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This study was an exploration of the impact of men's circumcision status on their sexual partners, focusing on sexual functioning, sexual satisfaction, general preferences for circumcision status, and beliefs about circumcision status. A total of 196 individuals (168 women, 28 men) currently in a sexual relationship with a man were recruited for an online survey. Sexual functioning for female or male participants (assessed by the FSFI or IIEF-MSM, respectively) was not impacted by circumcision status, but women with intact partners reported higher levels of sexual satisfaction, while no differences were observed in the male sample. Women's responses indicated that circumcision status minimally impacted satisfaction with partner's genitals, while men with intact partners indicated significantly higher levels of satisfaction than those with circumcised partners. Overall, women and men rated high levels of satisfaction with their partner's circum-cision status and did not wish for it to change. Women indicated a slight preference for circumcised penises for vaginal intercourse and fellatio, and held more positive beliefs about circumcised penises, while men indicated a strong preference toward intact penises for all sexual activities assessed and held more positive beliefs about intact penises. The current study demonstrates distinct gender differences in attitudes toward circumcision status but minimal impact of circumcision status on sexual functioning. Future research should further explore sexual correlates of circumcision status, with a focus on direc-tionality of said correlates and the impact on couples, as well as replicating the findings with a larger sample, specifically with respect to the male sample.
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ARTICLE
You either have it or you don’t: The impact of male
circumcision status on sexual partners
Jennifer A. Bossio
1
, Caroline F. Pukall
1
, and Katie Bartley
1
1
Department of Psychology, Queen’s University, Kingston, Ontario
This study was an exploration of the impact of men’s circumcision status on their sexual partners, focusing
on sexual functioning, sexual satisfaction, general preferences for circumcision status, and beliefs about
circumcision status. A total of 196 individuals (168 women, 28 men) currently in a sexual relationship with
a man were recruited for an online survey. Sexual functioning for female or male participants (assessed
by the FSFI or IIEF-MSM, respectively) was not impacted by circumcision status, but women with intact
partners reported higher levels of sexual satisfaction, while no differences were observed in the male
sample. Women’s responses indicated that circumcision status minimally impacted satisfaction with partner’s
genitals, while men with intact partners indicated significantly higher levels of satisfaction than those with
circumcised partners. Overall, women and men rated high levels of satisfaction with their partner’s circum-
cision status and did not wish for it to change. Women indicated a slight preference for circumcised
penises for vaginal intercourse and fellatio, and held more positive beliefs about circumcised penises,
while men indicated a strong preference toward intact penises for all sexual activities assessed and held
more positive beliefs about intact penises. The current study demonstrates distinct gender differences
in attitudes toward circumcision status but minimal impact of circumcision status on sexual functioning.
Future research should further explore sexual correlates of circumcision status, with a focus on direc-
tionality of said correlates and the impact on couples, as well as replicating the findings with a larger
sample, specifically with respect to the male sample.
KEY WORDS: Circumcision, sexual functioning, sexual satisfaction, partner preferences
INTRODUCTION
Circumcision refers to the removal of some or all of the pre-
puce, or penile foreskin, and is one of the most widely per-
formed surgical procedures worldwide. There exists a great
deal of research on health outcomes associated with circumci-
sion, which has been fundamental in recent changes to public
policy in the United States; the most recent report by the
American Academy of Pediatrics (AAP) states that ‘‘the
benefits of neonatal circumcision outweigh the costs’’ (AAP,
2012). In addition, the Center for Disease Control (CDC)
has released a report that mirrors the AAP’s endorsement of
neonatal circumcision (CDC, 2014). Despite the body of re-
search outlining health correlates of circumcision, the impact
of circumcision on sexual correlates of men and their sexual
partners is extremely limited (see Bossio, Pukall & Steele, 2014).
Despite the existence of a handful of studies (e.g., Sorrells, et
al., 2007; Payne, Thaler, Kukkonen, Carrier, & Binik, 2007), it
remains unknown whether the removal of foreskin impacts
men’s penile sensitivity, sexual functioning, or sexual enjoy-
ment. In addition, research is needed to determine whether
the presence or absence of a penile foreskin differentially im-
pacts the sexual partners of men. Given that circumcision
results in changes to the anatomic structure of the penis (i.e.,
the removal of the mobile foreskin sheath), it would be im-
portant to assess whether such changes to the penis extend
beyond the individual.
The limited body of research exploring the effects of cir-
cumcision status on partner sexual functioning has produced
mixed results. O’Hara and O’Hara (1999) surveyed women
who reported having had sexual experiences with both intact
and circumcised men from magazines and an anti-circumci-
sion newsletter by inviting them to complete a mail-in survey
with over 40 questions related to sexual history, sexual func-
tioning, as well as subjective opinions about circumcision
status. The authors concluded that women were less likely to
experience ‘‘vaginal’’ orgasms, and were more likely to have
vaginal discomfort and reduced vaginal secretions during
intercourse with a circumcised man compared to an intact
partner. It also appeared that sexual enjoyment during ‘‘pro-
longed intercourse’’ was lower in women with their circum-
cised compared to intact partners; when referring to expe-
riences with circumcised partners, women were more likely
Correspondence concerning this article should be addressed to Jennifer A. Bossio, MSc, Department of Psychology, Queen’s University.
Email: Jennifer.Bossio@QueensU.ca
104 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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to report that they ‘‘want to get it over with’’ and were less
likely to ‘‘really get into it.’’ The authors concluded that
women prefer intact to circumcised sexual partners for sexual
enjoyment, citing the mobile sheath of the intact penis as a
potential anatomic explanation as it is believed to minimize
friction against the vaginal wall, allowing for the maintenance
of vaginal lubrication (O’Hara & O’Hara, 1999).
Frisch and colleagues (2011) assessed the impact of circum-
cision on sexual functioning using responses to a national
health survey from Denmark regarding the sexual lives of
male or female partners of men. Only 5% (n¼103) of the
total sample of sexually active men (N¼1996) reported
being circumcised, 15% (n¼15) of whom were circumcised
before the age of 6 months. Few differences in sexual func-
tioning were observed in the male sample; circumcised men
were more likely than intact men to report frequent orgasm
difficulties, but rates of erectile difficulties, early ejaculation,
and dyspareunia (i.e., pain during sexual intercourse) did not
differ between groups. Within the total sample of sexually
active female respondents (N¼1982), 4% (n¼75) reported
that their partner was circumcised, and 28% (n¼20) of
circumcised partners had undergone the procedure before 6
months of age. Women with circumcised partners were more
likely than women with intact partners to report difficulties
in overall sexual functioning, including orgasm difficulties,
insufficient vaginal lubrication, dyspareunia, and vaginismus
(i.e., difficulty with vaginal penetration).
The studies conducted by O’Hara and O’Hara (1999) as
well as Frisch and colleagues (2011) suggest that circumcision
is associated with negative outcomes on sexual functioning
for female partners. Although these two studies provide impor-
tant contributions to the circumcision literature, they have
some notable methodological shortcomings. For example, the
Frisch et al. (2011) sample was conducted on a population
where circumcision – especially in newborns – is exceedingly
rare. Frisch and colleagues did not control for the age at
circumcision, nor did their analyses consider women’s previ-
ous exposure to circumcision status. The methodology in the
O’Hara and O’Hara (1999) paper is also problematic, as a
proportion of the sample was recruited from an anti-circum-
cision newsletter, thus introducing a high likelihood of bias.
In addition, neither O’Hara and O’Hara (1999) nor Frisch
and colleagues (2011) make use of validated measures within
their surveys, but instead rely on single item responses for
their assessment of sexual functioning.
One additional study reported on changes in women’s
sexual satisfaction in African populations before and after
their partners underwent circumcision as adults (Kigozi et al.,
2009). Following their partner’s circumcision procedure, 2.9%
of the sample of women interviewed reported that their sexual
functioning was worse, 57.3% reported no change, and 39.8%
reported improvement in sexual functioning. The authors
concluded that male circumcision ‘‘has no deleterious effect
on female sexual satisfaction.’’ The randomized pre-post ex-
perimental design of this study offers a methodological ad-
vantage over self-report surveys; however, several factors
need to be considered before findings from this study can
reasonably be applied to non-African cultures. First, it is
currently unknown whether circumcision status differentially
impacts men or their partners depending on the age at which
the procedure is performed. Therefore, it is unclear whether
the findings from studies in which adult men are experimen-
tally assigned to undergo circumcision or not can be applied
to populations in which circumcision is typically performed
in neonates – the standard age in North America. As well,
multiple factors may contribute to changes in women’s self-
reported sexual functioning and satisfaction in pre-post circum-
cision studies. For example, the surgical alteration of men’s
genitals may lead to changes in behaviour or beliefs about
genitals/sexuality on the part of either partner, or perhaps
long periods of celibacy during post-surgical healing times
may impact reports of sexual satisfaction or functioning.
Indeed, aspects of human sexuality are highly variable over
time, irrespective of adult circumcision. Furthermore, the
purpose of the pre-post experimental design in the Kigozi
et al. (2009) study was to explore whether circumcision can
protect against HIV acquisition in African cultures, where
rates of HIV/AIDS are considered epidemic. It is possible
that participant’s expectations for the study may have in-
troduced a response bias, as all data were self-report, and
participants were fully informed of the purpose of the study.
Indeed, research exploring the acceptability of circumcision as
a protective procedure against HIV transmission illustrates
that men and women are willing to preferentially favour cir-
cumcision when they believe it offers protection against HIV
(Figueroa & Cooper, 2010; Gonzales et al., 2012; Mattson,
Bailey, Muga, Poulussen, & Onyango, 2005).
Individual or cultural beliefs about circumcision represent
another important area of study that has received little atten-
tion. Understanding beliefs about circumcision may shed
light onto the sociocultural impact of the procedure, which
may in turn lead to improved understanding of the role
of circumcision in the sexual lives of adults. Most research
assessing beliefs about circumcision focuses on individuals’
opinions about the acceptability of the procedure. Typically,
acceptability research takes the form of qualitative studies
or self-report questionnaires asking men and/or women to
comment on their willingness to circumcise themselves (in
the case of men), their partners (in the case of women; male
partners have not been included in the research at this time),
or their children (men and women). Often, hypothetical
situations are introduced to assess participant’s acceptance
of circumcision under particular conditions, for example, if
circumcision is shown to protect against HIV (Halperin, Fritz,
McFarland, & Woelk, 2005; Lagarde, Dirk, Puren, Reathe, &
Bertran, 2003; Rain-Taljaard et al., 2003; Tsela & Halperin,
2006), or if it was guaranteed to be a safe and affordable pro-
cedure (Bailey, Neema, & Othieno, 1999; Kebaabetswe et al.,
2003; Mattson et al., 2005; Scott, Weiss, & Viljoen, 2005). A
review by Westercamp and Bailey (2007) illustrated that
barriers to acceptability of circumcision in African countries
include pain, cultural/religious/social reasons, cost, fear of
The impact of male circumcision status on sexual partners
The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2 105
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complications, and feared negative impact to sexual function-
ing or partner’s sexual enjoyment. Factors that contribute
to the acceptability of circumcision include hygiene, believed
increases to sexual functioning or partner’s enjoyment, and
not surprisingly for a population at high risk of HIV/AIDs
protection against HIV or STIs. Researchers have recently
begun looking at populations of men who have sex with men
(MSM) to determine acceptability for circumcision as a
potential immunization against HIV transmission in this
population, which also has documented high rates of HIV/
AIDS. Again, it is not surprising that MSM populations were
willing to undergo circumcision if evidence for its effective-
ness against HIV/AIDS or other STIs was demonstrated,
although considerably higher acceptance rates were observed
for a sample of men from Brazil (86%; Gonzales et al., 2012)
than a sample of men from China (30%, Lau et al., 2011).
