Women's Preferences for Penile Circumcision In Sexual Partners
[Its very title reflects its bias: a more accurate title would have been "Women's preference for penile intactness vs circumcision in sexual partners: a small, local survey"]
Marvel L. Williamson, Ph.D., R.N.
Assistant Professor, College of Nursing
The University of Iowa
Iowa City, IA 52242
Paul S. Williamson, M.D.
Associate Professor, College of Medicine
The University of Iowa
Iowa City, IA
[Interleaved comments by HY]
Regardless of pediatricians' attempts to negate routine newborn
circumcision, U.S. circumcision rates remain constant. [No, the rates vary widely across the US but have fallen slowly over last two decades. It is doubtful that many paediatricians make any serious attempts to "negate" RIC.] This study hypothesized that, because circumcision is usually a maternal choice and the circumcised penises are perceived by young women as more attractive, most women prefer circumcision for sexual reasons.
Of 145 new mothers of sons responding to this survey, 71-83% preferred circumcised
penises for each sexual activity listed.
Visual appeal and sexual hygiene were predominant reasons for favoring
circumcised sexual partners. Even among women having sexual experience only with
uncircumcised partners, only half preferred uncircumcised penises for sexual partners.
Eighty-nine percent of the sample had had their sons circumcised. This study furthers
debate over whether circumcision decisions should be based solely on medical
considerations limited to the newborn period.
In spite of recent attempt by the American Academy of Pediatrics
and other organizations to persuade the public to abandon the practice of
routine newborn circumcision (e.g., Thompson, King & Knox, 1975; American Academy of Pediatrics, 1984) [What attempt? The AAP's last three reports - the latest in 1999 - have been ambivalent, to say the least], new parents have continued to request the
procedure at the same high rates (Metcalf, Osborn, & Mariani, 1983). In the United States, approximately
75-90% of newborn males are circumcised, compared to only 10% of Europeans [the figure for newborn Europeans is far lower]
and 20% of males in general worldwide (Jones, 1985; Wallerstein, 1985) [the great majority of them Muslims circumcised in boyhood].
One survey of 200 women concerning their maternal attitudes
[towards] circumcision revealed that mothers were not giving medically valid reasons for having their sons circumcised, and the authors concluded that health care providers needed to do a better job of educating parents about the medical risks and benefits of the procedure (Lovell & Cox, 1979).
Even after other researchers launched extensive programs to inform prospective
parents about the lack of "absolute medical indication" for circumcision, no significant
change in the rate of newborn circumcisions could be observed in targeted samples (Herrera, Hsu, Salcedo, & Ruiz, 1982; Herrera, Cochran, Herrera, & Wallace, 1983; Land & Policastro, 1983; Rand, Emmons, & Johnson, 1983; Stein, Marx, Taggart, & Bass, 1982).
Parents within the United States who do not have their sons circumcised report the main
reason is cultural. That is, most are a part of a subgroup, often Hispanic, that traditionally
does not circumcise (Ernst, Philip, & Orman, 1987). [Who needs a reason not to cut off part of their baby's genitals? This article completely fails to mention - let alone give any serious consideration to - any of the many good reasons not to, such as risks, complications, loss of the foreskin's functions, etc. etc.]
Only 10% of the subjects who choose to leave their sons uncircumcised cite being convinced on the basis of reading or on physician's advice (Kreuger & Osborn, 1986; Stein et al., 1982).
It has been demonstrated that mothers more than fathers usually
decide whether to have their sons circumcised (Bean & Egelhoff, 1984; Williamson & Williamson, 1984). [Or do they, as the person on the spot, just register the joint decision?] Although informed consent for circumcision now includes information on how easy it can be to give proper penile hygiene to an uncircumcised baby, [It does? Some "informed" consent forms give no information at all.] mothers persist in their
desire to have their male infants circumcised. This trend is particularly
noteworthy within the current financial context in which many third party
payers deny coverage for newborn circumcisions (Medical World News, 1986. [But the majority still do.]
Review of the Literature and Conceptual Framework
Controversy characterized the history of circumcision.
Circumcision has existed since the Stone Age for unknown reasons (Jacobs, 1943). In
earliest written records documenting its use, religious beliefs required
that the male foreskin be removed as an outward display of faith and
membership in the group.
