Monthly Archives: April 2016

The lies they tell, the crimes they make

South Florida based doctor Christopher Hollowell posted a video of a circumcision of a 1 year old child. During the narration, Hollowell first appears satisfied about the lower rates of circumcision (and even misrepresents it) but as the video progresses, he becomes strongly biased for circumcision.

Dr. Christopher Hollowell

Dr. Christopher Hollowell

He claims that as a urologist, he sees all the cases where uncircumcised boys have problems. He claims, for example, that the 1 year old child he is circumcising has phimosis and balanitis.

This is problematic already. Most babies are born with congenital phimosis (also known as physiological phimosis), which is a normal condition: the foreskin is not ready to retract. It takes years, for this phimosis to be overcome, with the average age being 10 and a large variance. Being non-retractable at 15-17 is still normal.

Balanitis is often claimed as a reason for non-neonatal circumcisions. However, balanitis simply means inflammation of the penis. Quite often, it’s just an ammoniacal dermatitis resulting from bacteria in the feces staying in the diaper for too long, and can be resolved with medicine and patience, without need for surgery.

The doctor claims the child has severe penile adhesions. What he is doing is patologizing a normal condition. As we have often explained in this blog, the foreskin and the glans start as a single structure, and at some point a layer starts desquamating, creating the subpreputial space. This layer is called the balanopreputial sinechiae or balanopreputial lamina, and it dissolves slowly through several years. But our doctors tend to call it adhesions. The AAP erroneously claims that these adhesions should be resolved by the 4th month of life.

At 1 year of age, these “adhesions” are in fact normal. The foreskin and the glans are still in the process of separating, and there is no need to rush them.

Dr. Hollowell then pulls the foreskin back and claims that the penis of this child has a “cobra head effect” because pulling it down causes the glans to curve downwards, pulled by the frenulum. Based on this observation, he proceeds to excise the frenulum.

Dr Christopher Hollowell cutting the frenulum of a 1 year old boy

Dr Christopher Hollowell cutting the frenulum of a 1 year old boy

Personally, I consider the removal of the frenulum of a child a criminal act. And it is also unnecessary.

It is unnecessary because at 1 year of age, the penis of this boy has not reached its adult size, so any present consideration will completely change during puberty, once production of testosterone increases and the body starts reaching its adult size. So even if the frenulum is short now, it still has plenty of time to grow. Not only that, but even if at 18 the  frenulum was still short (frenulum breve), there are non-invasive ways of correcting it. There is no need to fully remove it.

I believe that removing it is a criminal act because the frenulum carries an artery and a high concentration of nerves. The frenulum itself is said to be one of the most pleasurable parts of the penis -by those who were lucky enough to retain their full frenulum, or did not suffer total damage of it. So, to remove it before the person has attained an age of maturity seems to me a purposely damaging action which has long term effects over the sexual experience of that child.

The loss of irrigation due to cutting the frenular artery can potentially have long term effects. Some suggest that ischemia (lack of blood) is behind the common occurrence of meatal stenosis in circumcised boys. Loss of blood flow could also affect the surface of the glans, as hypothesized by Ken McGrath. Finally, loss of blood flow could be related to erectile dysfunction later in life.

Dr. Hollowell repeats several times that the foreskin is very vascular tissue, yet he doesn’t seem affected by the idea of removing it.

He says that he likes to think of circumcision as plastic surgery of the penis and that he likes to think that every man likes to have a beautiful looking penis. But, isn’t it problematic to perform plastic surgery on the genitals of a child, to think of the genitals of a child in terms of “beautiful looking” as a result of plastic surgery – particularly when performed without consent of the person?

During the procedure he marks the line where he is going to cut. It can be observed that the line is traced around the center of the penis. Now, if we consider that the foreskin is a double layered area, then the total area of tissue being removed accounts for approximately two thirds of the covering of the penis. If it was single layered, it would be one half, but since the foreskin is double layered, it counts two times, thus the total tissue removed is 2/3rds or 66% of the covering of the penis.