Thus, beliefs about the acceptability of circumcision appear
contingent on several medical and sociocultural factors. Ex-
panding acceptability research to include additional factors
beyond health benefits, such as circumcision status preference,
impact on sexual functioning or enjoyment, or beliefs about
circumcision status would provide valuable information on
possible sociocultural or relationship factors related to the
procedure – aspects of the circumcision literature that have
otherwise gone unaddressed.
An alternative avenue to explore popular beliefs about cir-
cumcision may be parent’s reasons for choosing to circumcise
or not circumcise their newborn sons. A considerable amount
of research demonstrates that the medical literature has
minimal impact on parent’s decision to circumcise their sons
or not (Tiemstra 1999; Oh et al., 2002; Walton, Ostbye, &
Campbell, 1997; Larsen & Williams, 1990). Binner and col-
leagues (2002) surveyed a sample of women giving birth in
the United States, and found no change in the mother’s deci-
sion to circumcise their sons or not after reading an empiri-
cally based AAP handout summarizing the medical literature
on circumcision. Commonly reported reasons parents cite for
deciding whether or not to circumcise their sons include the
father’s circumcision status (Rediger & Muller, 2013; Xu &
Goldman, 2008; Walton et al., 1997) and hygiene (Rediger &
Muller, 2013; Xu & Goldman, 2008). In some cases, women
report reasons related to their son’s future sexuality, including
visual appeal of the genitals or increased sexual enjoyment
(Williamson & Williamson, 1988). Once again, research on
parent’s decision to circumcise or not circumcise their sons
provides some information about public opinion toward the
procedure, but fails to directly assess the impact of such
opinions on men, their sexual partners, and the sexual lives
of couples.
Research on the impact of circumcision on the sexual lives
of men and their partners is limited, as the majority of re-
search on circumcision has focused on health correlates.
What research does exist fails to take into account potentially
important confounding variables (e.g., age at circumcision,
sexual orientation; see Bossio et al., 2014 for a review) or lacks
methodological rigor (e.g., not accounting for past exposure
to circumcision status, not including validated measures).
The current study aims to address the impact of neonatal cir-
cumcision on the sexual lives of men’s partners. We recruited
a sample of women and men who report being in a current
sexual relationship with a man with the intent to explore the
impact of circumcision status on the following domains: (i)
sexual functioning; (ii) sexual satisfaction; (iii) general prefer-
ences for circumcision status; and (iv) beliefs about circumci-
sion status.
METHODS
Participants
Eligible participants met the following criteria: (i) over the age
of 18; (ii) able to read and write English fluently; and (iii) in a
sexual relationship with a cisgendered (i.e., biologically born)
male partner for at least the past 3 months. Participants were
excluded based on the following criteria: (i) if they or their
partner were circumcised as an adult, or circumcised to
correct a medical condition (e.g., phimosis); (ii) if they or
their partner had any anatomic or medical abnormalities of
the penis (e.g., complications during circumcision, hypo-
spadias, genital modifications such as piercings); and (iii) if
their partner had a diagnosis of a sexual dysfunction.
A total of 196 individuals who met eligibility criteria com-
pleted the study in full. Participants ranged in age from 19
to 71 years (M¼27.5, SD ¼8.6), and included 168 women
between the ages of 19 and 57 years (M¼26.9, SD ¼7.4)
and 28 men between the ages of 20 and 71 years (M¼31.5,
SD ¼13.4). All participants reported being in a sexual rela-
tionship with a man for a minimum of three months; the
average length of relationship was 4.2 years (SD ¼5.2 years;
range ¼3 months – 35.3 years; see Table 1).
The majority of participants indicated that they were born
in Canada (n¼145; 74%) or the United States (n¼24;
12.2%), while others reported that they were born in Europe
(n¼9; 4.6%) or other countries (n¼15; 7.5%). The current
sample was highly educated, with the majority indicating that
they attended college or university (n¼120; 61.2%), and many
indicating graduate-level education (n¼66; 33.7%); the largest
subsample of this group indicated that they were currently in
school (n¼105; 53.6%), while others were employed full-
time (n¼59; 30.1%) or part-time (n¼22; 11.2%). The
majority of this sample indicated their current religious stance
as Agnostic, Atheist, or ‘‘none’’ (n¼113; 57.7%), although
many indicated that they were Catholic/Christian (n¼39;
19.9%), Jewish (n¼11; 5.6%), or another religion. Most
participants described their relationship as monogamously
dating (n¼124; 63.3%), married (n¼35; 17.9%), or common-
law/engaged (n¼25; 12.8%); however, a subsample of the
sample reported that they were in an open relationship
(n¼8; 4.1%) or single (n¼4; 2%; Table 2).
Jennifer A. Bossio et al.
106 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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Table 1. Participant and couple characteristics
Female partners
(n¼168)
Male partners
(n¼28)
Characteristic MSDRange MSDRange Fp
Age of Participant (yrs) 26.87 7.40 19–57 31.50 13.40 20–71 6.98 .009
Age of Partner (yrs) 28.28 8.65 19–70 32.18 14.25 18–69 3.94 .05
Length of Relationship (mos) 50.68 62.49 3–424 50.29 70.88 3 –243 0.001 .98
Table 2. Participant Demographics
Characteristic
Women (n¼168)
%(n)
Men (n¼28)
%(n)
Total (N¼196)
%(N)
Birthplace
Canada 78.6 (132) 46.4 (13) 74.0 (145)
United States 8.3 (14) 35.7 (10) 12.2 (24)
Europe 4.8 (8) 3.6 (1) 4.6 (9)
Other 8.3 (14) 14.3 (4) 7.5 (15)
Education
High school graduate 3.6 (6) 10.7 (3) 4.6 (9)
Community college 6.0 (10) 10.7 (3) 6.6 (13)
Vocational training 0.6 (1) 0.0 (0) 0.5 (1)
University undergraduate 56.0 (94) 46.4 (13) 54.6 (107)
University graduate 33.9 (57) 32.1 (9) 33.7 (66)
Occupation
Employed Full-Time 29.2 (49) 35.7 (10) 30.1 (59)
Employed Part-Time 10.7 (18) 14.3 (4) 11.2 (22)
Student 56.0 (94) 39.3 (11) 53.6 (105)
Parenting Full-Time 2.4 (4) 0.0 (0) 2.0 (4)
Disability 1.2 (2) 7.1 (2) 2.0 (4)
Unemployed 0.6 (1) 0.0 (0) 0.5 (1)
Retired 0.0 (0) 3.6 (1) 0.5 (1)
Religion (Current)
None / Atheist / Agnostic 55.3 (93) 71.4 (20) 57.7 (113)
Spiritual, no label 9.5 (16) 10.7 (3) 9.7 (19)
Catholic 12.5 (21) 0.0 (0) 10.7 (21)
Christian 10.1 (17) 3.6 (1) 9.2 (18)
Jewish 6.5 (11) 0.0 (0) 5.6 (11)
Muslim 0.6 (1) 0.0 (0) 0.5 (1)
Other 4.2 (7) 14.3 (4) 6.6 (13)
Relationship Status
Single 1.8 (3) 3.6 (1) 2.0 (4)
Dating, monogamous 64.3 (108) 57.1 (16) 63.3 (124)
Dating, non-monogamous 2.4 (4) 14.3 (4) 4.1 (8)
Common-law 8.3 (14) 7.1 (2) 8.2 (16)
Engaged 3.6 (6) 10.7 (3) 4.6 (9)
Married 19.6 (33) 7.1 (2) 17.9 (35)
Nature of Relationship
Exclusive 92.9 (156) 64.3 (18) 88.8 (174)
Non-exclusive 6.5 (11) 35.7 (10) 11.2 (21)
Circumcision Status of Current Partner
Circumcised 54.8 (92) 50.0 (14) 54.1 (106)
Intact 45.2 (76) 50.0 (14) 45.9 (90)
Circumcision Status of Self
Circumcised 46.4 (15)
Intact 53.6 (13)
The impact of male circumcision status on sexual partners
The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2 107
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Measures
Experience with circumcision status. Participants were asked
to indicate the circumcision status of their current partner, as
well as recall the number of circumcised and/or intact past
sexual partners that participants had engaged in a series of
different sexual activities with (i.e., vaginal intercourse (women
only), anal intercourse, fellatio (performed on a partner), and
manual-penile stimulation (performed on a partner). A cir-
cumcised partner was defined as a man who had undergone
a surgical procedure to have his penile foreskin removed
shortly after birth, while an intact partner was defined as a
man whose penile foreskin had not been surgically removed
(i.e., the penile foreskin was intact). Participants also indi-
cated the circumcision status of the first partner they engaged
in penetrative intercourse with, as well as the circumcision
status of the partner with whom they achieved their first orgasm
(if applicable).
Satisfaction with partner’s circumcision status. Partners
indicated their personal levels of satisfaction with their cur-
rent partner’s circumcision status on several variables, includ-
ing: satisfaction overall, how much of a positive issue their
partner’s circumcision is in their everyday life, how much of
a negative issue it is, how satisfied they are with their partner’s
circumcision status when their partner’s penis is flaccid and
when it is erect, and the extent to which they wished their
partner was the opposite circumcision status. Questions were
answered on a 10-point Likert-type scale, where ‘‘1’’ indicated
‘‘very dissatisfied’’ and ‘‘10’’ indicated ‘‘very satisfied.’
Female sexual functioning. Female participants completed
the Female Sexual Function Index (FSFI; Rosen et al., 2000), a
19-item measure of sexual dysfunction. The FSFI provides a
measure of sexual functioning on six domains: desire, arousal,
lubrication, orgasm, pain, and satisfaction. Higher scores in-
dicate greater sexual functioning. The FSFI and its subscales
demonstrate good test-retest reliability in each domain when
re-administered within a four-week period (r¼.79 to .86)
and the test possesses high internal consistency (Cronbach’s
alpha values observed at a¼0.82 and higher; Rosen et al.,
2000). Cronbach’s alpha values for the current study were ob-
served at a¼0.79 and higher. In addition, highly significant
mean difference scores on each of the subscales between
women with sexual arousal disorder and age-matched con-
trols indicate good construct validity (pa.001) (Masheb,
Lozano-Blanco, Kohorn, Minkin, & Kerns, 2004; Rosen et al.,
2000).