In some cultures, circumcision signified a boy's
entrance into manhood. In whatever setting, the uncircumcised were looked
down upon for being pagan or unmasculine.
Later, the European elite class made circumcision exclusive privilege in the Victorian era (Jones, 1985). This notion persisted even into the early twentieth century as evidence that a man had been born into a situation where the luxury of circumcision could be afforded. [Circumcision is now right out of favour among all classes in Britain and Europe.]
Circumcision has not solely been a status symbol, however. Within
certain circumstances it was a necessity. Entire armies found themselves
immobilized by balanitis, a painful inflammation under the foreskin [Balanitis, inflammation of the glans, also occurs in the circumcised] due
primarily to lack of access to bathing facilities. (King, 1979) [The publication is obscure - does King document this this extraordinary claim, or just repeat gossip? There are first-hand accounts of military doctors with a circumcision compulsion who invented such epidemics.] Societies that live in arid, sandy environments where water is precious learned long ago about the merits of circumcision. [This is a myth: various desert tribes do not circumcise.]
Even today, hygiene can be so difficult within some segments of the health care
system, such as in institutions for the elderly or the mentally handicapped where patients
may resist personal hygiene care, that circumcision eventually has to be performed to
prevent infections or other complications of the foreskin (Harris, 1986). [What do they do to the women in their care?]
Inadequate penile hygiene, which is more likely in uncircumcised
men, is resurfacing again as a predictor of carcinoma of the penis (Jussawalla, Yeole, & Natekar, 1985). [Yet cancer of the penis is rarer in some countries where circumcision is almost unknown, such as Denmark, than the US.] After
the proclamation by the American Academy of Pediatrics against
circumcision, studies have since begun reporting a relationship between
uncircumcision and the incidence of urinary tract infection in male
children (Ginsburg & McCracken, 1982; Shapiro, 1984; Wiswell et al, 1987). [Yes, when one "reason" for circumcision is disposed of, another arises, and another.]
Other complications, especially balanitis, bring about
significantly more medical visits for uncircumcised boys than for penile
problems in circumcised boys (Herzog & Alverez, 1986). Good hygiene, which itself can be difficult
for even the best intentioned parents, does not entirely eliminate these
problems (Krueger & Osborn, 1986).
[For the penis, as for every other part of the body, it is trivially true that because it is there it can give trouble. For no other part of the body is routine surgical removal recommended as a preventative.]
It is argued, therefore, that pediatricians have an incomplete
perspective in the current debate over whether circumcision for newborns is
necessary. Furthermore, medical indications and contradictions aside,
insight into the cultural and sexual rationale for why the American public
and American women in particular prefer circumcision is missing. Social
reasons for circumcision, when conceded at all, are dismissed by medical
personnel as being unjustifiable vis-a-vis existing "scientific" proof.
In addition, arguments that cite historical fallacies about circumcision fail
tests of logic when posing as premises for concluding that circumcision for
any reason is wrong (Grossman & Posner, 1984).
[True, if anyone had made such a deduction. The historical fallacies help to explain why circumcision became customary. It now continues largely under the momentum of that custom - which the authors seem to be at extraordinary pains to defend.]
The debate on medical grounds seems to miss a major portion of the
reasoning, though. In the face of the current campaign against
circumcision, why is it still requested at such high rates? What
motivations do American women have for wanting American males to be
In a study by Bean and Egelhoff of 277 new mothers of sons,
78% reported favoring circumcision even before becoming pregnant and having
to make a conscious choice affecting a son, and 91% ultimately decide to
have their newborn son circumcised (1984). [The question arises what pressures they were under in the hospitals.] Even those woman whose husbands were
uncircumcised overwhelmingly opted for circumcision. [So much for "A boy should look like his father" - unless his father is circumcised.]
The reason must seem important enough to woman for them to withstand pressure from physicians and others who oppose circumcision. [This begs the question that there is any such pressure. There is ample anecdotal evidence that the vast bulk of the pressure is in the other direction.] Brown & Brown go as far as to say that "the circumcision decision of the United States is emerging as a cultural ritual rather than the result of medical misunderstanding among parents" (1987). [It has been for most of the 20th century.]
