Foreskin, or not to foreskin, that is the question...

Each semester I have my students ask questions at the beginning of class that they hope to have answered, and again at the end of class to share what questions remain unanswered. The following question related to circumcision and foreskin jumped out at me, because it is a common question each semester.

Can you feel the difference when having sex with a guy who is circumcised compared to a guy who is not?

Let me clarify, this is a general question from a student, not directed at me specifically. Since the students share these questions anonymously, my best guess is that this question is from a female student. I will definitely NOT be sharing any of my own personal information, but will share what I've discovered in research. I will address this mainly from a heterocentric viewpoint, solely based on the fact that the primary research I've discovered is quite heterocentric. However, my best guess is that the information shared here could relate to anal, oral and manual sexual encounters as well.

What is the foreskin? What is the difference between circumcised and not circumcised?
Before we can answer the student's much more interesting question, we must briefly discuss what it means to be circumcised, or not. Almost all males are born with a foreskin. The foreskin is a covering to the male penis and glans area. This sheathlike covering is retractable, typically around puberty, and is comprised mainly of an outer skin layer, an inner layer of mucous membrane and rich tactile nerve endings. Foreskin is notably elastic and naturally retracts and glides during sexual intercourse.

The purpose of the foreskin is greatly debated, but appears to have the function of protecting the penis, keeping the external penile tissue lubricated and soft, likely increasing sensation during sexual arousal and intercourse, and possibly facilitating lubrication in the female during intercourse. (Taylor, J., Lockwood, A., & Taylor, A. (1996, February). The prepuce: Specialized mucosa of the penis and its loss to circumcision. British Journal of Urology, 77, pp291-295).

Male circumcision in the United States is typically performed in infancy. Circumcision is a surgical procedure to remove the prepuce from the penis. There is some debate about whether the infants will remember any pain associated with the procedure, but analgesics are currently recommended by the American Academy of Pediatrics (AAP).

The Politics of Circumcision
The topic of circumcision itself is highly political and highly charged with emotion. The American Academy of Pediatrics (AAP) has been consistent throughout the decades (1971 forward) on its stance that there are "no valid medical indications for circumcision during the neonatal period". In 1977 they AAP proclaimed a similar stance that for other than non-therapeutic reasons, circumcision during the neonatal period is an elective procedure. The current AAP policy statement (1999, and reaffirmed in May 2005) is that "data are not sufficient to recommend routine neonatal circumcision." (American Academy of pediatrics: Circumcision Policy Statement [Electronic version]. (1999, March). Pediatrics, 103(3), 686-693.)

Strangely, although the AAP, through its expansive literature review has ascertained that circumcision should be considered elective, not recommended as a routine procedure, and that there are no valid medical indications for circumcision during the neonatal period, the practice in the United States is currently in the 55.9% range. The rates are highest in the Northeast and Midwest (65.3% and 71.1% respectively), and lowest in the South and the West (54.6% and 40.5% respectively) (Centers for Disease Control, National Center for Health Statistics, 2008). While the Jewish and Muslim communities practice circumcision for cited religious reasons, this still does not account for the large number of circumcisions performed in the States.

Many activist groups and men who feel that they were cheated by their parents and pediatricians deciding on circumcision in their infancy feel that circumcision should be an individual choice and should not be left in the hands of parents and physicians. San Francisco is currently considering banning the practice of circumcision for individuals under the age of 17 within its jurisdiction. The proposal currently states that the ban would extend to even those who engage in the practice for religious reasons. Penalties could include up to 1 year jail time and up to a $1,000 fine.

What does the research tell us?
Politics aside, it appears that an individual who routinely keeps his foreskin clean will have health issues similar to individuals who have been circumcised. (American Academy of pediatrics: Circumcision Policy Statement [Electronic version]. (1999, March). Pediatrics, 103(3), 686-693.) It is possible that the foreskin has a sensate purpose and a lubricating role, but most men whether circumcised or not, continue to enjoy partaking in sexual behaviors of their choice. Unfortunately, there is not much research on whether females prefer the feeling of a circumcised or uncircumcised penis. Most of the information at this point continues to be anecdotal.

The answer?
To answer the original question, although very few women in the States have had the opportunity to compare circumcised versus uncircumcised penises, the answer is likely "Yes". For those who have complained about foreskin, it appears that their comments are mainly related to appearance due to lack of previous exposure and less to function. Anecdotal reports from women state that, other than some confusion over how to administer a blow job, many women report that they enjoy intercourse with a man who is uncircumcised. Some women report that they are able to maintain lubrication more effectively without the aid of lubricants with a penis which retains its foreskin. Some women report that they can feel the penis glide in and out of the foreskin and that this is an enjoyable sensation and a turn-on. However, many women report that they also enjoy intercourse with a man who is circumcised as well.

More research may be needed, but since many men do not have the choice to retain their foreskin at this point in history, just let us leave this with the thought that it's not the foreskin that counts, but the motion of the ocean.

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For more information on foreskin (and other topics related to human sexuality), please see Dr. Paul Joannides book, "The Guide to Getting it On" (2009, Goofy Foot Press pp 357-366). You can also visit his website at http://www.goofyfootpress.com/

Another great, readable website which provides more information on foreskin and circumcision (as well as other topics related to human sexuality), please see Scarleteen at http://www.scarleteen.com/

To be, or not to be, abstinence is the question...

