempt at a crude description of the biomechanics of male masturbation is, you’re correct to note, not derived from carefully controlled scientific experiments—nor is anyone else’s. Were you to offer a counter-hypothesis, whatever it might be, you’d be equally guilty of speculating; I thought that’s what we were doing. Second, many uncircumcised men do indeed masturbate by playing the foreskin up and down over the glans and shaft; I’m one of them, and I’ve seen many men masturbate, both in real life and in pornographic films, and this is extremely common practice. I’m baffled that you’d pick an argument here. If a man has a shorter foreskin he’ll stretch it back and forth and if it’s not long enough to go up over the corona and back down, it’s not a problem. The point is simply to stretch and relax it. I saw someone struggling to explain this to you over at Marianne Baker’s site, and it appears you’re being every bit as stubborn here.

Ian wrote on 26 August 2014 at 3:31 a.m.:

  • ‘Whether cut or not it’s stimulation of the glans that generates erotic sensation. Accept this and there is no mystery “why tightly circumcised men fail to disabuse themselves of the perception that the glans is particularly vital”.’


Do you really not see that this is precisely the point in contention here? I’m tempted to ask why men don’t just masturbate by touching their glans directly instead of messing about with the penile skin (or what’s left of it); I already offered an explanation: that direct and only direct stimulation of the glans is uncomfortable, because it’s packed with nociceptors rather than touch-sensitive nerve endings and its ‘threshold for touch is actually the pain threshold’, while the penile skin contains an abundance of highly-sensitive mechanoreceptors in the ridged band (or what’s left of it).

Clearly we’ll have to disagree here. Still, though, seeing circumcised men masturbating by gripping their shaft skin and stretching it up and down a couple of centimetres (without even touching the glans!) fatally undermines the ‘glans as everything’ thesis; more importantly, however, so does the histological literature! When I do stimulate my glans directly I find it quite uncomfortable; unlike other men, I don’t erroneously attribute this to the glans being ‘too sensitive’, however. My foreskin gliding back and forth is positively a religious experience, though. I wonder why that is, but I’ll not lose any sleep over it.

  • ‘As for genital corps, you have made a case that the evidence for their erotogenicity is circumstantial, but you are wrong to say there is no evidence.’

Unless you regard as evidence the unsubstantiated assertions of the likes of the author of that most venerated of scientific treatises ‘Sexual Feeling in Married Men and Women’, then, no, there is no evidence. Please cite a single experimental study in which it is determined that ‘genital’ corpuscles are proven unique in their capacity to mediate erogenous (or even simply tactile) sensation. You can’t, of course, for no such evidence exists; you seem to count speculation as a sort of evidence provided it appears in a nominally scientific text and its author isn’t assumed by you to be opposed to circumcision.

  • ‘Their consistent association with erotic areas, in particular the glans (which you deny is erotogenic) and clitoris is evidence. ‘

Again, it’s very difficult for ‘genital’ corpuscles to not be ‘associated’ with ‘erotic areas’ when they’re only called ‘genital’ corpuscles if ‘associated’ with ‘erotic areas’. Otherwise, once again, they’ve just been called Krause bulbs. ‘Genital’ corpuscles have not been assumed (without evidence) to be specialised for the mediation of erogenous sensation for any reason other than that, by definition, they are found only in structures believed (without evidence) to be specialised for the mediation of erogenous sensation. I get the strange feeling that I’m repeating myself.

Ian wrote on 26 August 2014 at 3:41 a.m.:

  • ‘And as it is mechanical stimulation that creates erotic sensation it is likely that the relevant nerves will be mechanoreceptors.’

Agreed, and the foreskin’s ridged band is replete with very sensitive mechanoreceptors, while in the glans they are vastly outnumbered (nine to one, remember) by nociceptors.

  • ‘It is not enough to point to similar nerve ends in non-erotic areas.’