One idea that has been overlooked is that the penis is a sexual
instrument, not just a passageway for urination. [The authors fail to follow through on this idea, that it is a sexual instrument that belongs to a particular person, or that its foreskin is integral to its sexual function. Their entire focus is on what his mother, who has - we may hope - no sexual interest in it, thinks about its sexual function.] For example, circumcision
at puberty in nonliterate cultures is in some ways a sexual recognition of
the emerging man (Bettelheim, 1954; Money, Cawte, Bianchi, & Nurcombe, 1970; Kitahara, 1976). The permanent exposure of the glans of the penis
renders it a sexual tool.
[An accurate observation. And is it not extraordinary that in a literate society, people might seriously consider surgically modifying the penis of a baby in order to render it, full-time and life-long, a more visibly "sexual tool"? Many men might not want their penis looking like a "sexual tool" whenever it is exposed - in the shower with other men, for example.]
Most research conducted previously on the reasons newborn males are
circumcised fails to include a reference to the perceived sexual appeal of
a circumcised penis over an uncircumcised one.
Typical lists of reasons from which the subjects could choose offered only hygiene, religion, father's or sibling's circumcision status, and other traditional
explanations. At the most, an "Other" category included in some surveys
caught untold thoughts on the perceived advantage of circumcision. Without
the inclusion of sexual attitudes toward penis type on such a list,
respondents would typically hesitate to spontaneously present sexual
rationale favoring circumcision, particularly in reference to a newborn
Admitting to sexual desires and preferences is difficult enough for
subjects even in straightforward studies. Without the researcher conceding
the possibility, it is not likely a mother would volunteer information
about her hopes for her son's future sexual attractiveness.
It was not until a study on cultural values associated with the
decision to circumcise, in which Harris used unstructured interviews, that
the sexual overtones of newborn circumcision were explicitly reported (1986). One
of her findings was that a circumcised penis has a certain "cosmetic
appeal," that in America the exposed glans is more pleasing aesthetically.
She concluded that circumcision could be an acceptable practice based on
cultural values, and that the health care delivery system could be a more
"perceptive cultural broker" with regard to honoring a society's view of
[Yes, this is a most extraordinary conclusion. In what other realm might a health care delivery system even dream of "honoring a society's view of beauty" by performing surgery on a healthy baby, quite regardless of that person's view of beauty?]
In asking various groups about why circumcision may be indicated, a
few surveys have included a response category labeled "cultural," which may
have been construed by some subjects to include sexual attitudes.
One such study found that significantly more obstetricians than pediatricians
believed that the culture was a valid reason for neonatal circumcision (Herrera & Macaraeg, 1984).
What the concept of culture means, though, is that to many Americans
circumcision seems to be normal because that is what they are accustomed to
seeing. This could certainly be true, in that what people are used to is
what they prefer.
This cultural perspective brings circumcision into a
new arena, one in which the rigidity by some health professionals fosters
alienation and resistance (Gellis, 1978). Some go so far as to say that opting for
circumcision indicates an emotional response that is not based on rational
decision making (Brown & Brown, 1987).
[Most Intactivists would heartily agree with that. Where we differ from the authors is in their assumption that health professionals have any role in cooperating with irrational decision-making involving life-altering surgery on a healthy, non-consenting third party.]
A study of female preference for certain male body parts showed
that 89% of woman students at a southern college preferred pictures of
circumcised penises over uncircumcised ones (Wildman, Wildman, Brown & Trice, 1976).
This is as close as the literature comes to facing the persistent preference by
American women for circumcision, as best displayed by new mothers of male infants. To
date, no study has explored the possible sexual motivations behind circumcision,
It was the purpose of this investigation, therefore, to determine
if women, particularly mothers who recently made a decision about
circumcision of their newborn sons, do indeed prefer circumcised sexual
partners, and if so, for what reasons. This study hypothesized that most
American woman prefer circumcised penises in their sexual relations, a
factor unrelated to the purported ["purported"? demonstrated] lack of medical indications for the
Women 18 years of age and older who delivered full-term healthy
sons within the previous month at a major midwest medical center comprised
the targeted sample. [The midwest in general, and Iowa in particular, are areas of the highest infant circumcision rates in the US, which itself has the second-highest rate in the world.] Candidates for the study were chosen during a 6-month
period based upon their willingness to participate in an earlier study that
dealt with who and what influenced their decisions to circumcise or not
circumcise their babies. [This willingness may not be randomly distributed. It might well be that women who bucked the trend to circumcise also resisted an inquiry into their sexual preferences.] The sample had been randomly selected and 85%
made up the group to whom questionnaires were mailed for this study.
vicki ekwall (divinefate) wrote on NPR on August 25,2010
AND by the way that study of 145 iowa mothers: I was one of those mothers! I was 19 they chose young ignorant mothers with no worldly experience and I had a girl child. At the time I knew nothing of circumcision dangers or benefits! They asked me if my child had been born [a boy] would I have circumcised and absentmindedly I said yes it had no relevance to me! ONLY then did they ask me to fill out the survey! So that too was a skewed sample!