Abstinence...we've all heard the word, but what does it mean?  For some it brings to mind images of priests and nuns, for others the "purity" of waiting until marriage, while for others it is merely a 14th century Middle English word pertaining to refraining from the indulgence of an appetite. 

Now, for many folks, typically associated with religious and conservative value systems, abstinence relates to a lifestyle choice, either for a lifetime, or up until the point of marriage. Abstinence related to a long-term lifestyle choice, such as that embraced by Catholic priests and nuns and Buddhist monks is typically termed "celibacy". Abstinence related to remaining "pure" before marriage and maintaining the sexual relationship with the "sacrament of marriage", is usually termed "chastity".

However, sexual abstinence can be more broadly interpreted. For instance, some individuals engage in periodic abstinence, due to the onset of disease or due to lack of opportunity. If your partner has a herpes outbreak, you and your partner may choose to be abstinent until the outbreak is cleared up. For some individuals who are undergoing treatment for cancer, the side effects of the treatment may result in abstinent behavior. Sometimes, individuals lack a partner and may experience involuntary abstinence until another partner enters their life. In Judaism and Islam, abstinence is indicated during the female menstrual cycle. Some individuals include masturbation in their definition of abstinence, others believe that someone can be abstinent but still can masturbate.

In the context of this blog, we are referring to sexual abstinence, which may be periodic or long-term and which includes refraining from a vast array of sexual behaviors.  Regardless of your feelings about sexual abstinence, there are two benefits that are constant, with perfect use:  1) No risk of infection through sexually transmitted infections (STI) and 2) No risk of pregnancy.

You may ask, what does "perfect use" mean?  Perfect use means no sexual intercourse with another person or animal.  You may also wonder, what does "sexual intercourse" mean?  Sexual intercourse includes a variety of behaviors, such as insertion of penis into the vagina (vaginal intercourse), insertion of penis into the anus (anal intercourse), oral sex including fellatio (blow jobs), cunnilingus (going down on a woman), and rimming (licking the anus), genital rubbing with or without penetration, mutual masturbation, sharing sex toys and so forth.  Additionally, when discussing sexual intercourse, we are including male-female, male-male, female-female and human-animal interactions.  Now this is by no means a comprehensive list.  You may be surprised at the array of behaviors people engage in without understanding they are violating the precepts for "perfect use" in abstinence.

Sadly, many abstinence-only programs focus more on the risk of an unwanted pregnancy than on the possibility of disease and the variety of behaviors that should be discussed.  Many focus only on male-to-female sexual behaviors, typically related to vaginal intercourse, thus limiting the definitions of what is and what isn't considered risky behavior.  When the issue of disease is taught, often it is linked directly to death.  While fear and guilt are tactics used by insurance salesmen, it is not an especially useful technique when attempting to change teen or young adult behavior.

Research to-date has overwhelmingly demonstrated that abstinence-only educational programs are not any more effective than no program in reducing sexual intercourse, or reducing risky sexual behavior in teens.  In fact, the research on abstinence-only programs is "limited and discouraging" (Collins, Alagiri, Summers & Morin, 2002) .  However, abstinence-plus and comprehensive sexual education programs are supported by peer-reviewed journal data which strongly indicates that these types of programs do result in behavior change with young people including "delaying sex and ... using contraception more consistently and carefully" (Kirby, 2007) . 

Delaying sex is a form of abstinence which can have positive results including (as stated above):  Two benefits that are constant, with perfect use: 1) No risk of infection through sexually transmitted infections (STI) and 2) No risk of pregnancy.  Are you seeing a theme here? 

The moral of this question of abstinence is that abstinence in and of itself is a complex topic.  Choosing abstinence is a viable choice, but it is important to determine what your goals are in making that choice.  It is also important not to impose fear and guilt on yourself if, after choosing to be abstinent you inadvertently abstain from abstinence, either by choice or by accident.  (Say that 5 times fast!) 

Am I Normal?

This is a question I am asked a lot as a college instructor of Human Sexuality.   If you've found your way here, you may have a similar question:  "Am I Normal"? 

My first response is usually, "Normal is a Myth".  The rationale behind this response is that it depends on how you define normal.  It depends, for instance, on what you are basing your definition on:  Statistics, Context, Mood?    For example, if you look, act and dress like a Goth and you are hanging out with other Goths, then from the outside in, you sure appear normal.  However, if you wear your Gothic garb to your grandma's religious service, are you still normal?  Contextually, based on appearances alone, likely not, unless your grandma and all her religious peers are Goths too.  However, beyond appearances, you may very well fit in quite well once people get to know you and lo!  You are normal again. 

When we are speaking about Human Sexuality, normal needs to be addressed in context.  I will do my best to base my topics and responses to your questions in research (not boring research, just verifiable facts). 

The title of this blog is "Pending Normal".  When people aren't sure of an answer to their question, then their question is pending.  Please feel free to ask away and we will hopefully move you from pending status to an accepted status.  Ask away!  My students call me Ms. Flores, or Heather and you are welcome to do the same, should you choose!