Circumcision removing between 1/2 to 2/3 or the penile covering

Circumcision removing between 1/2 to 2/3 or the penile covering

Hollowell says that when asked why do the procedure at one year and not at birth, his response is that he couldn’t do it before and had to try conservative measures because of the age. He then goes on an explanation about aging and bleeding that has more to do with Jewish myths than with actual science. “The foreskin we’ve learned over centuries that if you cut the foreskin before the 10th day of life you will have very little bleeding of the foreskin, so many cultures will just do it as a ceremony without any problems, however after that time, if you decide to cut the foreskin it will bleed significantly and in young boys, a little bit of bleeding can be devastating“. He says this without acknowledging that the only cultures that circumcise babies are the Jewish and the American culture, not “many cultures“, and the reasons he gives have more to do with bible myths than with any solid science. In fact, babies circumcised on the 8th day according to the Jewish tradition, may still die from exsanguination, as we have previously showed in this blog.

As he explains this, Hollowell keeps cauterizing the penis to stop any bleeding. Has anyone studied the harm caused by cauterizing all those blood vessels? If American doctors were using more recent circumcision technology, they would be able to circumcise children and adults without cauterizing the inside of the penis as if it was a piece of grilled steak.

Overzealous cauterizing of the internal parts of the penis

Dr. Hollowell zealously cauterizing the internal parts of the penis

Now, the real reason why Hollowell performs these circumcisions at 1 year of age has everything to do with insurance and little to do with medical reasons. See, for a few years, Medicaid didn’t cover neonatal circumcisions in Florida. So instead of paying the $200 to $800 out of pocket, many families waited one year at least, and then procured a referral for circumcision. Because there has to be a diagnosis code for insurance to cover it, doctors would diagnose phimosis, knowing very well that they are providing a fraudulent diagnosis because those children are perfectly normal. But at that point, because of the age, the procedure (at least in the U.S.) requires general anesthesia and becomes a more involved surgical procedure (mostly because the American doctors are not using the most recently invented devices for non-neonatal circumcision, which would greatly reduce the cost and risks of the procedure), so now the procedure is up to 20 times more expensive.

This medical fraud is what led one doctor Saleem Islam to claim that the cost of circumcisions in Florida “skyrocketed” after Medicaid stopped covering neonatal circumcisions. Doctor Islam in his paper candidly recognized that parents came asking for circumcision for their children, but didn’t mention that those circumcisions would be fraudulent because they were not based on real medical necessity – so they shouldn’t even be covered at all.

So this is the reason Hollowell is circumcising a 1 year old child over a diagnostic of phimosis and balanitis: because the parents did not want to pay the low cost of a neonatal circumcision out of pocket and preferred to seek a referral after the age of one, for a more complicated and risky procedure under general anesthesia and at a higher cost to the tax payers.

Closer to the end of the video (while suturing the penis) Hollowell goes into his litany of things that can happen to uncircumcised boys: they can have adhesions, they can have balanitis, they can develop penile cancer later, they can have urinary tract infections,  they have more risks of getting STDs… all the myths we’ve heard over and over.

And then he compares circumcision to a vaccine. “And I tell you if you could have a vaccine that gave the same results we would jump at it every time, so it is quite interesting to see where our new thought process is on what we would do to offer this to young boys again on a routine basis

The lies they say:

  • The child has phimosis
  • The child has balanitis
  • The adhesions are abnormal
  • The frenulum causes the penis to bend downward
  • Circumcision protects against STDs, penile cancer, etc.
  • Circumcision is a surgical vaccine
  • He won’t know the difference

The crimes they make:

  • Fraudulent use of insurance
  • Cutting one of the most pleasurable areas of the penis – the frenulum
  • American doctors don’t use the most recent technology for non-neonatal circumcisions – thus increasing the risks, complications and cost of the procedure.
  • Subjecting a 1 year old child to general anesthesia for a non-medical surgery (plastic surgery of the penis – give the child a beautiful penis).

Shame on you Dr. Christopher Hollowell.

 

Understanding intactivism

While in circwatch we often discuss studies, articles and publications, and point their flaws, contradictions and conflicts of interest, we are first and foremost bound to the principles of bodily autonomy and genital integrity.

Performing irreversible “elective” surgery on non consenting individuals violates the principle of bodily autonomy. It denies the person the right to provide informed consent and make an informed choice.

Removing part of the genitals of children without medical consent violates their genital integrity, part of the children’s right to physical integrity.

