The male prepuce, or foreskin, is a highly mobile and extraordinarily sensitive double fold of tissue that is the end of the penis. Why do Americans go out of their way to remove this part of human anatomy, when the rest of the world does not?
Note: Never have I gotten so many comments and emails in response to a blog post, much less rumors that I’m a man. I’ll keep that in mind. And for the record, it wasn’t until 2014 that I had the opportunity to put a man’s intact penis in my very much female vagina. This frictionless appendage made me realize that sex doesn’t have to be painful or cause hazardous inflammation. And with that image in your mind…
I was nineteen or twenty years old when a male friend of mine, we’ll call him Bill, let me in on a most shocking fact: He was missing part of his penis, and so were almost all boys and men that I had ever seen in my entire life, as well as all the anatomical diagrams that I had ever seen. Ever.
Sure, I had heard of circumcision as a Jewish religious practice, but thought myself unlikely to ever see its results. Little did I know, all the male genitalia I had seen both in real life and as depicted in American anatomy books, had been edited in exactly the same way. The shock from this revelation overwhelmed me for weeks, especially since I considered myself to be fairly knowledgeable about anatomy. (My interests included biology and drawing biological structures).
Why would anyone selectively remove foreskins, not just from real people but from scientific anatomical texts, which I had thought were meant to represent the natural human form? And why did no one ever tell me about this? It was as though a basic feature that males (of all mammals) are normally born with was not to be understood or even acknowledged.
I spent the next few weeks at the local library, immersing myself in primary and secondary source materials on the relevant anatomy, medicine and history, before I was satisfied that I had an accurate understanding of what was going on. To summarize what I had found:
- The foreskin (or prepuce) is a man’s most sensitive erogenous zone, more well-developed in humans than in other species of mammal. It has unique sexual functions (more on that later), which circumcision effectively destroys — and this is intentional:
- Although foreskin-chopping was once a purely religious or cultural practice, it was introduced to American medicine in the late 1800s, as a ‘cure-all’, thanks to the trend of pathologizing (treating as illness) normal human sexuality and healthy genitalia.
At the time, many doctors believed that sexual stimulation and ejaculation literally drained men of their vitality and caused all manner of illnesses and mental problems. Semen was thought to take a lot of blood to make, and losing one ounce was considered the equivalent of losing a quart of blood. Painfully severing the man or boy’s most erogenous zone was recommended, and in orphanages, it was more common to sever the penile nerve as well. This was meant to traumatize and discourage him from masturbating, lest his health deteriorate from excessive ejaculations (which was diagnosed as “spermatorrhea”).
There were many quack remedies in the 1800s to improve men’s virility and erections, and to keep them from losing semen via masturbating and nocturnal emissions. This was not considered a contradiction because a man’s purpose was thought to be saving his sperm for making babies.
This may be a shock to some, although my readers may be more familiar with the ancient belief that women suffered from a vague illness called “hysteria”, especially if they experienced such “symptoms” as sexual desire and vaginal lubrication. Typically, this was a “disorder” of women who didn’t have husbands, or whose husbands left them wanting in bed, and it was thought that the buildup of sexual fluids such as “female sperm” (ejaculate) were poisoning them. In order to relieve “hysteria” symptoms, the two-thousand year old wisdom of treating it involved “massage” techniques of the “womb” (vulva), in order to induce a “hysterical paroxysm” (orgasm).
For doctors in the 1800s, this was hard work, so often they recommended a midwife to do this, and later on invented a number of vibrators and water jets that were much more effective. The fact that vibrators were the fifth household appliance to become electrified is a testament to the pathologization of women’s sexuality, not to their sexual freedom, as is popularly imagined. (That part happened later.)
Importantly, this treatment was not openly considered to be sexual because it did not involve penetration, thanks to the male-centered view of sex. This is how masturbation (that is, without a medically-sanctioned device) could be thought of as causing illness in females. However, there was another, less popular “treatment” to discourage “irritation” and “over-stimulation” in females — excision of the external clitoris. In other words, medicalized ‘female circumcision’. Various forms of this practice appeared sporadically until the 1970s, and were even funded by Medicaid and promoted for the same reasons as male circumcision (appearance, cleanliness, health, etc).
It may come as a shock to find that in the U.S., many widespread popular beliefs about the penis today are actually based on the same Victorian Era quackery rather than medical science. Indeed, the non-therapeutic circumcision of infant boys has continued to be medicalized in the U.S., and to a lesser extent in Canada, due to such persistent beliefs. Thanks to Lewis Sayre, notable surgeon and pro-circumcision quack of the 1870’s, one example is the pathologization of completely normal infant foreskins.
This continues today in hospitals, thanks to continued ignorance about penile gross anatomy: attempts to ‘fix’ the child’s normal foreskin often result in severe injury and pain. More about this shortly.
