My friend’s fiancée insists on adult circumcision

Dear Dr. Milrod:

A 30-year old acquaintance of mine from northern Europe is getting married to his American girlfriend. She is Jewish, he is a Scandinavian atheist. She is now demanding that he undergo circumcision before marriage, or else her parents will not accept him as her husband. He is mostly afraid that he will lose all sensation in his penis, and that “sex will become worthless.”  From what I have read – everything from Masters and Johnson, to discussing this with urologists, colleagues and friends – circumcision does not seem to affect the sexual experience at all. Some reports I have read have even stated that sex is more enjoyable after circumcision. Above all, women seem to prefer circumcised partners, but maybe that is just in the United States. In addition, new research has shown that circumcision reduces HIV infection by over 50%. In short, I have told him that he need not worry, and that my recommendation is that he should undergo circumcision and become happily married. His fiancée is fantastic and they love each other. Nevertheless – what is your opinion on the matter?

Dr. B in Beverly Hills


Dear Dr. B:

There are many factors to consider in this case. My response is informed by formal studies, anecdotal evidence, personal bias and knowledge of Judaism and its practices, including my experience in counseling Orthodox as well as secular Jews. First of all, it is important to ascertain the particular affiliation/branch of the fiancée’s Judaism. This has a bearing on the type of circumcision that will be accepted, should this man consider going through with the procedure. If she is Orthodox or Conservadox/Conservative, a proper bris will be necessary, complete with removal of a substantial amount of foreskin. If she is Modern Reform, the Rabbinical Council (or just the rabbi) may be satisfied with a symbolic bris, drawing blood from the penis but leaving the foreskin intact. This is something that needs to be discussed with the Rabbi, as I am assuming this man is also converting? Without his religious conversion, there is no sense in circumcision, as a mere procedure will not make him a Jew in any fashion.

The family needs to abide by the rabbinical edict or counsel in this matter. If the family is insisting on this procedure without guidance from a rabbi, then the procedure is questionable. Most likely, the procedure will be performed in a hospital by a physician, although if these people are really frum, i.e. highly Orthodox, there may be a mohel involved. If the surgery is successful, he will not lose complete sensation, but his sensation will surely be diminished. As the glans continues to be exposed to air, rubbing of fabric, etc., it will slowly keratinize. In addition, he will lose some ability to self-lubricate. This will have consequences on his technique and style of intercourse. He will no longer be able to use the same technique in terms of intromissive intercourse. Since he is no longer self-lubricating, they will need to rely on her ability to lubricate from excitement. In view of the fact that some women’s lubrication diminishes due to lack of sexual excitement throughout years of accommodation and habituation to the same individual (i.e., it may take her longer to get excited), in addition to hormonal changes, they may now become steady consumers of lubricants. In addition – and this is probably the worst aspect for a woman – the penis will no longer be “screwing” itself into the vaginal cavity with the help of the prepuce and the natural lubrication. He will need considerably more friction, which, in slang terms means that he will “bang” rather than “screw.” This can cause considerable dryness if the sex act is prolonged, and may give her pain after some minutes of intromissive sex.

If the surgery is less than optimal, he could experience a variety of issues as the penis heals. The loss of frenulum where there are extreme nerve endings responding to pleasure cannot be overstated. There are no guarantees except one – he will lose some sensation.

It is true that there is a visual bias of women in the United States for circumcised penises; this visual bias does not exist in countries where men are not circumcised. This is a simple argument that can be explained with cultural preferences. But cultural preferences do not mitigate the fact that when you perform needless surgery on a healthy organ, you are doing something for visual appeal only – the procedure has zero function. At that stage, you may ask yourself what happened to primum non nocere, but that is for physicians to decide. I do not know of a single uncircumcised physician advocating this procedure unless there are serious medical indications. Not to mention the psychological agony this man is currently being put through by pressure from her and the family.
Now, addressing Masters and Johnson: We need to differ between loss of sensation and loss of sexual function. As with any surgical procedure, there are risks. If there are no adverse issues during the surgery itself, his sexual function will certainly be intact. If the goal is to preserve sexual function, then of course he can have the circumcision. But for him, there is a 100% certainty that he will experience loss of sensation once he is completely healed. As to the African study on reduced HIV rates: This is data that can be interpreted in various ways. Suffice it to say that these studies were performed on impoverished Sub-Saharan populations where other factors such as cleanliness, diet and sexual partners were confounding variables. The figure above is simply not reflective of conditions in the United States. If that were the case where the vast majority of men are circumcised, we should never have seen the rates of HIV among the gay population that we saw in the early 80s-mid 90s.

Quite frankly, he may become happily married, but his sex life surely will never be the same. If your good friend the fiancée had met an African man and his family insisted that she go through a modified adult clitoridectomy, would you advise her to do so? There are cultural biases and prejudices in many different directions and each and every one of them needs to be examined. But as a professional sexologist, I never advise anyone to get circumcised unless there is a medical condition indicating this procedure.

Christine Milrod, PhD


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