Both violations are ethically problematic.

Sure, there is often a discussion of whether there are benefits or harm, whether circumcision affects sexual function or sensitivity or not. But that is basically an academic discussion.

Let’s be clear. If a child was in a life or death situation, where not performing a circumcision would easily cause the child to die or be permanently impaired, it would be irresponsible to not do it. But that is not the case with neonatal circumcision or with child circumcision.

As clearly indicated by the AAP and discussed by the members of the task force, circumcision is often a non-medical decision based on cultural, religious or family factors. And that is problematic.

By performing a circumcision on your newborn child, you are denying this newborn person the right to choose, the right to make informed decisions over his own genitals, and you are depriving him of a normal part of his body. As a parent you may have the best of intentions, but you are missing this side of the issue.

Doctors should not be enabling parents. This is often perceived by parents as a recommendation, resulting in tilting the balance without regards for the future preferences or desires of the minor individual.

Even if there is a lower risk of a minor or rare condition, there is also a harm in circumcising. The procedure is irreversible and leaves permanent marks – a scar and missing parts. There are low incidence high impact risks that should be taken into consideration as well.

We are not “anti-circumcision”. We have no issue with people becoming circumcised – as long as they can provide informed consent. But we have problems with people forcing minors to undergo permanent reductive procedures on their genitalia.

Andrew Freedman, of the AAP 2012 Task Force on Circumcision, wrote: “It is inconceivable that there will ever be a study whose results are so overwhelming as to mandate or abolish circumcision for everyone, overriding all deeply held religious and cultural beliefs.” And while this is true, it should not be taken as a carte blanche to override children’s ownership of their own bodies. It should be taken to apply to your choice over your own body, not your choice over someone else’s body. You don’t own your child’s body.

Your child’s body should not be an accessory to your religious or cultural expression. Your child’s freedom of choice and bodily integrity are at stake. Please, respect the dignity and personhood of your child.

Jennifer Bossio confirmed: foreskin most sensitive part of penis

Yet she was too biased to admit it!

Bossio, Jennifer, “EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN” is a PhD thesis which attempts to “provide a multidimensional perspective of the sexual correlates of circumcision with implications for public policy and individual stakeholders (e.g., medical professionals, parents, men).”

Jennifer Bossio validated Sorrells study and didn't recognize it

Jennifer Bossio validated Sorrells study and didn’t recognize it.

Chapter 3 is dedicated to study penile sensitivity in men who were circumcised as babies, vs. men who were not circumcised (intact). This is evidently a response to the 2007 study “Fine-touch pressure thresholds in the adult penis” by Sorrells et al.

Bossio writes (pg. 69): “we did not obtain sufficient evidence to support the notion that the foreskin of adult intact men is the most sensitive region of the penis to all forms of stimuli; however, the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested, and it was significantly more sensitive to warmth than the glans penis.” She also writes: “our results—and those of Payne et al. (2007)—differ from those of Sorrells and colleagues (2007) who found that the glans penis in circumcised men was less sensitive to touch than in intact men.”

In her conclusions, Bossio writes that “we directly assessed the assumption that circumcision leads to a reduction in penile sensitivity by testing tactile detection, thermal sensation, and pain thresholds at multiple sites on the penis” and offers one conclusion that “this study provides no evidence that neonatal circumcision decreases penile sensitivity, no evidence that the exposed glans penis in circumcised men becomes less sensitive over time, and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis.” and then suggests that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision

Finally, she concludes that “findings from this study can be used to inform individual stakeholders, public policy makers, medical health care professionals, and parents regarding the minimal long-term implications of neonatal circumcision on penile sensitivity.”

We have issues with the inclusion and exclusion criteria. Excluding participants over 40 years of age creates a bias. Many individuals restoring their foreskins typically started after their 40s. They also excluded individuals with history of sexual dysfunction.

Reading her paper we found contradictions to her assertions that “this study provides no evidence that neonatal circumcision decreases penile sensitivity [...] and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis“.

We also suggest that Bossio missed a vital point by neglecting to study men who have undergone non-surgical foreskin restoration.