Male sexual functioning. Male participants completed the
International Index of Erectile Function: Adapted tool for
Men who have Sex with Men (IIEF-MSM; Coyne et al.,
2010). The IIEF-MSM is a 14-item measure of sexual dys-
function that has been adapted from the IIEF for use with
men who have sex with men (MSM). Lower values indicate
better sexual functioning. The measure assesses five domains
of sexual functioning: erectile function, intercourse satisfac-
tion, orgasmic function, sexual desire, and overall satisfaction.
The IIEF-MSM has been shown to be a valid and reliable
measure of men’s sexual functioning, and all subscales possess
high internal consistency (Cronbach’s alpha values have been
observed at a¼0.82 and higher; Coyne et al., 2010). The
current study produced Cronbach’s alpha values of a¼0.71
and higher.
General preferences for circumcision status. Participants
were asked to indicate the circumcision status of their ideal
partner for four (women) or three (men) different sexual ac-
tivities performed on the partner: vaginal intercourse (women
only), anal intercourse, fellatio, and manual-penile stimula-
tion. Participants were asked to indicate circumcision status
preferences for each sexual activity on an 11-point bi-polar
scale, such that one end of the scale (0) represented full pref-
erence for an intact penis, the mid-point (5) indicated no
preference for a given circumcision status, and the opposite
end of the scale (10) indicated full preference for a circum-
cised penis. This scale allowed participants to indicate the de-
gree of preference for either an intact or circumcised partner
on a 5-point departure from the midpoint (no preference).
Thus, on the 11-point scale, 0 to 4 represented degree of pref-
erence for an intact partner (where 0 is full preference for
intact and 4 is slight preference), 5 represented no preference
for a specific circumcision status, and 6 to 10 represented
degree of preference for a circumcised partner (where 10 is
full preference for circumcised and 6 is slight preference).
Beliefs about circumcision status. Beliefs about circum-
cision status were assessed on several domains. Participants
were provided with a series of statements and asked to indi-
cate which – if any – circumcision status best fit the descrip-
tion. Beliefs included the following: most hygienic, cleaner,
the social norm, most common in my country, most common
for my age group, more erotic, more attractive, more natural,
provides greater pleasure during penile-vaginal intercourse,
provides greater pleasure during penile-anal intercourse, feels
nicer to touch, is more interesting, reduces risk of trans-
mitting STIs, is preferred by men themselves, is preferred by
female sexual partners of men, and is preferred by male sexual
partners of men. Participants were provided with the option
to decline to respond, or to indicate that they do not perceive
a difference.
Procedure
Study procedures were approved by the University’s General
Research Ethics Board (GREB). Participants were recruited
to take part in an online survey through print advertisements
placed within Queen’s University campus and the surround-
ing community, located in Kingston, Ontario. Online advertise-
ments were also used via social media websites (e.g., Facebook,
Twitter), as well as relevant online communities and listservs.
Data were collected online, and completion of the survey
took approximately 30 minutes. The survey was hosted through
the Checkbox website (Checkbox Survey Inc., Watertown,
MA) and stored on a secure, private server located on the
University campus. After completion, participants were eligi-
ble to enter their name in a monthly prize draw for $75 CAD;
this prize draw lasted over the duration of data collection.
Jennifer A. Bossio et al.
108 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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RESULTS
Experiences with Circumcision Status
Women. Of the women in the current sample, 76 (45.2%) re-
ported being in a current sexual relationship with an in-
tact man, and 92 (54.8%) reported being in a current sexual
relationship with a circumcised man (Table 2). Group com-
parisons revealed that women with circumcised partners
were significantly older than women with intact partners
(F(1,167) ¼10.58, p¼.001), and had significantly older
partners (F(1, 167) ¼11.06, p¼.001). Women with circum-
cised partners reported having had a greater number of cir-
cumcised partners for vaginal (F(1, 163) ¼8.47, p¼.004),
anal (F(1, 57) ¼8.86, p¼.004), oral (F(1, 161) ¼5.92,
p¼.016), and manual (F(1, 159) ¼5.19, p¼.024) sexual
activities. Conversely, women with intact partners reported
having a greater number of intact partners for vaginal
(F(1, 163) ¼19.44, p<.001), oral (F(1, 166) ¼18.03, p<.001),
and manual (F(1, 159) ¼16.11, p<.001) sexual activities,
but not anal intercourse (F(1, 57) ¼3.64, p¼.06; Table 3).
The number of women in the current sample who engaged
in sexual activities with circumcised men only, intact men
only, and both circumcised and intact men was tallied (Table
4). Most women were able to identify the circumcision status
of their partners for any given activity. The largest proportion
of women reported having had vaginal intercourse, fellatio,
and manual-penile stimulation with both circumcised and in-
tact men; equal numbers of women reported engaging in anal
penetrative intercourse with circumcised or intact men only.
Men. An equal number of men within the current sample
reported presently being in a sexual relationship with intact
and circumcised partners (n¼14, 50%; Table 2). Men were
significantly older than the female sample. Unlike the female
sample, no significant differences were observed with respect
to the age of the male sample (F(1, 27) ¼3.50, p¼.07) or
their sexual partners (F(1, 27) ¼2.54, p¼.12) based on
circumcision status. In addition, among the male sample,
men’s age did not differ as a function of their own circum-
cision status (F(1, 27) ¼0.13, p¼.72; Table 3).
Table 3. Breakdown of women and men’s age, partner’s age, and sexual experiences by circumcision status of their current
partners
Current partner’s circumcision status
Circumcised Intact
Women
M(SD)
Men
M(SD)
Women
M(SD)
Men
M(SD)
Age 28.52 (8.50) 36.00 (16.36) 24.88 (5.26) 26.93 (7.84)
Partner’s age 30.24 (9.54) 36.36 (16.44) 25.91 (6.77) 28.00 (10.68)
Vaginal intercourse
# C partners 4.99 (4.87) 3.05 (3.14)
# I partners 1.56 (1.21) 3.01 (2.84)
Anal intercourse
# C partners 2.24 (1.15) 4.29 (4.57) 1.38 (1.05) 7.64 (10.87)
# I partners 1.38 (0.73) 2.64 (3.92) 1.76 (0.79) 7.64 (9.80)
Fellatio
# C partners 4.85 (5.01) 8.57 (8.83) 3.15 (3.54) 9.07 (10.87)
# I partners 1.54 (1.30) 5.57 (5.37) 2.76 (2.35) 10 (11.97)
Manual-penile stimulation
# C partners 4.88 (5.58) 5.86 (7.38) 3.18 (3.48) 9.86 (10.36)
# I partners 1.53 (1.31) 3.57 (5.17) 2.89 (2.80) 10.86 (12.13)
Note: C¼circumcised; I ¼intact
Table 4. Breakdown of women and men’s sexual experiences by circumcision status
Intact only Circumcised only Both intact and circumcised Don’t know
Sexual Activity Women
%(n)
Men
%(n)
Women
%(n)
Men
%(n)
Women
%(n)
Men
%(n)
Women
%(n)
Men
%(n)
Vaginal intercourse 15.85 (26) 28.66 (47) 46.34 (76) 9.15 (15)
Anal intercourse 12.50 (21) 21.43 (6) 12.50 (21) 14.29 (4) 5.36 (9) 50.00 (14) 4.17 (7) 10.71 (3)
Fellatio 13.69 (23) 14.29 (4) 25.00 (42) 7.14 (2) 45.24 (76) 71.43 (20) 12.50 (21) 3.57 (1)
Manual-penile stimulation 13.69 (23) 7.14 (2) 23.21 (39) 3.57 (1) 43.45 (73) 71.43 (20) 14.29 (24) 14.29 (4)
The impact of male circumcision status on sexual partners
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Like women, men were tallied based on whether they had
engaged in various sexual activities with circumcised partners
only, intact partners only, or both circumcised and intact
partners (see Table 4). Similar to women, the largest per-
centage of men reported having had anal intercourse, fellatio,
and manual-penile stimulation with both circumcised and
intact men.
Satisfaction with Partner’s Circumcision Status
Men and women participants were analyzed separately on
their responses to several questions about their own level of
satisfaction with their current partner’s circumcision status.
All analyses were repeated controlling for the circumcision
status of participant’s first partner, the number of sexual part-
ner’s of each circumcision status they reported, participant’s
age, and in the case of men, their own circumcision status.
Past experiences and cohort effects did not impact analyses,
thus these results are not included here.
Women. Women’s satisfaction with their current partner’s
circumcision status was not significantly different between
women with a circumcised partner and those with an intact
partner (F(1, 166) ¼0.01, p¼.93); women with either a cir-
cumcised or intact partner rated feeling highly satisfied with
their partner’s circumcision status. Women did not differ in
ratings of their partner’s circumcision status as a positive
(F(1, 164) ¼0.001, p¼0.97) or negative issue for them
(F(1, 165) ¼.12, p¼.73) regardless of the status of their
partner.
Participants were asked to rate their level of satisfaction
with their partner’s circumcision status when their partner’s
penis was flaccid and when it was erect. Women with cir-
cumcised partners were significantly more satisfied with
their partner’s circumcision status when flaccid compared to
women with intact partners, F(1, 164) ¼5.07, p¼.03, partial
h
2
¼.03. However, groups no longer differed in satisfaction
ratings with their partner’s circumcision status when their
partner was erect, F(1, 166) ¼.73, p¼.39. Lastly, women
were asked to indicate the extent to which they wished their
partner was the opposite circumcision status, and women
indicated equally low responses to this question, irrespective
of partner’s circumcision status, F(1, 164) ¼0.27, p¼.61
(Figure 1).
Men. Men’s satisfaction with their partner’s circumcision
status was not significantly different between men with a cir-
cumcised and those with an intact partner (F(1, 26) ¼3.17,
p¼0.09). Men with intact partners rated their partner’s
circumcision status as a significantly more positive issue than
men with circumcised partners, F(1, 26) ¼7.29, p¼.01, par-
tial h
2
¼.22. Similarly, men rated their partner’s circumcised
penis as a significantly more negative issue for them com-
pared to men with intact partners, F(1, 26) ¼10.24, p¼.004,
partial h
2
¼.28.
Men with intact partners reported that they were signifi-
cantly more satisfied with their partner’s circumcision status
when flaccid (F(1, 26) ¼8.36, p¼.008, partial h
2
¼.24) and
when erect (F(1, 26) ¼6.31, p¼.02, partial h
2
¼.20) com-
pared to men with circumcised partners. Lastly, men responded
Figure 1. Women’s self-reported satisfaction with their partner’s circumcision status
*p<.05
Jennifer A. Bossio et al.
110 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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with consistently low rates when asked to indicate the extent
to which they wished their partner was the opposite circumci-
sion status, irrespective of their partner’s circumcision status,
F(1, 26) ¼1.42, p¼.25 (Figure 2).