Which is precisely why I wish you’d stop rubbishing the foreskin by arguing that, as Meissner corpuscles are found in the fingertips—and we don’t get off by typing!—any such mechanoreceptors in the penis—other than the glans, of course!—must be worthless. I can orgasm by stretching my foreskin back and forth; I can orgasm when my girlfriend’s tongue flickers across some of my ridged band. I can get no such feelings from my fingertips, I unreservedly grant you.

  • ‘They are similar but not identical, despite Chouchkov’

Differences in morphological characteristics of the various sensory receptors can be perceived due to all sorts of things, including where in the body they’re found and the age of the subject. Of course, as previously noted, histological artefacts account for many of the imagined differences, too. Chouchkov isn’t the only one to call a Krause bulb a Krause bulb when he sees one.

  • ‘and there is still the matter of where they map to in the brain.’

Indeed, and unless you have proof that the receptors of the glans are doing something that those of the foreskin are not, you’re in no position to make grand claims for the former and rubbish the latter.

  • ‘I will try to remember to qualify future references with “thought to be” but I have an article in the sceptical press for which it may be too late (I’ll ask the editor).’

Unless it’s your mission to confuse others as you’ve confused yourself, why not just drop it? It’s patently an attempt to mislead readers who have neither the time nor inclination to read up on all of this; you're prattling on about 'genital' corpuscles in a transparent effort to denigrate the foreskin and, once again, to trivialise the harms of circumcision (of which you believe there to be none). Please, just take it out and save me the hassle of having to correct you the next time you make the claim publicly.

Stephen Moreton wrote on 26 August 2014 at 11:05 p.m.:

Ian: Your latest barrage shows the Gish gallop is not unique to creationists. But quantity is not quality. Your posts are as repetitive, speculative, convoluted and irrelevant as ever, and still miss the point that if the foreskin is half as good as intactivists say then its loss would be calamitous. If good sensations come from it then removing it will remove those sensations. Period. And if only a scrap of the wonderful ridged band remained then only a scrap of those sensations would remain. Anyone circ’d as an adult would notice that. I have NO remnant of ridged band or frenulum. None. Yet my member feels as good as it ever did. If half of my retinas were lost half my vision would be too, if half the nerves in my cochlea were lost half my hearing would be too. Cut out my tongue and gone would be my sense of taste. Why should it be different for any other sensory apparatus? There is no mystery why men, cut or not, report good sensations from their glans. It’s because good sensations come from their glans. Get over it. We can argue indefinitely about the roles of various nerve ends or the quality of studies on FGM (which is irrelevant, we’re not talking about FGM). The glans is a major source of erotic sensation and I only have to put a hand in my pants to verify that, although the science says it too - Yang and Bradley’s 1998 & 1999 papers in J. Urol. are very emphatic that the glans is “a sensory structure” for sexual function. Zhang et al 2009 “Dorsal penile nerves and primary premature ejaculation” found that men with abnormal glans innervation (too many dorsal nerve branches) had glans hypersensitivity and PE. Kuhn (1950) was able to induce orgasm in spinal chord injury patients by stimulating the corona and frenulum areas (i.e. the areas where Halata & Munger found the most genital corps, which they distinguish from Krause bulbs, by the way). Schober also found erotic sensation from the shaft, so the glans is not the only source, but all the men, cut or uncut, ranked the glans first. Those with foreskins put them last (compared to other penile parts). You are also wrong, again, about masturbation. Even if not directly touching the glans (a rare way of doing it) the tugging action on the shaft skin will tug on the glans and stimulate it. And men who use lube apply it to the glans and rub all over it. The glans is their target part. In your quest to belittle the glans and elevate the foreskin to sacrosanct magnificence you have got yourself into a state of delusion and denial, so it is pointless continuing to argue with you. And yes, there was someone (“David”) using strikingly similar, faulty arguments on Marianne Baker’s blog, so similar in choice of words, even claiming to rather lose a leg than his foreskin, I am left wondering if you are the same person under different aliases.

Ian wrote on 27 August 2014 at 12:18 a.m.:

With your latest post you appear to have gotten yourself even more angry and confused, so I'm happy now to call it a day. This was an interesting exchange, though. All the best.

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