Non-therapeutic circumcision of boys by medical professionals did spread to a few other countries — most of which have long rejected it on the grounds that it is extremely harmful, with no significant medical benefit. As for the few cultures that continue to give routine infant penis-reductions a veil of medical validation, the justifications for it depend on the culture and era. In other words, it is based on local beliefs, not science. The scientific literature reveals the physical, neurological, and psychological harms of this tradition, but these are creatively ignored or glossed-over in much of the U.S. medical community.
This past April 28th, the Seattle Atheists invited John Geisheker to correct some of these myths. He is Executive Director and General Counsel for Doctors Opposing Circumcision (DOC), an organization which opposes the unnecessary genital surgery of any child.
His presentation was video-recorded and uploaded on YouTube, so if you’re interested, you can open the link in a new tab before reading on:
I have handily rehashed most of what he says in the rest of my article, partly thanks to the notes I took — which you can see me doing in the center of the frame.
So, how did an anti-sexuality practice of the Victorian Era ever become normalized and progressive? And, what was missing from all those anatomy books, anyway? Even anatomy books I’ve seen that include the foreskin do not have a detailed visual representation of it, nor do they have much description beyond saying that’s skin that covers the tip of the penis. But it isn’t.
An anatomy lesson that a medical professional should not need:
While Europeans, Chinese, Japanese, and most other people may wonder why anyone would need to explain this most mundane fact, the truth is that the foreskin is not well-understood in U.S. culture and medicine. One of Geisheker’s jobs is tracking cases of American doctors who are so outrageously ignorant of intact penile anatomy that they cause serious pain and injury, usually to infants.
They don’t even know the following basic facts, so read carefully:
- At birth, a boy’s foreskin is fused to his glans via a membrane called the balano-preputial lamina (BPL). Much like the membrane that fuses the fingernail to the finger, it acts as a living ‘glue’.
- The same is true of the prepuce and glans of the clitoris: The female foreskin is also called the ‘clitoral hood’.
- Over the years, little ‘pearls’ of the membrane die off, thus gradually separating the foreskin and glans, creating the preputial space. (This is also true of the clitoris.)
- In 2012, the AAP’s recommendation for cleaning babies’ foreskins is to retract them — thus tearing the foreskin and glans apart — and to wash the bleeding wound with soap and water.
- The soap, of course, causes inflammation and can lead to infections and other serious problems. Yes, this is an erroneous example of “medical advice” for infants in the U.S., although in most of the world, the advice is, basically, “leave it alone, it takes care of itself.”
- In fact, a male should not use soap beneath his foreskin for the same reason that a female should not wash her own internal bits with it: It changes the pH of those areas and causes inflammation, which can lead to imbalances of microflora and infection.
The AAP also said that “adhesions” (the natural fused condition of the foreskin) will “resolve” by 2 to 4 months of age. As I’ve mentioned, the foreskin doesn’t fully retract until around puberty, when the boy is most ready to use it.
“I just find this astonishing,” says Geisheker, of the fact that there are still medical professionals who don’t understand this ordinary, basic bit of anatomy.
So, how did all this ignorance start, anyway?
A Unique Erogenous Zone
Although the technical details are known today, the foreskin was already well-understood by Renaissance anatomists as to be the most erogenous part of the penis, while the glans was known to be the dullest. This knowledge carried on into the 1800s, which is why the Americans (and later, other Anglophones) targeted it in their anti-masturbation crusade. Let’s take a look at its role in sexual function, as understood by modern medical science:
The Semmes-Weinstein esthiometer is used to test skin sensitivity for patients with burns or neuropathy. The readings from a man’s foreskin, particularly the mucus membrane of the ‘lip’ and inner surface, go off the high end of the scale.
A 2007 study, published in BJU international, mapped the fine-touch sensitivity regions on circumcised versus intact penises, concluding that:
“The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.” (Emphasis mine.)
The authors’ fine-touch maps can be seen below, but first a bit of explanation about what is pictured in their illustration.
The foreskin is packed with fine-touch nerve endings called Meissner’s corpuscles. You can sort coins by feeling the edges using the front of your hands, which are dense with Meissner’s corpuscles, whereas this is not true for the backs of your hands. In the U.S., the glans is popularly imagined to be the most sensitive part of the penis, but in fact it is dominated by free nerve endings, which primarily sense pain. It has about the same fine-touch sensitivity as your earlobe, and wouldn’t be of much use for penile coin-sorting (if you’re into that). The glans is less of an erogenous zone and more of a device to hold the foreskin in its proper shape and to keep the inner surface moist: Its presence only makes functional sense when one considers it is meant to work with the foreskin.
- As the penis becomes erect, the foreskin is pulled back, rolling inside-out, everting its most sensitive areas, and (usually) exposing the glans. It can also be retracted simply by pulling the skin of the shaft toward the body. (You can view an animation and videos here.)
