Surgery Guide

As described in Edut L’Yisrael: Sheiruta di’Tzlota (a text on customs surrounding weddings and births in Judaism, published in Israel c. 1960), the current practice appears to be a combination of two distinct customs.

Firstly, as stressed in the Kabbalistic sources, the night before the circumcision is considered a spiritually dangerous time for the baby; as such, the father would gather ten men to conduct a vigil to study Torah to protect him from metaphysical damage. Thus, this night is given the Yiddish name, “night of watching [or 'guarding']“.

Secondly, non-Kabbalistic sources describe a practice several centuries old that on the Friday night before the bris milah, a melamed would take his preschool-age students to say Shema near the baby, and afterwards receive candy (or their equivalent at that point in history, namely nuts or dried fruit.) This may have been more for the sake of the children’s education than for the baby.

A vach nacht (וואך-נאכט, vacht nacht or vakhnakht, lit: “watch night” in Yiddish) is the night before the bris milah (”circumcision”) of a male Jewish child, when he is in need of added spiritual protection. A standard “vach nacht” custom, practised by many Ashkenazi Jews, is to have children come and recite the Shema Yisrael and other verses from the Torah near the baby. In Hasidic communities a celebratory meal is held. In many Sephardic communities, the corresponding ceremony is called Brit Yitzchak (”covenant of Isaac”.)

A skin bridge is a penile skin adhesion, most frequently occurring as a consequence of circumcision. It is formed when, after circumcision, the inner lining of the remaining foreskin attaches to another part of the penis (normally the glans) as the cut heals.[1] It can lead to painful erections and usually requires surgical correction.[2]

O’Hara and O’Hara argue that foreskin is a natural gliding stimulator of the vaginal walls during intercourse, increasing a woman’s overall clitoral stimulation and helping her achieve orgasm more quickly and more often. Without the foreskin’s gliding action, they suggest, it can be more difficult for a woman to achieve orgasm during intercourse.[30] Bailey et al. report that there is a preference by women for the circumcised man, mentioning that circumcised men enter the woman more easily and cause fewer traumas.[31][verification needed]
Vaginal dryness and female arousal
A study by psychologists Bensley & Boyle (2003) reported that vaginal dryness can be a problem when the male partner is circumcised.[32] Boyle & Bensley (2001) reported that the lack of a foreskin in the male partner produces symptoms similar to those of female arousal disorder.[verification needed] The authors hypothesized that the gliding action possibly involved intercourse with an uncircumcised partner might help prevent the loss of vaginal lubrication.[verification needed] They stated that the respondents were self-selected, and that larger sample sizes are needed.[33] Boyle et al. (2002) state that self-selection is unreliable.[18]
Female visual arousal
Williamson et. al (1988) studied randomly selected young mothers in Iowa, where most men are circumcised, and found that 76% would prefer a circumcised penis for achieving sexual arousal through viewing it.[34] Williamson et al. conclude: “Not least among the considerations is the worth of sexual preference for male circumcision within the American culture as a valid reason for continuing the practice.”

Kim and Pang found that 20% reported that their sex life was worse after circumcision and 6% reported that it had improved. They concluded that “there was a decrease … sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.”[26]

Masood et al., in their study mentioned earlier of men circumcised for benign disease, found that 61% reported satisfaction with the results, while 17% felt it made things worse, and 22% expressed neutral sentiments. 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. The authors of the study concluded that the satisfaction rate was a ‘poor outcome,’ given the pre-procedure penile disease state and recommended discussing with prospective patients the results of this study during the informed consent process.[1]

Krieger et al. reported that in a trial in which 1,391 men were circumcised, more than 99% were “satisfied” with their circumcisions.[25]

Kigozi et al. reported finding “no trend in satisfaction among circumcised men”. The authors concluded that “[a]dult male circumcision does not adversely affect sexual satisfaction [...] in men”.[24]

Shen et al. reported that adult circumcision appeared to result in improved satisfaction in 34 cases (of 95 adults being circumcised), the association was statistically significant.[20]

Senkul et al. reported that they did not find a statistically significant difference in BMSFI satisfaction scores in their study of 42 adult circumcision patients.[22]

Collins et al. reported on a study of 15 adult circumcision patients. No statistically significant difference in BMSFI scores was observed.[23]

Fink et al. reported improved satisfaction (p=0.04). Half of the circumcised men reported benefits, while 38% reported harm. “Overall, 62% of men were satisfied with having been circumcised.” Fink attributes the improved satisfaction to the respondee’s aesthetic considerations and to a resolution of previous painful conditions.[2]

Several studies have investigated the effect of circumcision on sexual drive. Studies that did not find a statistically significant difference include Kim and Pang,[26] Collins et al.,[23] and Senkul et al..[22]

In a study by Korean researchers of 255 men circumcised after the age of 20 and 18 who were not circumcised, Kim and Pang reported that masturbatory pleasure decreased in 48% of the respondents and increased in 8%. Masturbatory difficulty increased in 63% but was easier in 37%. They concluded that there was a decrease in masturbatory pleasure after circumcision.[26]

