Circumcision

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Circumcision

I do not have a foreskin. Over the years I've gradually developed a dry, keratinised glans which causes me considerable discomfort, especially when I'm cold or my penis rubs on my underwear. But even without that experience, I wouldn't support routine circumcision.

I think circumcision without anesthetic - which is how it's traditionally been done - is incredibly cruel to a baby. There's also some evidence that sex is better for both heterosexual partners if the man's penis is intact, and it seems likely that removing such sensitive sexual tissue is going to reduce his sexual pleasure.

Over the years, I've had emails from both pro- and anti- circumcision advocates which has caused me to think about the issues involved. What are, in fact, the rights and wrongs of circumcision? Is it ever justifiable? Is tradition blinding us to more fundamental issues of individual liberty and sexual satisfaction? Here are links to two important articles written by medical experts on the rights and wrongs of circumcision.

Between prophylaxis and child abuse: the ethics of neonatal male circumcision.

How not to argue about circumcision

Maybe the most important conclusion they make is that circumcision on babies without anesthetic (which is, unbelievably, still widespread) is morally wrong. To get a flavor of what such an operation involves, here's a link to a website where you can see photographs and watch a video clip of a baby's circumcision. Warning: it is a distressing sight. Here is the website: http://www.intact.ca

Click Here For Site Contents Page

 

Pages On Penis Anatomy & Circumcision:

Penile anatomy and circumcision 1
Penile anatomy & circumcision 2
Functions of the foreskin
Foreskin restoration
Subincision

 

Do we ever think about what a circumcision really entails, or why it's being done? Think of it this way: a baby's parents are making a decision about his body which is irreversible: they are ordering the doctor to cut off part of his penis. Would they cut off part of his ear, or finger, or anything else?

Then why is it acceptable to mutilate his penis? Operating on a baby because it's a social custom is hardly justifiable in a modern society. Even when there is a religious motivation, I think we're overlooking the effects on the baby's comfort and the man-to-be's sexual pleasure.

Some people say a circumcised penis is a hygienic penis. But Mother Nature would not have evolved the foreskin if it was simply a redundant piece of tissue that harbors infection. It's there for a purpose, and the most likely purpose is male sexual pleasure. Besides which, recent research shows that there simply isn't any benefit on hygiene grounds. (Of course, this attitude comes from the Victorians, who meant something different by hygiene, anyway. They meant "moral" hygiene, i.e. no masturbation and a minimum of sexual pleasure. They thought circumcision would stop masturbation. It didn't then, and it doesn't now.)

Some mothers (and even some fathers, who should know better) say they want their son to look like all the other boys! Ridiculous! As for the idea that women prefer a circumcised penis - well, they would, wouldn't they? They've never had the chance to enjoy being fucked by a complete one, so they don't know what they're missing.

And it's not even true that everyone has a penis that looks "like that" any more. In America the American Pediatric Association has recently changed its stance and it doesn't recommend circumcision anymore, so the number of boys being cut is dropping all the time. Worldwide, 80% of men are uncircumcised. This may not help men with hypospadias who may give us an insight into the psychology of a man who feels different to the normal - you can read about it on this site. In the majority of men with hypospadias, ejaculation is normal. This maybe of some reassurance to young men with hypospadias who are not yet sexually active. It is important to ensure that good sexual function is maintained by masturbating normally, not in a harsh or traumatic fashion - for example, by thrusting against the mattress of the bed.

But what effect does parentally inspired circumcision have on the baby to whom it is done, the boy as he grows up, and the man as an adult? There are some very strong views expressed on the web, both for and against the practice. The strongest are undoubtedly from men who are very angry they were cut at birth. They seem to be full of rage about this "mutilation" inflicted on them in childhood, and they have presented lots of information about why circumcision should be stopped as a routine practice. They've also developed foreskin restoration techniques which stretch the penile skin and produce a new foreskin. 

The worst thing for me about circumcision is that the routine circumcision of babies has been done without anesthetic. This is barbaric. Imagine the pain you feel if your foreskin gets trapped in a zip, or something similar.

Now imagine having it cut off without anesthetic. And then imagine it being done to a baby. As to the argument that a baby doesn't feel anything, or at least doesn't remember it, well, that just leaves me speechless. But even if an anesthetic was used that wouldn't make circumcision acceptable.

The foreskin of a baby boy won't retract because of the natural attachments between his glans and the foreskin. As he grows, these attachments become weaker, and eventually by about five, the skin is fully retractable. If the foreskin and glans are separated before this, they are literally torn apart, and the glans can become scarred and damaged.

(There are plenty of pictures of the consequences of botched circumcision on one of the links below.) And sometimes the attachments do not separate as they should, remaining intact until puberty. Information on this is included in one another of the links below.