- When fully retracted, the foreskin is just about sufficient to cover the entire shaft: Although the length varies, it makes up approximately one half of the skin on the penis.
- What is removed by circumcision is about three inches long and five inches in circumference — think of a 3×5 index card. That’s the actual size. Although it is sometimes described as a ‘tiny little piece of skin’, this is only true of tiny little infants, not sexually active men.
- The most erogenous tissue of the foreskin is to be found in the frenulum and ridged band. A frenulum is a cord-like fusion of flesh which holds a moving structure to a fixed structure, like the one found under your tongue.
- The penile frenulum anchors the foreskin to the underside of the glans and is highly sensitive to stretching (which it does a lot of during intercourse and masturbation). It is partly or totally removed with circumcision.
I have also learned of many pleasurable acts that can be done with a foreskin that circumcised males cannot do. For example, a partner can pull the foreskin forward over the glans and slip his/her tongue between them, thus stimulating two surfaces at once. Another technique involves pulling the foreskin forward and outward and directing a jet of water to flow underneath it. Even just pinching the foreskin shut during urination, allowing it to ‘balloon’, activates its stretch sensors in an unusual way (this also can happen naturally when a boy’s foreskin is partially separated, which is harmless, but sometimes confounds parents). Such inflation can also be achieved with air — a different type of “blow job”, shall we say? It is also possible to use the muscular tip to stimulate the nipples, clitoris, or other parts of the partner. In the case of male-on-male sex, there is the practice of ‘docking’, which means to pull the foreskin forward so that it envelops the partner’s glans. If both partners are intact, they can do ‘double-docking’, with one foreskin within the other. In fact, stimulating only the most erogenous areas are enough to elicit an orgasm. Indeed, the foreskin is thought to play an important role in controlling and modulating male orgasm.
Geisheker challenges the audience to find a book in the University of Washington medical library that says the foreskin is the seat of sexual sensation. Most medical books do, but all the books at UW he has seen have incorrectly said it is the glans.
This is also what Bill had told me, back in 2002, after revealing his shocking news. (But who could blame him? He got that from a medical text!) He also said that the foreskin was the least sensitive part of the penis, which is also a common belief I have heard. He insisted that the part’s only function was to protect the glans, and is no longer needed because humans wear clothes. What I discovered at the library was that the glans is covered in mucus membrane and is meant to be an internal structure which can be exposed, like the tongue. When left exposed to the outside world for weeks, the glans develops a layer of dead, dry skin — especially when there is clothing rubbing against it — thus blocking the sensitivity of the underlying nerves. If the foreskin is restored and the glans is re-internalized, this callus will actually dissolve within two weeks, improving sensitivity. (BTW, this can be done via ‘tugging’ devices or even tape, which expand the tissue without surgery. Such techniques are becoming popular as awareness of these facts spreads).
Bill had been right in saying that the foreskin has a protective function, but he was wrong about the details: One aspect of this function involves the dartos fascia, the layer of muscle fibers that pulls the scrotum towards the body. As I have hinted at already, this layer is also found in the foreskin, which allows it to close over the glans and pull it inward. This is handy in cold water, and even helps to prevent frostbite. The smegma of the inner surfaces also contains chemicals and immune cells which protect the penis from microorganisms and viruses. For more information (and citations) on foreskin functions, you may want to start here.
To say that circumcision has no effect on sexual pleasure or function is to be dishonest about how the penis works, or neurology, for that matter. Indeed, removing such an extensive amount of penile nerve feedback can cause a number of problems, from erectile dysfunction to premature ejaculation, which are more common among circumcised men, and which can develop in men after circumcision. Other problems include tingling, numbness, a significant decrease in sexual sensation, and even debilitatingly painful over-sensitivity. Results vary because the cause involves destroying and damaging complex, densely-innervated structures, the remainder of which must then heal and re-wire themselves to the brain in one fashion or another.
Although the literature shows that men who are circumcised work harder for sexual satisfaction, and to this end must practice more types of stimulation, this is re-interpreted by pro-circumcision advocates to mean that circumcised men have more fun and get more oral sex.
At TAM 2012, I talked to a man from Denmark, who told me that some girls get the idea from American porn that vigorous motion and lots of lubricant is needed to stimulate a man. As they become more experienced with Danish men, who are almost all intact, they find this not to be the case. I actually wrote about this encounter near the bottom of this post. Indeed, there are a few studies that purport to show that circumcision has no effect on penile sensitivity or sexual function. That is because of fatal design flaws, including that the scientists are measuring everything but the foreskin.
What they found was that the sensitivity of the glans and shaft skin are not that much different whether or not you have a foreskin, yet they are completely silent about the sensation that comes from the foreskin itself. So, nearly half the penis’ sensitivity is entirely omitted and ignored, rendering this research worthless. To conclude that removing the foreskin doesn’t affect the penis is to pretend that the foreskin