Laumann et al. reported that circumcised men in their survey displayed a greater rates of experience of various sexual practices, including oral sex, anal sex, and masturbation.[27] For example, among whites the “estimated ratio of the odds of masturbating at least once a month for circumcised men was 1.76 that for uncircumcised men.” Dr. Laumann provides two explanations for the difference in sexual practices. “One is that uncircumcised men, a minority in this country, may feel a stigma that inhibits them. Another is that circumcision reduces sensitivity in the penis, leading circumcised men to try a range of sexual activities.” [29]

Fink et al. did not find a change in sexual activity with adult circumcision (p=0.22).[2]

Waldinger et al. recruited 500 men (98 circumcised and 261 not-circumcised) from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States and studied their ejaculation times during sexual intercourse. They found that circumcised men took on average 6.7 minutes to ejaculate, compared with 6.0 minutes for uncircumcised men. This difference was not statistically significant. The comparison excluded Turkey, which was significantly different from the other countries studied.[28] Commenting on the study, Sorrells et al. said “Turkish men, the vast majority of whom are circumcised, had the shortest Intravaginal ejaculation latency time (IELT).”[4]

Collins et al. conducted a prospective study of 15 adult circumcision patients, using the Brief Male Sexual Function Inventory (BMSFI). The authors did not find a statistically significant effect on ejaculation scores.[23]

In a study of 42 Turkish men circumcised for religious reasons, Senkul et al. did not find a statistically significant difference in BMSFI ejaculation scores, but found a significant increase in the mean time to ejaculate. The authors suggested that delayed ejaculation may be seen as a benefit.[22]

In a telephone survey of 10,173 Australian men, 22% of uncircumcised men and 26% of circumcised men reported reaching orgasm too quickly for at least one month in the previous year. The difference was not statistically significant.[21]

Kigozi et al. reported that, in a randomised controlled trial of 4,456 men of whom 2,474 were selected to be circumcised, the authors did not find a statistically significant effect on premature ejaculation.[24]

Krieger et al. reported on a randomised controlled trial of 2,784 participants, of whom 1,391 were randomised to be circumcised. 54.5% of circumcised men described their ease of reaching orgasm as “much more” at 24 months after randomisation.[25]

In a study of 255 circumcised men and 118 uncircumcised men, Kim and Pang reported no statistically significant difference in ejaculation or ejaculation latency time between circumcised and uncircumcised participants.[26]

In a study of 150 men circumcised for benign disease, Masood et al. reported that 13% reported improvement in premature ejaculation after circumcision, 33% reported that premature ejaculation became worse, and 53% reported no change.[1]

Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase,[20] or decrease,[21] in erectile dysfunction among circumcised men, while other studies have shown little to no effect.[22][23][1][24][25]

Fink et al., in an American study of 123 men, found that medically necessitated circumcision resulted in worsened erectile function (p=0.01).[2]

Kim and Pang reported no significant difference in erection.[26]

Laumann et al. reported that the likelihood of having difficulty in maintaining an erection was lower for circumcised men, but only at the 0.07 level (OR 0.66; 95% CI, 0.42-1.03).[27]

Some recent researchers have asserted that the foreskin may be sexually responsive.[12][13][14][15] Opponents of circumcision have cited these studies, which report on the sensitivity or innervation of the foreskin, claiming a sexual role based upon the presence of nerve-endings in the foreskin sensitive to light touch, stroking and fluttering sensations.

Circumcision removes the ridged band at the end of the foreskin.[14] Taylor (1996) observed that the ridged band had more Meissner’s corpuscles — a kind of nerve ending that is concentrated in areas of greatest sensitivity[citation needed] — than the areas of the foreskin with smooth mucus membranes. Taylor postulated that the ridged band is sexually sensitive and plays a role in normal sexual function. He also suggested that the gliding action, possible only when there was enough loose skin on the shaft of the penis, serves to stimulate the ridged band through contact with the corona of the glans penis during vaginal intercourse.[16] This gliding action was also described by Lakshmanan (1980).[17]

Sorrells et al. (2007), in the study discussed above, measured fine-touch pressure thresholds of the penis, and concluded “The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates” (removes) “the most sensitive parts of the penis.” According to Sorrells et al., the five penile areas most sensitive to fine-touch are located on the foreskin. [4] This is disputed by Waskett and Morris, who argue that Sorrells’ “[table] 2 shows this applies only to their position 3, the orifice rim of the prepuce.” However, they stated that after they used the Bonferroni method to correct for multiple comparisons, “this significance disappeared.” [9] Young responded to Waskett and Morriss’s criticisms saying “Sorrells et al. compared 12 points that the two have in common, as well as five the circumcised penis does not have, and two (of scar tissue) that only the circumcised penis has. By disregarding those seven points (which they miscount) in their table, Waskett and Morris have removed the major source of difference and restored the major fault of the undocumented, unreviewed and vaguely described (but widely quoted) study by Masters and Johnson[3], that of ignoring the foreskin.”[10]

Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with “heightened erogenous sensitivity,” stating “the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision.”[18] They concluded, “Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well.”

Conversely, in a 2008 study, Krieger et al. stated that “Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm.”[19]