Circumcision and Phimosis: A clear-cut decision?

My wife is nursing the baby and my kids are planted in front of the TV. I have a few minutes of peace. I sneak into the bathroom, lock the door, and prepare to try to turn my penis inside out.

Days ago, I discovered that my penis wasn’t normal. My foreskin stretches down, rather than retracting. What appeared to be my glans was still all covered up, terminating in a 1mm sized opening at the top. (This man has pics of what I could easily mistake for my own penis)

It explains everything. Sex has always been enjoyable, but always ends the same way: I get tired or she gets bored. Thank goodness I don’t need condoms any more. I have 100% sympathy for men who refuse them. For me, they deaden all feeling except for warmth. (“Am I in you?” “Um, that’s my leg.”). We’ve found other methods of birth control. Not that we need it — I can last forever.

I can either go on with my life or fix this now.

The C word

Many people feel strongly about circumcision. Rightly so — there are vanishingly few reasons to have this procedure done on a child. But as an adult, with a medical reason, I thought the decision would be a no-brainer. If there’s a medical reason, it’s free in Canada, and doctors don’t push unnecessary procedures. (We send all the greedy ones south, and tell them it’s “brain drain”)

I trust facts and data. I trust peer reviewed studies. But what they are telling me doesn’t make the decision easy.

It’s a controversial issue, which means unbiased information is scarce. By some accounts that I have read from people with phimosis, it completely changes their life and they highly recommend it. Other quotes are from people that “lost sensation” or “ruined their life”. The trouble is, all of these quotes are from one-sided internet sites, and not representative of the typical experience.

This testimonial seems encouraging: 

I always felt sexual intercourse was a bit of a let down when I lost my virginity, because it felt no different to when I masturbated. I suppose what I am saying is that the foreskin just seemed to slide back and forth over the glans during intercourse, and that was the same experience that I had when I masturbated.

I always remember thinking when I first had intercourse that it just wasn’t any great revelation. But OOHHH! how different things are without a foreskin to get in the way. I cant believe how good it is now. Last weekend I just couldn’t believe intercourse could be so enjoyable. The feeling of the glans in direct stimulation against the vagina and not a foreskin is wonderful.

You have probably heard it all before, but intercourse certainly is better circumcised. Take it from one who knows. This will make you laugh but I rub vitamin E cream into the wound to help it heal. And then we very gently “… well … let me just say sex is great … fantastic.. nothing to get in the way.

I have no regrets. I have ABSOLUTELY no regrets. There is nothing I miss about my post-operative state. Which is strange because I really went into this being totally realistic and thinking I may have some regrets. But sex is far more enjoyable. And with summer on the way cleanliness is going to be so much easier, even now for that matter. 2 Well it’s late and I am going home. I hope to hear from you soon and thanks for your help and advice.”

On the other hand, @BSR163 from twitter has counselled real people who have been cut after they had reached sexual maturity and had experienced sex prior to circumcision:

All were profoundly affected by the change and loss that they experienced.

Two reported the initial joy of the liberation of the glans, but found it was short-lived. Both subsequently experienced major difficulties reaching orgasm without (in 1 case, using a rough towel) or in the other, using a ‘death grip’. Neither techniques are compatible with normal sexual interiors. The vagina cannot replicate the ‘death grip’. With their increasing difficulties, their confidence was knocked and they experienced ED… even though they were on their 20s.

Once circumcised, you will experience two effects. The ‘liberation’ of your glans will probably be fantastic initially, though at the same time, hypersensitive in an uncomfortable way, not a sexual way. The second effect will be the apparent and immediate loss of the main source of your (up until circumcision) sexual stimulation. It will be absent.

However, once the glans has been exposed for a number of years, the epithelium on the glans will noticeably thicken and keratinize. The net effect of this will be a further dulling of the sensation derived from the glans as the receptors are buried deeper under the thickening skin. In order to reach orgasm, you will likely need to use significant force and friction, resulting in rougher sex or masturbation. Jack-hammer sex is how it is often described.

In a personal message, I confronted the author of A Circumcision Diary with this information. Two years after his experience, he writes:

If that is true then keratinisation is a non-factor for sensation. My glans also doesn’t look or feel any different than it did a month out. The sensation hasn’t changed since the six month mark, either. Knowing what I do about skin physiology, keratinisation shouldn’t affect sensation that much anyway, because it doesn’t change the way the nerves are stimulated. I think that sensation is “lost” because the glans is untrained to touch after being occluded for so long, so there’s a period of increased sensation immediately after surgery, followed by a slow decrease to a new normal. It is simply acclimatisation to new stimuli.

I’m sure we could go on forever. Let us leave the intactivists and the circumcisionists to duke it out on Twitter. In any case, anecdotes are no way to make a life-changing medical decision.

Let’s use science

In 2002 some researchers followed up on men who were circumcised as adults and asked them how they felt. Of the responders, 47% reported that sex was more pleasurable and satisfying after the circumcision. 38% reported a problem or perceived difficulty afterwards. Overall, 62% of men were satisfied with having been circumcised. Read the study

So it’s not a slam-dunk decision. The odds are that I would be happy and raving about it. But there is a four in ten chance I’d have “some difficulties”,  and only a 50/50 shot at better sex.

Dr. John Aquino, medical director of Ontario Men’s Health, echoes this in a Toronto Star interview:

“It’s like rolling the dice. You don’t know what’s going to happen,” he says, adding it can either increase or decrease sensitivity. “Most of the time it’ll probably make (the penis) less sensitive because there’s a lot of nerve endings in the foreskin.”

The other primary method of getting rid of phimosis is to beg your doctor for some steroid cream, and slather it on, and “stretch” daily for 2 months to a year. Reading over the internet forums, it’s clear why American doctors aren’t jumping at the chance to recommend it. Can you imagine your doctor telling you to do something for 20 minutes a day, for months? Patient compliance would be astoundingly low. While you’re at it, why don’t you work out three times a week and and eat ten daily servings of vegetables?

In 2005, some researchers intercepted children who were scheduled for circumcision and gave their parents specific instructions:

1. Apply steroid cream to the foreskin every day.
2. Four times a day for a month, retract the foreskin gently as much as possible without causing pain or strictures for one minute.

At the end of one month, 71% of the most severe cases were fully cured. The ones who weren’t  were allowed to go for another month, and a third if necessary. By the end of three months, only 2 / 50 of the most severe cases went on to surgery — a 96% success rate. (Read the study)

That’s rather clear.

At 35 years, I’m much older than the kids in the study, but I have little to loose.

• I’ll try stretching and cream for a month.
• If my opening gets any bigger at all, I’ll try it some more.

Odds are good that it’ll resolve my condition. If all else fails, I’ll get snipped and I’m 62% likely to be happy with it.

That’s why I’m locked in the bathroom, stretching my foreskin. I’m frustrated now because I can’t grasp near enough to the opening.

“Can you try get your finger in it?” a forum poster asks. Sure, if I were a gerbil.

I can only pinch the skin around it and raise it higher. The hole remains tight. Not even a soda straw would fit through it.

My wife is calling now. One of the kids has spilled orange juice on the couch. Stretching will have to wait today.

My story continues here.

Follow me on Twitter: @PhimosisJourney