The care and hygiene of a baby boy's penis is quite simple - it simply involves washing his penis without retracting the foreskin. Later in life, for both boys and men, the procedure is just as simple: you just wash away the smegma, a natural substance that can accumulate around the glans of the penis in uncircumcised men.

A circumcised man will never have smegma, for the rubbing effect of clothing on the head of his penis will change the natural condition and properties of the skin, and can make the penis head dry, rough and uncomfortable.

Certainly this seems to be the biggest complaint of many circumcised men, myself included. Boxer shorts are impossible because of the irritation of the dry glans rubbing on the cotton. Ingeniously, someone has even come up with an undergarment to soothe this irritation.  

Finally, it is essential that a boy born with hypospadias is not circumcised, as the foreskin tissue may be needed for repair of his abnormal penis. There is a link on this below, and you can read more about hypospadias on this website.

Circumcision and AIDS

There's just been news (December 2006) of two research projects which are claimed to have shown that circumcision reduces the risk of HIV infection - the virus that causes AIDS - by about 50%. These were actually rather small scale studies, and we await further confirmation of the results.

But even if this is correct, HIV transmission was only reduced by 50% over a short time scale, so this is in no way an effective means of reducing the spread of the disease. Once again  it looks as though circumcision may be promoted on the basis of incorrect claims about preventing disease!


Phimosis - your foreskin won't retract

The question that has featured more than any other in emails sent to this site is "What do I do if my foreskin won't retract?" You'll find some useful information on the problem page of this site (click here and go to section A1). There are pictures of two phimotic foreskins below.

phimosis


Circumcision and the foreskin - a personal contribution

Thanks to one of my readers, who contributed the piece below. 

I have been restoring my foreskin off and on for the past couple years, and I can tell you from personal experience... it works! And it is quite safe as long as one uses a modicum of common sense. Here is what I have found on the Internet so far about the foreskin's functions. 

Anatomically, the foreskin is far from being a redundant or useless piece of skin as many believe. Instead, it is an integral and multifunctional component of the male reproductive and sexual response system.

The inner foreskin contains the primary collection of highly specialized sexual response nerves available to the male, with the majority being concentrated in a concentric band of tightly pleated and slightly ridged tissue called Taylor's ridged bands just within the tip of the prepuce. This band encircles the penis and connects to the frenulum on the underside of the glans.

Since Taylor's bands and the frenulum are neurologically "wired" together it stands to reason that they work in concert to provide the intact male with an extensive sensory network. The mucosal tissue at the tip of the penis - i.e. the glans and inner foreskin - is extremely thin, typically having only one to two cells thickness' separating the underlying tissues, including the sexually sensitive nerve endings, from the outside world.

The remainder of the penile skin, though thicker than mucosal tissue, is also quite thin when compared to other body skin. This thinness brings the nerve endings close to the surface, making the entire penile shaft sensitive to a wide array of sensations. However the various types of nerves are not uniformly distributed through out the covering.

The highest concentration of sexually sensitive nerves are contained within Taylor's band at the tip of the foreskin. The inner foreskin provides the immunological protection for the mucosal tissues at the tip of the penis. The glans has little, if any, immunological functions of its own and derives its protection from intimate contact with the inner foreskin. The outer foreskin provides physical coverage and protection for both the delicate inner foreskin and the glans, while the inner mucosal surface of the foreskin provides emollients, lubricants, and protective antibodies to keep itself and the glans moist, supple, sensitive and healthy. 

The length of the penile shaft skin, including the inner foreskin, is not redundant but is specifically 'designed' to be longer than the penile shaft it covers. This allows the penile shaft to effortlessly glide within its own sheath during intercourse, preventing friction and abrasion for both the male and his sexual partner.

This 'mechanical' function is frequently called the "gliding mechanism". When the skin sheath is in its forward position - like a shirt sleeve buttoned at the wrist and the loose sleeve material pulled forward over a fist, with the fist representing the glans - the sensitive mucosal tissues of the glans and inner foreskin are hidden and protected by a double layer of tissue... the skin sheath folded over on itself.

[Editor's note: Is there a connection between circumcision and premature ejaculation? The authors of that paper suggested there might be. Other explore the various causes of premature ejaculation are discussed here by the authors of the current document.]

As the skin sheath is moved back toward the body it simultaneously exposes the glans and unfurls the sensitive inner foreskin along the length of the penile shaft so it may be exposed for stimulation.