First, the assertion that the foreskin is the most sensitive part of the penis comes directly from the Sorrells study, and it is one assertion that is often misunderstood. Sorrells simply evaluated “fine-touch pressure thresholds” – nothing more, nothing less. So when Sorrells concluded that “circumcision ablates the most sensitive parts of the penis” it should be read that “circumcision ablates the most sensitive parts of the penis [to fine-touch]“. Sorrells did not make any attempt to measure pleasure or satisfaction. Only fine touch, and his findings are consistent with those of Bossio as she said it herself, that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

So, if the foreskin is significantly more sensitive to touch, it follows that the circumcised penis, in which the foreskin has been removed, is less sensitive to touch – particularly to fine touch. Which again, contradicts her conclusion that her study “provides no evidence that neonatal circumcision decreases penile sensitivity“.

Now, we partially agree with her assertion that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision“, basically because the studies are missing one important point. Static stimulation is not the main method of stimulation during sexual activity. People don’t just lie down being stimulated by touch, warmth, pain, etc. Individuals move during sex. Stimulation is dynamic.

A visual comparison between a typical intact man masturbating, and a circumcised man masturbating, yields important differences – and  this has even been observed by circumcision promoters such as Guy Cox – in a paper published with the pen name of James Badger. While Badger describes it as a difference in preference, the reality is that it is a difference in what is possible to do with the available tissue.

Most intact men masturbate by grasping the mobile penile skin and sliding it up and down the shaft. In most cases this results in the glans being repeatedly covered and uncovered, with the rim of the foreskin stimulating the glans; typically the hand does not touch the glans. In the case of males with particularly long foreskins, the glans may never be uncovered at all, and the hand stimulates the glans only indirectly, through the foreskin.

In circumcised males, the typical technique consists in moving the penile skin what little length it can be moved during erection, or when no mobile skin is available at all, the hand rubs the penile skin, in which case external lubrication (hand lotion or adult lubricant) is needed to avoid chaffing the skin. In many cases direct contact with the glans is avoided unless using lubricant.

What this indicates is that there is a mechanic component of stimulation by using the foreskin as an agent, a mobile part, which interacts with the glans. Obviously, removing the foreskin makes this action impossible, thus altering the mechanism of stimulation for the circumcised male.

We can also consider that during heterosexual penetration, the glans touches the opening of the vagina and goes through its vestibule, but once inside it is not in contact with anything else. The vagina instead is grasping the penile skin, and facilitating its gliding motion during the repeated penetrative motion. For the circumcised male, the vagina simply rubs directly against the penile skin – because there is no movement of the skin, which tends to dry the lubrication of the vagina.

So there is a change that goes deeper than simple passive sensitivity. Circumcision alters the mechanics of the penis and causes stimulation to be different, both for the male and the female.

Bossio’s paper simply moves between two contradictory positions: 1) that the foreskin is more sensitive to touch, and 2) that the circumcised penis is as sensitive as the intact penis – which is simply not possible if a) the foreskin is more sensitive to touch and b) has been removed by circumcision.

It seems to me that given the importance of Sorrells’ study as a starting point to Bossio, she missed the mark. Neither Bossio nor her reviewers understood the meaning of “sensitivity” as used by Sorrells.

Perhaps the real importance of Bossio’s paper was to superficially contradict Sorrells, as an attempt to undermine a common argument used by promoters of genital integrity, and by calling the long-term implications of neonatal circumcision on penile sensitivity “minimal” she gained enough approval from a culturally biased academic community to obtain her PhD.

Misuse of Bossio’s paper:

Annette Fenner published in Nature Reviews Urology a highlight of Bossio’s published study (on The Journal of Urology), which is related to her thesis, with the superficial headline “Circumcision does not affect sensitivity“, and the first sentence, predictably enough, reads “Neonatal circumcision has minimal effects on penile sensitivity“. Fenner misrepresents Bossio’s paper by indicating that “No differences in tactile or pain thresholds, or sensitivity to warmth and heat pain, were observed between circumcised and intact men“. This clearly contradicts Bossio’s assertion that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

She then offers an allegedly quoted conclusion that Bossio’s data “do not support the idea that foreskin removal is detrimental to penile sensitivity.” – a quote that is really an inaccurate paraphrase, and we repeat, is deeply flawed based on the non-existent definition of sensitivity.