Sexual Functioning
Women. A logistic regression analysis was conducted to pre-
dict partner’s circumcision status using 5 scales of the FSFI
(desire, arousal, lubrication, orgasm frequency, and pain) as
predictors. The satisfaction subscale was not included in this
analysis (see next subsection). A test of the full model against
a constant only model was not statistically significant, indi-
cating that the predictors do not distinguish between cir-
cumcised or intact sexual partners in the current sample
(w
2
¼3.85, p¼.57, df ¼5). The logistic regression was re-
peated controlling for women’s age to assess for a cohort
effect, but the pattern of results was unchanged.
Separate one-way ANOVAs were employed with the above
mentioned five FSFI subscales as dependent variables, and
partner circumcision status (circumcised or intact) as the
independent variable to investigate whether women’s sexual
functioning differs as a function of their partner’s circum-
cision status. Analyses were repeated using ANCOVAs to
control for women’s age; results did not differ from those re-
ported here, and thus are not included. Women with circum-
cised and intact partners did not differ significantly on their
self-reported responses to the FSFI subscales measuring sexual
desire (F(1, 166) ¼1.12, p¼.29), experiences of sexual arousal
(F(1, 166) ¼0.21, p¼.65), vaginal lubrication (F(1, 166) ¼
0.98, p¼.32), orgasm ease (F(1, 166) ¼0.39, p¼.53) or
pain with penetrative intercourse (F(1, 166) ¼1.45, p¼.23;
Table 5).
Men. A similar logistic regression analysis to the female
sample was conducted with the male sample to predict
partner’s circumcision status using 4 scales of the IIEF-MSM
(desire, erectile functioning, intercourse satisfaction, and orgasm
functioning) as predictors. The satisfaction subscale of the
IIEF-MSM was not included in this analysis (see next subsec-
tion). A test of the full model against a constant only model
was not statistically significant, indicating that the predictors
do not distinguish between circumcised or intact sexual part-
ners in the current sample (w
2
¼1.15, p¼.89, df ¼4). The
inclusion of men’s age as a covariate in the logistic regression
did not change the pattern of results.
Separate one-way ANOVAs were employed with the afore-
mentioned four IIEF-MSM subscales as dependent variables,
and partner circumcision status (circumcised or intact) as
the independent variable to investigate whether men’s sexual
functioning differs depending on the circumcision status of
their partners. Similar ANCOVAs were included to control
for men’s age; the pattern of results were unchanged from
those reported here. Men’s responses did not differ signifi-
cantly as a function of partner’s circumcision status for any
Figure 2. Men’s self-reported satisfaction with their partner’s circumcision status
*p<.05
**p<.01
The impact of male circumcision status on sexual partners
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subscale of the IIEF-MSM, including self-reported sexual desire
(F(1, 26) ¼0.00, p¼1.00), erectile functioning (F(1, 19) ¼
0.23, p¼.64), intercourse satisfaction (F(1, 26) ¼2.41, p¼.13),
or orgasm functioning (F(1, 26) ¼0.01, p¼.98; Table 5).
Sexual Satisfaction
Women. Women’s scores on the Sexual Satisfaction subscale
of the FSFI were compared across partner circumcision status.
A one-way ANOVA revealed a significant main effect of cir-
cumcision status, F(1, 166) ¼4.51, p¼.04, partial h
2
¼.03
(Table 5). Women with intact partners reported significantly
higher levels of sexual satisfaction than women with circum-
cised partners. Including women’s age as a covariate pro-
duced the same pattern of results.
Men. Men’s scores on the Overall Sexual Satisfaction
subscale of the IIEF-MSM were compared across partner’s
circumcision status. A one-way ANOVA revealed a no signif-
icant effect of circumcision status on men’s sexual satisfac-
tion, F(1, 26) ¼4.25, p¼.05 (Table 5). An ANCOVA con-
trolling for men’s age produced the same pattern of results.
General Preferences for Circumcision Status
Women. To evaluate whether women prefer men with a
certain circumcision status for a variety of sexual activities
(i.e., vaginal intercourse, anal intercourse, fellatio, and manual-
penile stimulation), separate one-sample t-tests were con-
ducted. Mean circumcision status preference scores for each
sexual activity type was compared to the test-value of 5,
which represents no preference for circumcision status. Only
women who had experience with the sexual activity in ques-
tion were included in each analysis.
The sample mean circumcision preference score for vaginal
intercourse of 5.78 (SD ¼2.89) was significantly different from
the test-value of 5 (t(163) ¼3.46, p¼.001, d¼0.27, 95% CI
[0.33, 1.23]) in the direction of a preference for a circumcised
penis. Cohen’s dindicates a small effect size. The sample
mean circumcision preference score for anal intercourse of
5.52 (SD ¼2.95) was not different from 5 (t(55) ¼1.32,
p¼.19). The sample mean circumcision preference score for
fellatio of 6.28 (SD ¼3.04) was significantly different from 5
(t(161) ¼5.38, p<.001, d¼0.42, 95% CI [0.81, 1.76]) in the
direction of a preference for a circumcised penis. Cohen’s d
indicates a medium effect. Lastly, the sample mean circum-
cision preference score for manual-penile stimulation of 5.38
(SD ¼3.19) was not significantly different from 5 (t(159) ¼
1.51, p¼.13). Thus, women in the present sample demon-
strated a preference for a circumcised penis when engaging
in vaginal intercourse and fellatio, but no preference with re-
spect to circumcision status for anal intercourse or manual-
penile stimulation (see Figure 3).
Men. To evaluate whether men prefer a certain circumci-
sion status for anal intercourse, fellatio, and manual-penile
stimulation, separate one-sample t-tests were performed. The
mean preference score for each sexual activity type (i.e., anal
intercourse, fellatio, and manual-penile stimulation) was com-
pared to the test-value of 5, the number representing no pref-
erence for circumcision status. Similar to women, men who
had not engaged in the given activity were excluded from the
analysis.
The sample mean circumcision preference score for anal
intercourse of 3.29 (SD ¼2.42) was significantly different
from 5 (t(27) ¼3.75, p¼.001, d¼0.71, 95% CI [2.65,
0.78]) in the direction of a preference for an intact penis.
Cohen’s dindicates a large effect size. Similarly, the sample
mean circumcision preference score for fellatio of 3.32
(SD ¼3.12) was significantly different from 5 (t(27) ¼2.85,
p¼.008, d¼0.54, 95% CI [2.89, 0.47]) in the direction
of a preference for an intact circumcision status. Cohen’s d
indicates a medium effect size. Finally, the sample mean cir-
cumcision preference score for manual-penile stimulation of
2.50 (SD ¼2.62) was also significantly different from 5
(t(27) ¼5.05, p<.001, d¼0.95, 95% CI [3.52, 1.48]) in
the direction of a preference for an intact circumcision status.
Cohen’s dindicates a large effect size (Figure 4).
Table 5. Women and men’s sexual functioning assessed on individual subscales of the FSFI and IIEF
Sexual
desire
M (SD)
Vaginal
lubrication
M (SD)
Sexual
arousal
M (SD)
Orgasm
ease
M (SD)
Sexual
satisfaction
M (SD)
Pain with
penetration
M (SD)
Women C partner 7.09 (2.23) 18.09 (2.96) 17.55 (2.57) 11.91 (3.13) 13.04 (2.46)*13.04 (2.60)
I partner 7.42 (1.76) 18.49 (2.09) 17.72 (2.21) 11.61 (3.15) 13.75 (1.69)*13.75 (1.99)
Sexual
desire
M (SD)
Erectile
functioning
M (SD)
Intercourse
satisfaction
M (SD)
Orgasm
functioning
M (SD)
Sexual
satisfaction
M (SD)
Men C partner 3.93 (1.49) 11.40 (6.22) 4.50 (1.29) 4.36 (2.10) 4.50 (1.29)
I partner 3.93 (1.44) 10.27 (4.63) 3.86 (0.86) 4.29 (2.16) 3.86 (0.86)
*p<.05
Note: C¼circumcised; I ¼intact; scales for women indicate subscales from the FSFI, while scales for men indicate IIEF-MSM subscales.
Jennifer A. Bossio et al.
112 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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Figure 3. Women’s circumcision status preference for different sexual activities
*p<.05
**p<.01
***p<.001
Figure 4. Men’s circumcision status preference for different sexual activities
*p<.05
**p<.01
***p<.001
The impact of male circumcision status on sexual partners
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Beliefs about Circumcision Statuses
We tested whether women and men believe circumcision
status matters on several different factors by indicating which
circumcision status (intact, circumcised, or no difference) was
best described by a series of statements (e.g., ‘‘The most hy-
gienic circumcision status is. . .’’). Chi-square analyses were
conducted for women and men to compare whether there
was a significant difference between the number of partici-
pants who indicated ‘‘no difference’’ compared to those who
chose one circumcision status or another. Significant analyses
were followed-up to determine which circumcision status was
more commonly attributed to a certain statement (Figures 5
and 6).
Women. There was a significant difference in the number
of women who indicated circumcision status makes no differ-
ence compared to those who indicated circumcision status
does make a difference on the following attributions: hygiene,
cleanliness, social norm, more common in their country,
more common for their age group, natural, attractive, pro-
vides more pleasure during anal intercourse, pleasurable to
touch, reduced STIs, preference for men, and preference for
female partners of men. Women indicated a belief that cir-
cumcised penises were more: hygienic (w
2
¼86.74, p<.001,
df ¼1), clean (w
2
¼73.49, p<.001, df ¼1), socially norma-
tive (w
2
¼50.74, p<.001, df ¼1), common in their country
(w
2
¼47.32, p<.001, df ¼1), common for their age group
(w
2
¼60.47, p<.001, df ¼1), attractive (w
2
¼41.95, p<.001,
df ¼1), pleasurable to touch (w
2
¼8.82, p¼.003, df ¼1),
likely to lower risk of STIs (w
2
¼32.97, p<.001, df ¼1),
and that they are more preferred by men themselves
(w
2
¼4.96, p¼.03, df ¼1) as well as female sexual partners
of men (w
2
¼71.05, p<.001, df ¼1). Women indicated that
intact penises were more natural (w
2
¼108.70, p<.001,
df ¼1), and they indicated that circumcision status makes
no difference for pleasure during anal sex (w
2
¼30.03,
p<.001, df ¼1). Women did not indicate that circumcision
status was relevant for the following beliefs: most erotic, most
pleasurable during vaginal intercourse, most interesting, and
most preferred by male sexual partners of men.
Men. There was a significant difference in the number of
men who indicated that circumcision status does versus does
not matter on the following belief statements: social norm,
common for their country, common for their age group,
erotic, natural, attractive, pleasurable to touch, and inter-
esting. Men indicated that circumcised penises were more
common in their country (w
2
¼5.26, p¼.02, df ¼1) and
they indicated a belief that intact penises are more: natural
(w
2
¼23.15, p<.001, df ¼1), attractive (w
2
¼5.00, p¼.03,
df ¼1), pleasurable to touch (w
2
¼14.72, p<.001, df ¼1),
erotic (w
2
¼7.20, p¼.007, df ¼1), and interesting (w
2
¼
18.18, p<.001, df ¼1). Men in the present sample did not
significantly differ in whether they believed circumcised or in-
tact penises to be the social norm (w
2
¼2.01, p¼.08, df ¼1)
or more common for their age group (w
2
¼0.73, p¼.39,
df ¼1). Men did not indicate that circumcision status was
Figure 5. Women’s beliefs about circumcision status
*p<.05
**p<.01
***p<.001
Jennifer A. Bossio et al.