Of the 269 women who received the questionnaire, 148 returned their forms
yielding a response rate of 55%. Three were unusable, yielding a final
sample of 145. Due to the explicit sexual nature of the questions, this
rate compares favorably to the other research studies investigating such
personal sexual issues. [It still introduces a 46% inaccuracy into the outcome.]
Because there had been no previous data collection tool seeking
this type of information, it is necessary to first confirm the content
validity through its review by several experts. The survey instrument was
tested on a pilot group of women who gave subsequent feedback about its
clarity and the completeness of the response options available from which
to choose. By comparing the outcome of this questionnaire to certain
items on the previously conducted study on the group of 269, it was also
possible to establish the reliability of the individual subject's responses
over a period of time.
The survey was highly personal, asking the women about their own
sexual experiences with men and about their preferences for circumcised or
uncircumcised penises for various sexual activities. No reference was made
to the women's decision to circumcise their own sons or not.
This survey dealt entirely with adult sexual experiences and preferences in order to
distinguish the two issues and allow for correlational tests between their choices as
parents and their attitudes as sexual adult women.
Each subject had received a thorough review of circumcision at the hospital when
deciding about their son's candidacy for the procedure. Each was also shown
drawings of both uncircumcised and circumcised penises. It was assumed,
therefore, that the subjects knew what circumcision meant and what types of
penises their sexual partners had. Lay terminology was used in each
question. Prior to implementation of the study, all procedures and tools
received approval by a human research subjects' rights board.
Confidentiality was guaranteed to the subjects and was maintained
throughout the study.
Most of the newborn sons of mothers in the sample had been
circumcised (89%). This percent is similar to the circumcision rate
prevailing in the geographic area at the time of data collection.
Of the women in the sample, 83.7% were married, 12.8% were single,
and 3.5% were separated, divorced, or widowed.
By race, 97.9% were Caucasian, 1.4% were black, and 0.7% were Hispanic. Another
characteristic consistent with the midwest population generally was religion: 46.1% were
Protestant, 21.3% were Catholic, 29.1% claimed no religion, 0.7% were
Jewish, and the remaining 2.8% listed other religions.
The group was well educated. All but 12.7% had finished high school and 25.3%
had at least some higher education. Fourteen percent had finished college. There was a
weak correlation between higher education and the choice to circumcise the
newborn (rpb = 0.27).
In response to the question "With which penis types have you had
sexual experience?", 16.5% [of the 145 women who gave usable answers, that is, 24 women, or 8.9% of the total number asked] revealed that they had had sexual contract with
both circumcised and uncircumcised men. Only 5.5% had sexual experience exclusively with uncircumcised sexual partners, and the remainder of the
sample [78%, 113]was sexually experienced only with circumcised men. [This may be usefully contrasted with the study by O'Hara and O'Hara, where all the women had experience of both kinds, and, while the sample was admittedly self-selected, those who preferred intact men explained why they did, in terms of actual differences in sexual sensation and performance.]
The responses to "If you could choose anyone for your ideal male
sex partner, which circumcision type would you prefer he have for the
following activities?" as shown in Table 1. There was a strong correlation
between the circumcision status of her newborn son and a woman's ideal male
partner's status for the purpose of intercourse (phi = 0.86)m, and a
moderate correlation for visual appeal (phi = 0.50).
To investigate any possible relationship between the circumcision
status of one's father or brothers and the preferred type of ideal sexual
partner, correlational tests were made on those subjects who knew whether
these family members were circumcised. No similarities were found that
could be attributed to childhood exposed to penises of either type (phi =
0.12 for fathers and 0.06 for brothers).
It was interesting to note that 22% of the sample did not know whether their fathers
were circumcised and of those who had brothers, 9% did not know whether they were