Fenner then offers her own conclusion, the one that everybody was hoping for, the direct contradiction to Sorrells: “removing the foreskin does not, in fact, remove the most sensitive part of the penis.”

We have already shown above how deeply flawed is this, given that the same assertion is contradicted by Bossio herself.

But that’s what Bossio’s thesis was written for: to allow culturally biased academics to contradict Sorrells’ study by quoting a paper that didn’t understand what Sorrells was writing about, and which is so poor that it contradicts itself without raising the eyebrows of any mindless reviewer.

Misleading headlines

We wrote this review back in January, but we didn’t publish it, silently waiting. Last week, however, the media picked up Jennifer Bossio’s paper, and predictably, as we have often indicated, used misleading headlines to make this look as far more conclusive than it really is. Many of the articles we reviewed, clumsily include Bossio’s contradiction without pointing it out.

Some examples of these disappointing articles:

Science Daily: Neonatal circumcision does not reduce penile sensitivity in men, study finds (New research challenges widely accepted beliefs)

UPI: Study: Circumcision does not reduce penis sensitivity. This article even says “In men with foreskin, it was more sensitive to tactile stimulation than other parts of their penises, however when foreskin sensitivity was compared to other sites intact men had no greater sensitivity than the circumcised men” – the first part obviously contradicts the premise of the headline: if the foreskin is more sensitive to tactile stimulation, removing it has to reduce the penile sensitivity (to tactile stimulation). The second part of the statement simply makes no sense and seems to be a derailing tool.

Tech Times: Getting circumcised does not shrink male organ sensitivity.

Medical Express: Circumcision does not reduce penile sensitivity, research finds.  In this article, Bossio is quoted saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure“. However, that sentence alone already contradicts the headline – and the whole premise of Bossio’s publication. In fact, the underlined sentence alone shows that Bossio validated Sorrells’ study, the very study that she appears to be trying to contradict.

Queens University: NEWS RELEASE – New research finds circumcision does not reduce penile sensitivity. This must be the originating point of all these press releases, as Bossio’s study was the core of her PhD thesis at Queens University. This article, just like the one from Medical Express, quotes Bossio saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure” – which we are getting tired of repeating, contradicts the headline and the very premise of her study.

Daily Mail: Circumcision does NOT reduce sensitivity of the penis, experts say.  Unfortunately Bossio’s sad excuse of a study made its waves all the way to England. This article is preceded by 3 bullet points, one of which states: “Findings also suggest the foreskin is not the most sensitive part of the penis“. In this article, Bossio herself is quoted saying that her study “provides preliminary evidence to suggest that the foreskin is not the most sensitive part of the penis“. This version of the article avoids saying that “the foreskin was more sensitive to fine touch“, as the Queens University press release and the article on Medical Express did. Perhaps the contradiction would have been too obvious.

Healio, Medical Daily, True Viral News, Australian Networks, The Independent, I Fucking Love Science, GCO News, Renal and Urology News, Today’s Parent and many others also mindlessly reported on this absurd study.

So congratulations Jennifer Bossio. Your nonsense fooled a lot of people. Who knows how many men will be harmed because of your sad thesis.

UPDATE: Additional problems with Bossio’s paper

  • Some readers pointed out that Jennifer Bossio’s measuring point was the outside of the foreskin (see diagram). The foreskin is not a single structure. It has an outer layer of regular penile skin, and an inner layer of mucosa. There is also a transitional area which was pointed by Sorrells as the single most sensitive area to soft touch, and there is the frenulum, joining the ridged band and the inner foreskin to the glans and the meatus. Sorrells measured sensitivity at 8 different points of the foreskin. Bossio did not take measurements on the points indicated by Sorrells as the most sensitive ones to fine-touch sensation, which are the ridged band and the frenulum. Nevertheless, she found that the outer foreskin was significantly more sensitive to touch than the rest of the penis, which is consistent with Sorrells, even if her conclusions fail to indicate that.
    This was the site used by Bossio:
    bossio1
    These are the testing sites used by Sorrellssorrells_sites
  • According to the Queens University press release, Bossio “extended the research methods in her study to include warmth detection and heat pain because these stimuli are more likely to activate the nerve fibres associated with sexual pleasure“.For one, Sorrells did not make any claims regarding fine-touch sensitivity and pleasure.Second, “extending” the method makes the results difficult to compare. For example, Bossio writes “with respect to warmth detection, the foreskin was more sensitive than the glans penis, but not the midline shaft or an area proximal to the midline shaft. Using a different stimulus modality (warmth sensation, as opposed to fine-touch punctate pressure), we partially replicated the findings reported by Sorrells et al. (2007), in that the foreskin was more sensitive than the glans penis, but—unlike Sorrells—not two sites located on the penile shaft.” This makes no sense, because since Sorrells did not take measures of warmth sensitivity, there is no way to compare the data collected to Bossio in this aspect to anything in Sorrells study. It is not correct to say that this data “partially replicates” Sorrells given that they are referring to different types of stimulus.