114 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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relevant for the following beliefs: most hygienic, most clean,
most pleasurable for vaginal or anal intercourse, offers a re-
duction against STIs, is preferred by men, or is preferred by
female or male sexual partners of men.
DISCUSSION
Summary of Findings
This study was an exploratory examination into the impact of
men’s circumcision status on their sexual partners with a spe-
cific focus on sexual functioning, sexual satisfaction, general
preferences for circumcision status, and beliefs about circum-
cision status. Circumcision status did not appear to impact
sexual functioning for women or men who participated in
the current study, and while sexual satisfaction remained
similar between men with intact and circumcised partners,
women with intact partners reported higher levels of sexual
satisfaction. Women with circumcised partners reported higher
levels of satisfaction with their partner’s circumcision status
as compared to those with intact partners only when their
partner’s penis was flaccid. Conversely, men with intact partners
rated higher level of satisfaction with their partner’s circum-
cision status on multiple domains. Despite differences in
satisfaction across circumcision status, women and men rated
overall high levels of satisfaction with their partner’s circum-
cision status and did not wish for it to change. With respect
to partner’s preferences and beliefs about circumcision status,
women’s responses suggested that they favoured circumcised
penises for vaginal intercourse and manual-penile stimula-
tion, and that they held more positive beliefs about circum-
cised penises. In contrast, men’s responses indicated a strong
preference for intact penises for all sexual activities, and also
held more positive beliefs about intact penises.
Satisfaction with Partner’s Circumcision Status
We explored the importance of circumcision status within the
context of a sexual relationship by assessing women and
men’s satisfaction with their current partner’s circumcision
status. Within the current sample, women with circumcised
partners indicated higher levels of satisfaction with their
partner’s circumcision status compared to women with intact
partners only when their partner was flaccid. When erect,
circumcision status is difficult to distinguish, as the foreskin
of an intact penis is retracted to expose the glans, similar to
a circumcised penis. Presumably, women with intact partners
expressed slightly less satisfaction relative to women with cir-
cumcised partners in response to the increased visibility of
their partner’s foreskin when flaccid. In contrast, men with
intact partners reported consistently higher levels of satisfac-
tion with their partner’s circumcision status compared to
those with circumcised partners. The effect sizes observed in
the male sample for significant analyses were larger than the
effect size of the significant group difference in the female
sample, although significant effect sizes in the male sample
were small to moderate. It is unclear why gender differences
in satisfaction with partner circumcision status emerged in
the current sample.
Figure 6. Men’s belief about circumcision status
*p<.05
**p<.01
***p<.001
The impact of male circumcision status on sexual partners
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Perceptions of body and genital image have been tied to
sexual functioning and quality of life in women, and men
particularly gay identified men (e.g., Berman, Berman, Miles,
Pollets, & Powell, 2003; McCreary & Sadava, 2001; Peplau et
al., 2009; see also Weiderman, 2012). Partners undoubtedly
play a role in individual’s perceived body image; however, re-
search to date has not directly explored how a sexual partner’s
perceptions of one’s body/genitals impact the other person’s
body image. The results of the current study suggest that
women and men consider circumcision status when appraising
their partner’s genitals. It is important to note that although
levels of satisfaction varied with the circumcision status of
women and men’s sexual partners, participants rated consis-
tently high overall satisfaction with their partner’s circumci-
sion status and low levels of desire for their partner to be the
opposite circumcision status, irrespective of their partner’s
actual circumcision status. Women and men’s patterns of
response indicate that partner circumcision status is likely to
have minimal impact on the overall relationship. Further-
more, controlling for past experience with different circum-
cision statuses or the male participant’s own circumcision
status did not impact outcomes, thus the current study pro-
vides no evidence that familiarity with a particular circum-
cision status impacts satisfaction with the circumcision status
of one’s partner. Future research should explore the impact of
partner’s satisfaction with one’s circumcision status on men’s
perception of their overall body image, their sexual function-
ing, quality of life, and relationship functioning.
Sexual Functioning and Satisfaction
A largely untested argument in the circumcision literature is
whether the sexual functioning of men’s partners is differen-
tially effected by circumcision status. The rationale for this
hypothesis typically centers on the presence or absence of
the mobile sheath of skin (i.e., the foreskin). For example,
O’Hara and O’Hara (1999) hypothesize that the foreskin re-
duces friction during penetration, resulting in fewer vaginal/
anal abrasions for the receptive partner. Findings from the
current study offer no support for the hypothesis that foreskin
(or the lack thereof) impacts sexual functioning for female or
male partners of men, which is inconsistent with previous
research (Frisch et al., 2011; O’Hara & O’Hara, 1999). The
current study offers methodological advantages over previous
studies. Most notably, the current study employs the use of
standardized measures of sexual functioning for women and
men; previous research has relied on responses to single ques-
tions to assess different aspects of sexual functioning, such as
ease of orgasm or vaginal lubrication. Furthermore, this is the
first paper, to our knowledge, that includes a male sample in
the assessment of circumcision status’ impact on sexual func-
tioning.
The sexual satisfaction subscale of the FSFI and IIEF-MSM
was analyzed separately to explore the specific hypothesis that
self-reported sexual satisfaction will differ based on partner’s
circumcision status. Only women differed in their ratings of
sexual satisfaction, such that women with intact partners re-
ported higher levels of sexual satisfaction compared to those
with circumcised partners. The observation that women with
intact partners endorsed higher sexual satisfaction ratings on
the FSFI is interesting, considering that women’s responses
to other subsections of this survey indicated a preference for
circumcised penises (e.g., higher self-report satisfaction with
their partner’s flaccid penis compared to women with intact
partners, higher preference for circumcised penis during
some sexual activities, more positive beliefs about circumcised
penises). It is possible that the presence of foreskin provides
some benefits to sexual satisfaction outside of the domains as-
sessed by the FSFI. Additional research is required to clarify
the nuanced role of foreskin in sexual intercourse and partner
enjoyment/sexual satisfaction, particularly among women.
General Preferences for Circumcision Status
To further explore the role of circumcision status on the
sexual lives of men’s sexual partners, we tested the hypothesis
that individuals will demonstrate differential preferences for
circumcision status depending on the sexual activity. Indeed,
women and men demonstrated circumcision status preferences
for a range of sexual activities, and gender differences in these
patterns emerged. Women reported a small to medium pref-
erence toward circumcised partners for vaginal intercourse
and fellatio, but preference for anal intercourse or manual
stimulation of her partner’s genitals did not reach significance
(although they were in the direction of a preference for cir-
cumcised partners as well). Men, conversely, showed a large
preference toward intact partners for anal intercourse, fellatio,
and manual stimulation of his partner’s genitals. This pattern
of response is consistent with participant’s ratings of satisfac-
tion with their partner’s circumcision status, in that women
show some preference to circumcised penises, while men
demonstrate a much stronger preference to intact penises.
Previous research has hypothesized that sex with an intact
penis would be more enjoyable for men’s sexual partners due
to the mobility of the foreskin (e.g., O’Hara & O’Hara, 1999);
findings from the present study support this hypothesis for
men – who expressed a strong preference for sex with intact
partners – but not for women. Research has demonstrated
that sexual practices in MSM populations differ slightly based
on men’s circumcision status; circumcised men have been
shown to engage in a wider range of sexual activities than
intact men (Laumann, Masi, & Zuckerman, 1997), and are
more likely to engage in receptive anal sex (Mao et al., 2008).
Richters and colleagues (2006), in contrast, found no differ-
ences in men’s self-reported sexual practices with women
across circumcision status in a group of men recruited from
Australia, although circumcised men reported more liberal
sexual attitudes. The current study contributes to the litera-
ture, suggesting that circumcision status may be related to the
sexual practices of individuals or couples. Women’s reported
preference for some sexual activities with circumcised partners
is consistent with the results of Williamson and Williamson’s
Jennifer A. Bossio et al.
116 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
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(1988) study indicating that, in a small sample from the
United States, women preferred sexual activities with circum-
cised men. The present study is unique in that it is the first to
demonstrate a distinct preference for sex with intact men in a
sample of MSM; however, the rationale behind this finding
cannot be gleaned from the current study. Future research
should employ qualitative research methods to explore varia-
bles that factor into individual’s self-reported circumcision
status preference for sexual acts; for example, exploring
whether previous experiences (e.g., total number of sexual
partners, amount of experience with each circumcision status)
plays a role in future preference for either circumcision status.
Experimental methodology may contribute to the under-
standing of circumcision status on the sexual lives of men
and their partners by directly testing the hypothesized impact
foreskin is said to have on sexual functioning. Empirical studies
could explore physiologic consequences of sex with intact or
circumcised men, such as whether maintenance of vaginal
lubrication during penetrative intercourse varies with partner
circumcision status, or whether the presence of a mobile fore-
skin does, in fact, reduce the likelihood of dermal abrasions
during vaginal or anal intercourse.
Beliefs about Circumcision Status
The existence of multiple organizations both against (e.g.,
Intactivists, Canadian Foreskin Awareness Project [CFAP],
National Organization of Circumcision Information Resource
Centers [NOCIRC]) and in favour (e.g., Circinfo.net, Circlist)
of male circumcisions evidences that at least some members
of the public hold strong beliefs about circumcision. The
current study attempts to quantify some publically regarded
beliefs about circumcision status in a sample of women and
men. Consistent with results reported in this paper, women
and men differed in their beliefs about circumcision status;
women considered circumcision status relevant to a larger
number of facets compared to men, and overall, women typi-
cally attributed more positive beliefs to circumcised penises
while men attributed more positive beliefs to intact penises.
Past research suggests that North American women evaluate
circumcised penises more favourably (e.g., more pleasant to
touch, cleaner, look sexier; Williamson & Williamson, 1988),
but studies on circumcision beliefs have typically not included
MSM samples.
Gender differences were observed on all belief domains,
including those assessing health, social norms, and sexuality.
For example, women attributed more positive health-related
aspects of male genitalia to circumcised penises (e.g., they are
more hygienic, cleaner, and have lower risk of contracting an
STI) compared to men, who indicated circumcision status
was not relevant for any of these health factors. Women’s
endorsement of circumcised penises as socially normative
and men’s endorsement of intact penises as normative may
be attributable to cohort differences in the present sample;
men and their partners were significantly older than the
female sample, and thus potentially represent different pre-
valent circumcision practices over time (e.g., Nelson, Dunn,
Wan, & Wei, 2005). Decreasing rates of neonatal circumci-
sion in Canada and the US since the 1970s mean that one
would expect the younger sample of women to report intact
penises as more representative of the population; however,
rates of circumcision are known to vary widely by region
and ethnicity, which are factors we did not assess in the
current sample. Unfortunately, we are unable to directly assess
whether the observed results in the current study can be
attributed to a cohort effect. Similar gender differences were
observed with respect to belief statements about sexual aspects
of circumcision; once again, women demonstrate a clear pref-
erence for circumcision, while men prefer intact penises.
