Should Boys be Circumcised?

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The foreskin (prepuce) has been described as a simple fold of skin, with its structures and functions ignored. The foreskin actually is a complex organ, an integral part of the penis, with many important functions.

The foreskin protects the glans and the urinary meatus (opening) and performs many other integrated functions.

The immunological functions of the foreskin help protect the body from pathogens. The sphincter action of the preputial orifice prevents entry of infectious contaminants. Glands secrete lysozyme, an enzyme that breaks down cell walls of pathogens. The sub-preputial moisture lubricates and protects the mucosal lining of the glans and inner foreskin. The high vascularization of the foreskin brings cells to fight infection, while Langerhans cells secrete cytokines, proteins that regulate the intensity and duration of immune responses, and langerin, a substance that provides a barrier to HIV infection.

The foreskin provides the skin necessary to accommodate a full erection. Even when erect, the foreskin has a gliding action that provides additional sexual pleasure to the man and his partner. The gliding mechanism of the foreskin facilitates insertion and reduces friction and chafing during sex. The foreskin also provides a seal, keeping the secretions necessary for comfortable intercourse contained within the vagina.

The foreskin contains 20,000–70,000 erogenous nerve endings, the majority of which are concentrated in the ridged band, which encircles the inner opening of the foreskin. When the penis is flaccid, the nerve endings are protected but, when erect, they are exposed. Circumcision removes about three-fourths of the nerve endings in the penis, leaving the circumcised penis severely disabled by comparison.

These nerve endings allow a man to modulate his sexual experience. Without them, a man may feel pleasure, but, without warning, reaches ejaculation quickly. The greatest complaint of circumcised males is premature ejaculation.

Without the foreskin’s protection, the glans becomes keratinized (calloused). The free nerve endings in the glans become buried in layers of callused skin. Many circumcised males complain about sexual dysfunction and impotence because they lack the feelings and feedback meant to be provided by nerve endings that were amputated with circumcision. Circumcised men are 4.5 times more likely to be diagnosed with erectile dysfunction than intact men.

The foreskin plays an important role in protection, sexual function, and sexual pleasure.