    Sorrells declared that the foreskin was the most sensitive part (to soft-touch and to soft-touch only). Different parts of the body specialize in different kinds of sensitivity, according to our body’s needs. For example, our eyes are probably the most sensitive part to light. Our ears are probably the most sensitive part to sound. We wouldn’t try to assess sensitivity to sound in our eyes, or sensitivity to light in our ears. If the foreskin is sensitive to soft-touch, it is likely because we need that area to be sensitive to soft-touch, and removing it is going to affect the reasons why we need that sensitivity.

    Think about it this way. Removing one person’s eyes does not make the person deaf. But that is not a reason to justify removing the person’s eyes without necessity, particularly if we don’t know if the person needs to be sensitive to light.

  • Regardless of whether the foreskin is the most sensitive part, or just as sensitive as the rest of the penile skin, or if it was not sensitive at all, removing it would still violate the bodily autonomy and genital integrity of the person. Bossio writes on BJU that her “results are relevant to policy makers, parents of male children and the general public.” This statement misses the point that the most important stakeholder is the person holding the foreskin: the male child, the future male adult, and that no matter to what extent sensitivity is affected, removing the foreskin of the child deprives the child from the freedom to choose and the right to provide informed consent – thus violating his bodily autonomy and genital integrity.

    To be fair, on her thesis, Bossio writes that “Individual stakeholders are also expected to benefit from this research program, such as medical professionals, parents of male infants, and men themselves.” For some reason, “men themselves” were omitted from the conclusion in BJU.

  • Hugh Young pointed out that the graphics on Bossio’s thesis (i.e. figure 3.2) are collapsed across circumcision status. This conceals any existing difference between circumcised and uncircumcised.Figure 3.2 basically shows that the foreskin is more sensitive than the other testing points for tactile, warmth and heat pain (this last one only by a small difference), and that the glans is more sensitive to pain. The collapsed bars fail to show any difference. Young explains: “This makes the inclusion of the bar for the foreskin absurdly different from the others, because the foreskins of the cut men are non-existent. If their measurements were shown, their bars would be infinitely tall, indicating that no amount of pressure, heat etc, would evoke a response.” Sorrells study includes figures that are not collapsed by circumcision status. Two adjacent bars show the results for circumcised and uncircumcised. In the case of the circumcised males, the bar for non-existent measuring sites is simply omitted. If Jennifer Bossio wanted her study to be comparable to Sorrells, she should have considered presenting graphics that were comparable to those by Sorrells.Bossio’s figure 3.2
    bossio_fig

    Sorrells’ figure 3

    sorrells-fig

Bibliography

Bossio, J.A.EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN. Thesis (Ph.D, Psychology) — Queen’s University, 2015-09-18 00:15:45.183

http://qspace.library.queensu.ca/handle/1974/13627

 

Bossio, J.A. et al. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J. Urol. http://dx.doi.org/10.1016/j.juro.2015.12.080 (2015)

 

Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:864-9.

http://www.cirp.org/library/anatomy/sorrells_2007/

Badger J. A Survey about Masturbation and Circumcision. 2000

http://www.circlist.com/surveys/badger-06.html

 

Fenner, Annette  - Male circumcision: Circumcision does not affect sensitivity – Nat Rev Urol

PY  - 2016/01/20/online

VL  - advance online publication

http://www.nature.com/nrurol/journal/vaop/ncurrent/full/nrurol.2016.3.html