Perhaps gender differences in attitudes toward circumcision
status impact responses to previous sections in the current
survey, or vise versa. Unfortunately, we are unable to infer
directionality from the observational nature of the questions
asked in the current study. Future research should employ
experimental designs to assess the role that beliefs about
circumcision status plays on the sexual lives of men and their
sexual partners.
Limitations
The purpose of the current study was to offer an exploratory
investigation of circumcision status as it applies to the sexual
partners of men. Although this study offers some unique
methodological strengths over past research, such as the in-
clusion of a male sample, utilization of empirically validated
measures, and assessment of variables regarding circumcision
that have not yet been explored (e.g., satisfaction, personal
beliefs), this research is not without limitations. The current
study design relied on self-report, which introduces the likeli-
hood of responder bias, as well as errors in responding. For
example, Stoner and colleagues (2003) observed 6 out of 15
women recruited for a study on perception of partner’s risky
sexual behaviour misidentified their partner’s circumcision
status, which was later confirmed by physician examination.
The reliance on participant’s recall of past partner’s circum-
cision status is a shortcoming of the current study. Future
research should consider confirming partner’s circumcision
status by recruiting the partners themselves, or through the
use of a physician; however, it would not be feasible to
confirm circumcision status for all past partners, and thus
adequate statistical measures should be taken (e.g., ensuring
sufficient statistical power) to account for potential errors in
responding.
Another methodological shortcoming of the current study
is the relatively small sample size of MSM surveyed (n¼28).
Due to the small sample size, the results reported for this sub-
sample should be considered preliminary, and consequently
interpreted with caution. Future research should aim to repli-
cate the findings presented in this paper using a larger sample
of MSM. However, the sample of men included was diverse
with respect to the demographic variables assessed; for exam-
ple, the MSM’s sample age range is larger than that observed
The impact of male circumcision status on sexual partners
The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2 117
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in the female sample. Further, many of the effect sizes ob-
served in the male sample were of a size that suggests the
findings were robust. Therefore, the results pertaining to the
MSM sample reported in current study provides a valuable
contribution to the circumcision literature because it is the
first study – to our knowledge to explore the impact of cir-
cumcision status on a sample of men who have sex with men.
Although we observed several interesting effects within
this study, we are unable to infer causation behind such find-
ings. Future research exploring the impact of circumcision
status on men’s sexual partners should employ experimental
designs or qualitative methods to develop a greater under-
standing of the factors underlying participant’s responses.
Particular attention should be paid to the observed gender
differences, as well as the role of attitudes toward circumci-
sion status on study outcomes.
Conclusions
This study suggests that a man’s circumcision status plays a
role in the sexual life of his current partner, and this role
differs depending on the gender of that partner. This explora-
tory study demonstrated a general preference for circumcised
penises in the female sample recruited, and a preference for
intact penises in the male sample. Irrespective of individual’s
opinions about circumcision status, the presence or absence
of foreskin does not appear to impact sexual functioning for
women or men, although women with intact partners did re-
port significantly higher levels of sexual satisfaction compared
to women with circumcised partners. Furthermore, women
and men reported overall high satisfaction with their partner’s
genitals, and overwhelmingly reported that they did not wish
for a change in their partner’s circumcision status.
REFERENCES
American Academy of Pediatrics (2012). Male circumcision.
Pediatrics,130(3), e756–e785. http://dx.doi.org/10.1542/
peds.2012-1990
Bailey, R.C., Neema, S., & Othieno, R. (1999). Sexual behaviors and
other HIV risk factors in circumcised and uncircumcised men
in Uganda. JAIDS Journal of Acquired Immune Deficiency
Syndromes,22(3), 294–301. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/10770351. http://dx.doi.org/
10.1097/00126334-199911010-00012 Medline:10770351
Berman, L., Berman, J., Miles, M., Pollets, D., & Powell, J.A. (2003).
Genital self-image as a component of sexual health: relationship
between genital self-image, female sexual function, and quality of
life measures. Journal of Sex & Marital Therapy,29(sup1 Suppl
1), 11–21. http://dx.doi.org/10.1080/713847124
Medline:12735086
Binner, S.L., Mastrobattista, J.M., Day, M.C., Swaim, L.S., & Monga,
M. (2002). Effect of parental education on decision-making about
neonatal circumcision. Southern Medical Journal,95(4), 457–461.
http://dx.doi.org/10.1097/00007611-200204000-00016
Medline:11958247
Bossio, J.A., Pukall, C.F., & Steele, S. (2014). A review of the current
state of the male circumcision literature. Journal of Sexual
Medicine,11(12), 2847–2864. http://dx.doi.org/10.1111/
jsm.12703 Medline:25284631
CDC (2014). Recommendations for providers counseling male
patients and parents regarding male circumcision and the
prevention of HIV infection, STIs, and other health outcomes.
Available at: http://www.regulations.gov/#!documentDetail;
D=CDC-2014-0012-0003.
Coyne, K., Mandalia, S., McCullough, S., Catalan, J., Noestlinger, C.,
Colebunders, R., & Asboe, D. (2010). The International Index of
Erectile Function: development of an adapted tool for use in
HIV-positive men who have sex with men. Journal of Sexual
Medicine,7(2 Pt 1), 769–774. http://dx.doi.org/10.1111/j.1743-
6109.2009.01579.x Medline:19912494
Figueroa, J.P., & Cooper, C.J. (2010). Attitudes towards male cir-
cumcision among attendees at a sexually transmitted infection
clinic in Kingston, Jamaica. West Indian Medical Journal,59(4),
351–355. Medline:21355507
Frisch, M., Lindholm, M., & Grønbæk, M. (2011). Male circumcision
and sexual function in men and women: a survey-based, cross-
sectional study in Denmark. International Journal of Epidemiology,
40(5), 1367–1381. http://dx.doi.org/10.1093/ije/dyr104
Medline:21672947
Gonzales, F.A., Zea, M.C., Reisen, C.A., Bianchi, F.T., Betancourt
Rodrı
´guez, C.F., Aguilar Pardo, M., & Poppen, P.J. (2012).
Popular perceptions of circumcision among Colombian men who
have sex with men. Culture, Health & Sexuality,14(9), 991–1005.
http://dx.doi.org/10.1080/13691058.2012.712719
Medline:22917475
Halperin, D.T., Fritz, K., McFarland, W., & Woelk, G. (2005).
Acceptability of adult male circumcision for sexually transmitted
disease and HIV prevention in Zimbabwe. Sexually Transmitted
Diseases,32(4), 238–239. http://dx.doi.org/10.1097/
01.olq.0000149782.47456.5b Medline:15788922
Kebaabetswe, P., Lockman, S., Mogwe, S., Mandevu, R., Thior, I.,
Essex, M., & Shapiro, R.L. (2003). Male circumcision: an
acceptable strategy for HIV prevention in Botswana. Sexually
Transmitted Infections,79(3), 214–219. http://dx.doi.org/10.1136/
sti.79.3.214 Medline:12794204
Kigozi, G., Lukabwe, I., Kagaayi, J., Wawer, M.J., Nantume, B.,
Kigozi, G., ..., & Gray, R.H. (2009). Sexual satisfaction of women
partners of circumcised men in a randomized trial of male
circumcision in Rakai, Uganda. British Journal of Urology Inter-
national,104(11), 1698–1701. http://dx.doi.org/10.1111/j.1464-
410X.2009.08683.x Medline:19522862
Lagarde, E., Dirk, T., Puren, A., Reathe, R.T., & Bertran, A. (2003).
Acceptability of male circumcision as a tool for preventing HIV
infection in a highly infected community in South Africa. AIDS
(London, England),17(1), 89–95. http://dx.doi.org/10.1097/
00002030-200301030-00012 Medline:12478073
Larsen, G.L., & Williams, S.D. (1990). Postneonatal circumcision:
population profile. Pediatrics,85(5), 808–812. Medline:2330244
Lau, J.T.F., Zhang, J., Yan, H., Lin, C., Choi, K.C., Wang, Z., ..., &
Yang, H. (2011). Acceptability of circumcision as a means of HIV
prevention among men who have sex with men in China. AIDS
Care,23(11), 1472–1482. http://dx.doi.org/10.1080/
09540121.2011.565018 Medline:21732901
Jennifer A. Bossio et al.
118 The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2
http://www.utpjournals.press/doi/pdf/10.3138/cjhs.242-A2 - Jenn Bossio <jennifer.bossio@queensu.ca> - Thursday, August 13, 2015 8:14:55 AM - IP Address:67.68.0.231
Laumann, E.O., Masi, C.M., & Zuckerman, E.W. (1997). Circumci-
sion in the United States. Prevalence, prophylactic effects, and
sexual practice. Journal of the American Medical Association,
277(13), 1052–1057. http://dx.doi.org/10.1001/
jama.1997.03540370042034 Medline:9091693
Mao, L., Templeton, D.J., Crawford, J., Imrie, J., Prestage, G.P.,
Grulich, A.E., ...,&Kippax, S.C. (2008). Does circumcision make
a difference to the sexual experience of gay men? Findings from
the Health in Men (HIM) cohort. Journal of Sexual Medicine,
5(11), 2557–2561. http://dx.doi.org/10.1111/j.1743-
6109.2008.00845.x Medline:18422492
Masheb, R.M., Lozano-Blanco, C., Kohorn, E.I., Minkin, M.J., &
Kerns, R.D. (2004). Assessing sexual function and dyspareunia
with the Female Sexual Function Index (FSFI) in women with
vulvodynia. Journal of Sex & Marital Therapy,30(5), 315–324.
http://dx.doi.org/10.1080/00926230490463264 Medline:15672599
Mattson, C.L., Bailey, R.C., Muga, R., Poulussen, R., & Onyango,
T. (2005). Acceptability of male circumcision and predictors of
circumcision preference among men and women in Nyanza
Province, Kenya. AIDS Care,17(2), 182–194. http://dx.doi.org/
10.1080/09540120512331325671 Medline:15763713
McCreary, D.R., & Sadava, S.W. (2001). Gender differences in rela-
tionships among perceived attractiveness, life satisfaction, and
health in adults as a function of body mass index and perceived
weight. Psychology of Men & Masculinity,2(2), 108–116. http://
dx.doi.org/10.1037/1524-9220.2.2.108
Nelson, C.P., Dunn, R., Wan, J., & Wei, J.T. (2005). The increasing
incidence of newborn circumcision: Data from the nationwide
inpatient sample. Journal of Urology,173(3), 978–981. http://
dx.doi.org/10.1097/01.ju.0000145758.80937.7d Medline:15711354
O’Hara, K., & O’Hara, J. (1999). The effect of male circumcision on
the sexual enjoyment of the female partner. British Journal of
Urology International,83(S1 Suppl 1), 79–84. http://dx.doi.org/
10.1046/j.1464-410x.1999.0830s1079.x Medline:10349418
Oh, S.J., Kim, K.D., Kim, K.M., Kim, K.S., Kim, K.K., Kim, J.S., ..., &
Choi, H. (2002). Knowledge and attitudes of Korean parents
towards their son’s circumcision: a nationwide questionnaire
study. British Journal of Urology,89(4), 426–432. http://
dx.doi.org/10.1046/j.1464-4096.2001.01964.x Medline:11872037
Payne, K., Thaler, L., Kukkonen, T., Carrier, S., & Binik, Y. (2007).