Since the penile skin covering is mobile and not attached to underlying structures, rather like the eyelid "floats" over the eye, it has some unique characteristics dictated by its functions. Because the penile skin is basically a "tube" of skin "floating" over the internal shaft (similar to the shirt sleeve analogy), all of its internal systems such as nerves, blood supply, lymph, etc. must enter and exit via the ends of the tube rather than from underneath as occurs in the rest of the body. Severing any portion of the skin tube disrupts these delicate internal systems. The ability of the free floating penile skin to remain relatively motionless at the vaginal entrance as the shaft moves to and fro within its own protective sheath during heterosexual intercourse, tends to maintain the natural sexual lubricants within the vagina rather than withdrawing them with each stroke. This eliminates friction, dryness, and the need for any artificial lubricants... especially important as the female becomes menopausal and her youthful quantities of natural lubricants tend to decrease. 

Some people say the foreskin is redundant or extra skin, implying that it is of little or no use, and without any value or benefit to the male. Nothing could be further from the truth. Actually, the prepuce (foreskin) is a highly evolved portion of the male genital anatomy and is a unique specialized structure with important immunological, protective, mechanical, erogenous, and sexual functions. The prepuce is essential to normal copulation and allows the male to experience the full range of sexual sensations. As with females, all of the male's genital tissue structures have purpose and functionality. They are designed by nature to operate in unison as an integral system. Though several of the genital structures can be removed from either a male or female and still allow that person to function sexually and produce offspring, many of the sensory and protective functions are lost. Removal of any part of the genitals, particularly the male's prepuce or the female's clitoris, severely limits that person's ability to experience a full range of sexual sensations since the majority of sexually sensitive nerves are concentrated here.

If surgical alteration is done to the genitals in infancy or early childhood, the adults those children grow up to be will never know what sensations they are missing. They believe that what they feel and experience is the way it is supposed to be. They have nothing to compare with since the majority of highly-specialized, sexually-sensitive nerves and tissues were cut away. All they can experience with is the limited number of these nerves and tissue structures they are left with after surgical alteration. A complete set of intact genitals is the birthright of all children, both boys and girls. To surgically alter the genitals of either sex is to alter that person's sexual identity permanently and deprive them of a full sexual experience when they mature into adults. 

http://www.intact.ca The owners of this anti-circumcision site state: "Most importantly, the site includes a video of a circumcision that any parent considering circumcision for their child should see first."

How does sex with a circumcised man compare with sex with an uncircumcised man? What women say:

CIRP Org - article on sex with an uncut penis

The 1999 British Journal of Urology Supplement has a study of American women who have experienced sex with both intact and circumcised partners. The vast majority of surveyed women indicated that they prefer intercourse with a man with a natural penis (approximately 90%) and that they were significantly more likely to achieve a "vaginal" orgasm during intercourse with an uncircumcised man. And many women actually rated circumcised intercourse a negative experience when compared to the uncircumcised.

The development of the foreskin

At birth there is no separation between the epithelium of the glans and the under surface of the prepuce, so that at birth the prepuce is usually not retractile.

Separation occurs because of the spontaneous desquamation that starts at the end of the prepuce in the final stages of gestation, and proceeds at varying rates in different individuals. This means that there is no standard age at which the foreskin becomes fully retractile.

The innervation of the prepuce is from the dorsal nerve of the penis and branches of the perineal nerve. The prepuce is also innervated from the autonomic nervous system via the sacral nerve. This means that neither topical anesthetic nor a dorsal nerve block are effective in relieving the pain of circumcision.

When you look at the microscopic level, the prepuce has a dense population of fine nerve touch endings called Meissner's corpuscles. The glans, however, is innervated by nerves associated with pain and temperature sensation, except for the corona and frenulum. The glans glides over the prepuce in an uncircumcised man with considerably less friction than occurs in the movement of the circumcised penis against the vaginal wall. As quoted elsewhere on this website, women who have had sex with both circumcised and uncircumcised men appear to prefer the latter group as sexual partners.

It follows that the prepuce is highly specialized tissue, and removal of the foreskin causes a boy to lose most of the fine touch receptors of his penile skin.

Medical reasons for circumcision are different in children and adults.

In children, the ballooning of the penile skin during urination is not an indication of phimosis. If the prepuce begins to open and looks like a flower when it is gently moved as if to retract it (remember that retraction is actually not possible until several years of age and occasionally puberty), then it is not phimotic. The true sign of phimosis is that it forms the appearance of a helmet when retraction is attempted.

In an adult the only good reason for circumcision is pathological phimosis, which is nearly always due to BXO (balanitis xerotica obliterans). This is genital lichen sclerosis in males. The key  features are over-keratinization and collagen deposition within the papillary dermis. There is scarring of the preputial opening. In the worst cases of this condition, the prepuce and glans will be adherent. Inflammation of the prepuce is best conservatively managed, without circumcision, though circumcision is a permanent cure.