Sensation and sexual arousal in circumcised and uncircumcised
men. Journal of Sexual Medicine,4(3), 667–674. http://dx.doi.org/
10.1111/j.1743-6109.2007.00471.x Medline:17419812
Peplau, L.A., Frederick, D.A., Yee, C., Maisel, N., Lever, J., &
Ghavami, N. (2009). Body image satisfaction in heterosexual, gay,
and lesbian adults. Archives of Sexual Behavior,38(5), 713–725.
http://dx.doi.org/10.1007/s10508-008-9378-1 Medline:18712469
Rain-Taljaard, R.C., Lagarde, E., Taljaard, D.J., Campbell, C.,
MacPhail, C., Williams, B., & Auvert, B. (2003). Potential for an
intervention based on male circumcision in a South African town
with high levels of HIV infection. AIDS Care,15(3), 315–327.
http://dx.doi.org/10.1080/0954012031000105379
Medline:12828151
Rediger, C., & Muller, A.J. (2013). Parents’ rationale for male
circumcision. Canadian Family Physician,59(2), e110–e115.
Medline:23418252
Richters, J., Smith, A.M., de Visser, R.O., Grulich, A.E., & Rissel, C.E.
(2006). Circumcision in Australia: prevalence and effects on
sexual health. International Journal of STD & AIDS,17(8), 547
554. http://dx.doi.org/10.1258/095646206778145730
Medline:16925903
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh,
R., . . . , & D’Agostino, R., Jr. (2000). The Female Sexual Function
Index (FSFI): a multidimensional self-report instrument for the
assessment of female sexual function. Journal of Sex & Marital
Therapy,26(2), 191–208. http://dx.doi.org/10.1080/
009262300278597 Medline:10782451
Scott, B.E., Weiss, H.A., & Viljoen, J.I. (2005). The acceptability of
male circumcision as an HIV intervention among a rural Zulu
population, Kwazulu-Natal, South Africa. AIDS Care,17(3), 304–
313. http://dx.doi.org/10.1080/09540120412331299744
Medline:15832878
Sorrells, M.L., Snyder, J.L., Reiss, M.D., Eden, C., Milos, M.F.,
Wilcox, N., & Van Howe, R.S. (2007). Fine-touch pressure
thresholds in the adult penis. British Journal of Urology,99(4),
864–869. http://dx.doi.org/10.1111/j.1464-410X.2006.06685.x
Medline:17378847
Stoner, B.P., Whittington, W.L.H., Aral, S.O., Hughes, J.P., Hands-
field, H.H., & Holmes, K.K. (2003). Avoiding risky sex partners:
perception of partners’ risks v partners’ self reported risks.
Sexually Transmitted Infections,79(3), 197–201. http://
dx.doi.org/10.1136/sti.79.3.197 Medline:12794201
Tiemstra, J.D. (1999). Factors affecting the circumcision decision.
Journal of the American Board of Family Practice,12(1), 16–20.
http://dx.doi.org/10.3122/15572625-12-1-16 Medline:10050639
Tsela, S., & Halperin, D.T. (2006). Knowledge, attitudes and practices
regarding male circumcision in the Manzini (central) region of
Swaziland. In The XVI international AIDS conference. Toronto,
Canada.
Walton, R.E., Ostbye, T., & Campbell, M.K. (1997). Neonatal male
circumcision after delisting in Ontario. Survey of new parents.
Canadian Family Physician,43, 1241–1247. Medline:9241462
Weiderman, M.W. (2012). Body image and sexual functioning.
In T.F. Cash (Ed.), Encyclopedia of Body Image and Human
Appearance (pp. 148–152). San Diego: Academic Press. http://
dx.doi.org/10.1016/B978-0-12-384925-0.00022-5.
Westercamp, N., & Bailey, R.C. (2007). Acceptability of male
circumcision for prevention of HIV/AIDS in sub-Saharan Africa:
a review. AIDS and Behavior,11(3), 341–355. http://dx.doi.org/
10.1007/s10461-006-9169-4 Medline:17053855
Williamson, M.L., & Williamson, P.S. (1988). Women’s preferences
for penile circumcision in sexual partners. Journal of Sex Educa-
tion and Therapy,14, 8–12.
Xu, B., & Goldman, H. (2008). Newborn circumcision in Victoria,
Australia: reasons and parental attitudes. Australian and New
Zealand Journal of Surgery,78(11), 1019–1022. http://dx.doi.org/
10.1111/j.1445-2197.2008.04723.x Medline:18959705
The impact of male circumcision status on sexual partners
The Canadian Journal of Human Sexuality 24(2), 2015, pp. 104–119; doi:10.3138/cjhs.242-A2 119
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... Researchers in Canada noted that bias arising from the flawed study design and poorly framed questions caused this particular study to lack credibility, 20 and an opponent of MC in Denmark cautioned that the findings should be viewed with skepticism. 22 A more detailed critique stated that the first author revealed that "she conducted the study, not to understand the effects of circumcision, but to advance a personal crusade to end circumcision," doing so by "making this a women's issue." ...
... A Canadian study of women aged 19e71 years, 74% of whom were born in Canada and 12% in the United States, and 61.2% of whom had attended college or university, found that most held more positive feelings and beliefs about circumcised penises. 20 Stated preferences were 68% for the circumcised penis, 6% for the uncircumcised penis, and 26% for either ( Figure 2). The majority of women preferred the appearance of the circumcised flaccid penis (P ¼ .03), ...
... Williamson and Williamson asked "what is sexier about a circumcised penis?" 17 They suggested that "visualizing the glans, the urinary meatus, and the corona without these being hidden under a foreskin is arousing," and noted that exposure of these structures is the case for an erect penis. In support of this idea, Bossio et al 20 found that although women preferred the appearance of the circumcised penis when flaccid, their preference for the erect penis was similar whether circumcised or uncircumcised. According to Williamson and Williamson, "while the foreskin of an uncircumcised penis can be retracted, the circumcised penis exists in exposed beauty whether flaccid or erect." ...
Article
Full-text available
Introduction: Women's choices for a sexual partner are influenced by numerous personal, cultural, social, political and religious factors, and may also include aspects of penile anatomy such as male circumcision (MC) status. Aim: To perform a systematic review examining (i) whether MC status influences women's preference for sexual activity and the reasons for this, and (ii) whether women prefer MC for their sons. Methods: PRISMA-compliant searches were conducted of PubMed, Google Scholar, Embase, and the Cochrane Database of Systematic Reviews. Articles that met the inclusion criteria were rated for quality using the SIGN system. Results: Database searches identified 29 publications with original data for inclusion, including 22 for aim (i) and 4 of these and 7 others pertaining to aim (ii). In the overwhelming majority of studies, women expressed a preference for the circumcised penis. The main reasons given for this preference were better appearance, better hygiene, reduced risk of infection, and enhanced sexual activity, including vaginal intercourse, manual stimulation, and fellatio. In studies that assessed mothers' preference for MC of sons, health, disease prevention, and hygiene were cited as major reasons for this preference. Cultural differences in preference were evident among some of the studies examined. Nevertheless, a preference for a circumcised penis was seen in most populations regardless of the frequency of MC in the study setting. Conclusion: Women's preferences generally favor the circumcised penis for sexual activity, hygiene, and lower risk of infection. The findings add to the already well-established health benefits favoring MC and provide important sociosexual information on an issue of widespread interest. Morris BJ, Hankins CA, Lumbers ER, et al. Sex and Male Circumcision: Women's Preferences Across Different Cultures and Countries: A Systematic Review. Sex Med 2019;7:145-161.
... However, female respondents to cross-sectional surveys in other settings-Canada [50], Denmark [45], and an unspecified location [46]-reported significantly higher satisfaction with uncircumcised partners. Two of these studies recruited volunteers using advertisements, one including placement in an anti-circumcision newspaper [46], though respondents in the other conversely expressed a preference for circumcised partners [50]. ...
... However, female respondents to cross-sectional surveys in other settings-Canada [50], Denmark [45], and an unspecified location [46]-reported significantly higher satisfaction with uncircumcised partners. Two of these studies recruited volunteers using advertisements, one including placement in an anti-circumcision newspaper [46], though respondents in the other conversely expressed a preference for circumcised partners [50]. The third was a nationally representative survey in Denmark [45]. ...
... However, all three cross-sectional publications presented data on individual components of sexual function, which were not prespecified outcomes: orgasm ease, arousal, pain, and lubrication. The Canadian publication [50] reported nonsignificant and minimal differences for orgasm ease, arousal, pain, and lubrication, with slightly better outcomes for circumcised partners for the first two and for uncircumcised partners for the second two. The studies from Denmark and an unspecified location did not examine arousal but reported improved outcomes with uncircumcised partners with the other metrics. ...
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Male circumcision (MC) is a key HIV prevention intervention for men in countries with high HIV prevalence. Women’s understanding of MC is important but poorly understood. We conducted a systematic review including women’s knowledge of MC’s biomedical impacts and its association with female sexual satisfaction and function through October 2017. Thirty-eight articles were identified: thirty-two with knowledge outcomes, seven with sexual satisfaction, and four with sexual function (N = 38). Respondent proportions aware MC protects men from HIV were 9.84–91.8% (median 60.0%). Proportions aware MC protects men from STIs were 14.3–100% (72.6%). Proportions aware MC partially protects men from HIV were 37.5–82% (50.7%). Proportions aware MC is not proven to protect women from infection by an HIV-positive partner were 90.0–96.8% (93.0%). No increases over time were noted. Women’s MC knowledge is variable. Education could help women support MC and make better-informed sexual decisions.
... Partner perceptions of circumcision status may also be a contributing factor in the development of men's self-perceived genital image. Some studies suggest that female partners of men prefer the appearance of the circumcised penis (Bossio, Pukall, & Bartley 2015;Masood et al., 2005). Only a single study has explored men's opinions about their samesex partner's circumcision status (Bossio et al., 2015). ...
... Some studies suggest that female partners of men prefer the appearance of the circumcised penis (Bossio, Pukall, & Bartley 2015;Masood et al., 2005). Only a single study has explored men's opinions about their samesex partner's circumcision status (Bossio et al., 2015). In this study, men rated a strong preference for intact partners, irrespective of the rater's own circumcision status or sexual performance. ...
... Indeed, circumcision status did significantly differ based on geographical region, such that higher rates of intact men were from Western Europe, followed by Canada, and least reported being from the US, which is consistent with rates of circumcision (WHO, 2007). Higher rates of genital self-image in intact men within this sample of men should be interpreted with caution, however, as the effect size was very small and may be influenced by other factors not tested in this study, such as personal attitudes toward one's circumcision status, partners' attitudes toward one circumcision status (Bossio et al., 2015), or a cohort effect (indeed, age was significantly correlated with circumcision status). Overall, genital self-image was relatively high irrespective of circumcision status, indicating that although circumcised men reported lower genital self-image, it was not sufficiently low as to suggest that these men were overly distressed by their genital image. ...
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Factors that contribute to men's genital self-image are not well known, despite the documented psychological importance of body image more broadly. The current study used a simultaneous multiple regression to examine the relationship(s) between genital self-image, body image, pornography use, circumcision status, age, and social appearance anxiety among men from different geographic locations, and of differing sexual orientations (N=674). Participants were recruited from Canada (n=285), the United States (n=214), and Western Europe (n=121) through online recruitment methods. A total of 372 gay men/other men who have sex with men (MSM) and 302 heterosexual men were included in the present analyses. Men's genital self-image was significantly predicted by self-perceived body image and social appearance anxiety. Further univariate and multivariate analyses discussed include age, sexual orientation, country of origin, solo porn use, and circumcision status. Implications of the continued importance of parsing the differences between genital self-image and related variables for understanding sexual functioning and overall self-esteem are discussed.
... We draw the reader's attention to a screenshot of a post on "the WHOLE Network" (an anti-MC website) flagging Bossio's call for participants and inviting MC opponents to participate (see screenshot in reference [51]). Bossio's later data published in peer-reviewed journals [52] [53] were not, however, cited by H&C. They fail, moreover, to H&C then allude to (alleged) "functions" of the foreskin, but they do not offer a single example. ...
... But H&C speculate that the findings indicate that "Some circumcised men resort to oral/anal sex to compensate for penile desensitisation when vaginal intercourse is insufficiently stimulating."A reason for more frequent fellatio may be because of the strong preference by women for a circumcised penis for such activity, as found in a recent systematic review of all studies [105], and by Bossio et al. in her study [52]. Better health and hygiene (no smegma) appear to be major reasons. ...
... Summary of included articles [87][88][89] ...
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Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.
... Second, it is suggested that large numbers of people are unhappy with their circumcisions (Hammond and Carmack 2017), many of whom are taking steps to reverse the procedure. Studies suggest that women (at least in North America) prefer circumcised male partners and that men prefer uncircumcised partners (Bossio et al. 2015;Morris et al., 2019b). There is no suggestion that the resulting differences in sexual satisfaction are often more than minor. ...
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European culture and thought have long disfavored ritual child circumcision, which is obligatory to Jews and Muslims. Much opposition to this practice hinges on the notion that it represents an unwarranted unconsented physical assault on the child. This article takes issue with that conclusion. Furthermore, even if one were to grant this conclusion, the offense is not of sufficient magnitude to warrant government action to halt the practice. On the other hand, suppression of ritual child circumcision may represent an attack against cultures and societies in which circumcision is practiced.
Chapter
Circumcision consists of removal of the male prepuce (foreskin), leaving the penile glans (head) intact. Over a billion men alive today have undergone circumcision. The procedure has been widely performed for at least four millennia, largely as a religious or cultural rite. Performed on a healthy young boy under reasonably hygienic conditions, circumcision carries minimal risk of severe injury. There is no convincing evidence that it is a significant cause of urinary, reproductive, or sexual dysfunction. This chapter reviews the evidence on both sides of the circumcision debate. The chapter rejects or refutes deontic arguments against circumcision. Finding no strong evidence that childhood circumcision is a health risk, the chapter applies the State Intervention Test and finds that state interference with parental authorization of circumcision falls outside appropriate state scope of action.
Article
Societal perspectives on male circumcision and its implications are not well understood. In this exploratory qualitative study, participants (N = 34, 7 male, 27 female) enrolled in a human sexuality course were asked to share their perspectives on male circumcision through the development of a written response to open-ended questions. Written responses were analyzed using qualitative thematic analysis to determine the ways in which participants perceive male circumcision, as well as to explore the arguments, contradictions, and rationalizations emerging adults use to justify it. Participants were largely in support of circumcision and believe it to be beneficial in terms of hygiene, esthetics, social acceptability, and tradition. Participants acknowledged the risks of circumcision and rationalized them, indicating they were in favor of the procedure and would circumcise their own sons despite limited knowledge of the benefits and drawbacks. Findings indicate emerging adults do not often discuss male circumcision and do not carefully consider the procedure, perhaps due to the widespread belief that circumcision is a social norm that should not be questioned. Despite this lack of discussion or formal education on the topic, most of the emerging adults did express strong opinions in favor of circumcision based on their personal experiences and social interactions.
Article
General purpose: To increase health care professionals' awareness and perceptions of the skin as one of the largest body organs with multidimensional aspects and significant implications for interprofessional collaboration in whole-person care. Target audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. Learning objectives/outcomes: After participating in this educational activity, the participant should be better able to:1. Apply physiologic and integumentary knowledge to assessing common skin variations and problems.2. Summarize the results of the authors' literature review of the evidence regarding the emotional, psychosocial, cultural, and spiritual aspects of skin health and disorders. Abstract: The skin reflects not only a person's physical state of health, but also the dynamic interplay of emotional and cultural influences. This article will increase health practitioner understanding of the skin and skin assessment by highlighting its multidimensional aspects and significant implications for interprofessional collaboration in whole-person care. Through a multidimensional assessment of the skin, practitioners can better understand the health story of each patient and intervene holistically to improve overall well-being and quality of life.
Article
This article argues that to understand the role and place of the foreskin, we must address the aesthetic question that sits at its root. North American media often describe the foreskin as “ugly,” “gross,” or pejoratively “European”; all of which present, fundamentally, an aesthetic comment on what is pleasing. As such, this article investigates the aesthetic discourse surrounding the foreskin in relation to a range of materials that speak at or around the foreskin. In particular, it looks at sources deemed to be “common”—sex manuals, pregnancy manuals, and film and television—alongside theoretical and scientific studies. Undertaking a close reading of these materials, this article sheds light on the striking similarities that these distinct bodies of literature share and the way that aesthetics undergirds their arguments, often as a silent statement rather than exerted forcefully. Through this argument, this article breaks new ground on the way that we consider the foreskin, and, importantly, the aestheticization processes that shape our understanding of this seemingly ancillary component of the penis. Accordingly, this article contributes to a growing body of scholarship on the politics of the foreskin and circumcision by shifting the debate to consider the aesthetic.
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To determine which factors parents consider to be most important when pursuing elective circumcision procedures in newborn male children. Prospective survey. Saskatoon, Sask. A total of 230 participants attending prenatal classes in the Saskatoon Health Region over a 3-month period. Parents' plans to pursue circumcision, personal and family circumcision status, and factors influencing parents' decision making on the subject of elective circumcision. The reasons that parents most often gave for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer (44.8%), and the father being circumcised (40.9%). The reasons most commonly reported by parents for not supporting circumcision were it not being medically necessary (32.0%), the father being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%). Of all parents responding who were expecting children, 56.4% indicated they would consider pursuing elective circumcision if they had a son; 24.3% said they would not. In instances in which the father of the expected baby was circumcised, 81.9% of respondents were in favour of pursuing elective circumcision. When the father of the expected child was not circumcised, 14.9% were in favour of pursuing elective circumcision. Regression analysis showed that the relationship between the circumcision status of the father and support of elective circumcision was statistically significant (P < .001). Among couples in which the father was circumcised, 82.2% stated that circumcision by an experienced medical practitioner was a safe procedure for all boys, in contrast to 64.1% of couples in which the father of the expected child was not circumcised. When the expecting father was circumcised, no one responded that circumcision was an unsafe procedure, compared with 7.8% when the expecting father was not circumcised (P = .003). Despite new medical information and updated stances from various medical associations, newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father.
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Male circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among men who have sex with men is limited. Men who have sex with men in Bogotá, Colombia, either participated in a focus group in which they shared information regarding their perceptions of circumcision or completed a survey that assessed circumcision experiences, attitudes, beliefs and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus-group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus-group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed and recovery time minimised.
Article
In this article, body image is conceptualized as both self-perceived attractiveness and perceptions regarding one’s own genitals. Sexual functioning is conceptualized as both overall sexual experience and the degree to which the individual functions satisfactorily within a particular sexual interaction with a partner, including negotiation of safer sexual activities. The limited research on the intersection of these concepts has been based most often on heterosexual college student participants in the United States, leaving many important questions unanswered. In addition to drawing conclusions based on review of the existing research, important directions for future research are considered.
Article
Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP's 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association's template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners' competency in discussing circumcision's benefits and risks with parents.
Article
Introduction: Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Association of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results. Aims: The purpose of this review is to draw attention to the gaps within the circumcision literature that need to be addressed before significant changes to public policy regarding neonatal circumcision are made within North America. Methods: A literature review of peer-reviewed journal articles was performed. Main outcome measures: The main outcome measure was the state of circumcision research, especially with regard to new developments in the field, as it applies to North American populations. Results: This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men's sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes. Conclusion: Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.
Article
Objective. —To assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision. Design. —An analysis of data from the National Health and Social Life Survey. Participants. —A national probability sample of 1410 American men aged 18 to 59 years at the time of the survey. In addition, an oversample of black and Hispanic minority groups is included in comparative analyses. Main Outcome Measures. —The contraction of sexually transmitted diseases, the experience of sexual dysfunction, and experience with a series of sexual practices. Results. —We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases. However, uncircumcised men appear slightly more likely to experience sexual dysfunctions, especially later in life. Finally, we find that circumcised men engage in a more elaborated set of sexual practices. This pattern differs across ethnic groups, suggesting the influence of social factors. Conclusions. —The National Health and Social Life Survey evidence indicates a slight benefit of circumcision but a negligible association with most outcomes. These findings inform existing debates on the utility of circumcision. The considerable impact of circumcision status on sexual practice represents a new finding that should further enrich such discussion. Our results support the view that physicians and parents be informed of the potential benefits and risks before circumcising newborns.
Article
Research has shown that adolescent boys are more likely than girls to perceive themselves as underweight, whereas normal-weight girls are more likely than boys to perceive themselves as overweight. We extended this research to adults and explored relationships among gender, relative weight, and perceived weight and attractiveness, life satisfaction, and health. Data were obtained from the Niagara Young Adult Health Study, a community-based sample of 813 men and women 19–39 years old. Although men were more likely to be overweight, many thought they were lighter than they were. Although women were more likely to be underweight or normal weight, many thought they were heavier than they were. Overweight men rated themselves as more attractive and healthier compared to overweight women. Underweight women rated themselves as more attractive and healthier compared to underweight men. Why body weight misperceptions should be studied further was explored. (PsycINFO Database Record (c) 2012 APA, all rights reserved)