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Try out PMC Labs and tell us what you think. Learn More. Articles that met the inclusion criteria were rated for quality using the system. Database searches identified 29 publications with original data for inclusion, including 22 for aim i and 4 of these and 7 others pertaining to aim ii.

In the overwhelming majority of studies, women expressed a preference for the circumcised penis. The main reasons given for this preference were better appearance, better hygiene, reduced risk of infection, and enhanced sexual activity, including vaginal intercourse, manual stimulation, and fellatio. Cultural differences in preference were evident among some of the studies examined. Nevertheless, a preference for a circumcised penis was seen in most populations regardless of the frequency of MC in the study setting.

The findings add to the already well-established health benefits favoring MC and provide important sociosexual information on an issue of widespread interest. Sex Med ;— Precopulatory mate choices by females based on male genital traits occur in diverse species. This has led evolutionary biologists to suggest that premating sexual selection resulted in evolution of the comparatively large penis of humans relative to other primates.

A study of heterosexual women of various races found an association of penis size with attractiveness. The authors concluded that female mate choice could have driven the evolution of larger penises in humans. However, modifications to penis size also could have been driven by changes in the female reproductive tract associated with bipedal locomotion and the large head size of the human infant. Another feature of the human penis is male circumcision MC status. MC is an ancient practice 34 that may have emerged in Africa and accompanied the radiation of H sapiens out of that continent 35 approximatelyyears ago.

Privation stemming from Ice Ages and other forces may explain why MC subsequently ceased in European, northern Asian, and some other cultures. Nevertheless, the attitudes and sexual experience of women regarding MC is an important research question. already identified in searches were not included again. Titles and abstracts were examined, and the full texts of articles with the potential to meet the inclusion criteria were examined. The most relevant and representative articles on the topic were then cited. Bibliographies were examined to retrieve further key references. Publications pertaining to female circumcision and other genital modifications eg, female genital cutting or mutilation 15 were excluded.

In relation to aim i18 articles with original data were retrieved from PubMed. The PubMed search also yielded a specific critique of 1 of those articles. An additional article with original data was retrieved from Google Scholar. No further articles were identified from the Embase and Cochrane searches. Internet searches identified 2 articles and 1 conference abstract with original data, as well as a critique of 1 of the studies retrieved. Four of the studies relating to aim i also contained data relating to aim iiwhereas 6 studies relating only to aim ii were identified from the PubMed search and 1 such study was retrieved from an Internet search.

Table 2 summarizes the reasons other than for sexual activity related to their preferences as stated by the women in each study. Studies included, together with location, of women, ages, preference for sexual activity, and study quality by the grading system. Quality rating was based on an international grading system. Sexual experience of women with the same male partner before and after his circumcision. What follows is a country-by-country summary of the findings from each study. In a study of well-educated new mothers at a major Midwest medical center, Of the 5. No woman thought that an uncircumcised penis looked sexier.

Self-selection into the study of participants opposed to MC recruitment bias was acknowledged by the authors as a limitation of their study. Thus, the women surveyed were not likely representative of the general female population. Acquiescence bias—a tendency for survey respondents to agree with statements regardless of their content 41 —was also evident. The survey focused on vaginal sex, with no questions asked about oral sex, anal sex, or manual stimulation. Comments that participants provided at the end of the survey indicated that they may have been influenced by the survey itself.

Researchers in Canada noted that bias arising from the flawed study de and poorly framed questions caused this particular study to lack credibility, 20 and an opponent of MC in Denmark cautioned that the findings should be viewed with skepticism. Fellatio was not included in this part of the survey. The study found no difference in sexual functioning for female partners. No difference was expressed regarding sexual desire, vaginal lubrication, sexual arousal, ease of orgasm, sexual satisfaction, and pain with penetration.

The P values shown were from 1-way analysis of variance NS, not ificant. Right General preferences for male circumcision MC status, in which women were asked to state the MC status of their ideal sexual partner on an point scale for each of the 4 sexual activities shown, with 0 representing full preference for an uncircumcised penis, the midpoint indicating no preference, and 10 indicating full preference for a circumcised penis. The P values shown were from separate 1-sample t tests comparing MC status preference scores for each sexual activity type with the score of 5 no preference.

Only women who had experience with the particular sexual activity were included in each analysis. A study published in Australian Forum magazine involved a questionnaire placed in this magazine and in clinics of the Family Planning Association in Sydney. Three-quarters of the women had sexual experience with both circumcised and uncircumcised men. The latter is a point of difference from other studies and may be relevant; in a study of men who have sex with men, medical circumcision was associated with long-lasting clinical or psychological impairment of sexual function.

Frequent difficulty achieving orgasm were reported by of the 1, women. The Danish survey has been criticized on multiple grounds. The study did not correct for multiple testing. The authors of the aforementioned Canadian study 20 noted that their findings contrast with those reported in this Danish study.

The preference for having sexual activity with a circumcised man increased during this time, from Acceptance among those with uncircumcised partners in having their partner undergo MC also increased Focus group discussions that included 41 single women aged 16—24 years, 41 sex workers and barmaids aged 19—40 years, and 66 married women aged 27—71 years, all belonging to the noncircumcising Luo culture in Nyanza Province, revealed that the women largely agreed that MC status was irrelevant to their own sexual pleasure.

No statistics on preferences and opinions were calculated. The women who preferred circumcised men also reported more lifetime sexual partners median, 3 vs 2. Most of the women knew that they needed to maintain safe sexual practices, including the use of condoms. These women considered circumcised men to be more hygienic, to take longer to ejaculate thus providing a woman with greater pleasureand less likely to be infected with HIV and other STIs. A nonquantitative discussion group study of 18 HIV-negative and 15 HIV-positive married women in the Iringa region of Tanzania whose husbands had been circumcised in the year found a strong preference for MC because of increased sexual desirability, greater sexual pleasure, absence of pain during intercourse, social norms, and lower risk of infection by HIV and other STIs.

Several married women reported threatening to leave their uncircumcised husbands if they did not undergo circumcision. They also mentioned the improved ease of sexual intercourse after MC. An early study in Uganda noted that women from tribes that do not practice circumcision reported deriving greater sexual pleasure from circumcised men.

The authors concluded that MC has no deleterious effect on female sexual satisfaction, and that it actually might have social benefits in addition to the established health benefits. The authors stated that their findings should help dispel concerns about potential adverse effects of MC on female sexual function and satisfaction.

The adolescent females reported using their romantic relationships with males or the potential for a sexual relationship as leverage to promote circumcision, and demonstrated supportive attitudes concerning the post-MC wound healing process. Most female participants in Tanzania and Zimbabwe disclosed they would not initiate a relationship or would readily discontinue it if their partner refused VMMC.

Many believed that regardless of the benefits to herself, if a female truly cares for her partner, it is her duty to convince him to seek VMMC. The table provides a summary of the demographic data and findings; details of the studies follow. This factor correlated most strongly with whether a newborn son was circumcised. In a study in 13 Canadian provinces in which the early infant MC rate averaged A study in 3 locations in South Africa involving 3 ethnic groups found that None felt that a doctor or care provider would be involved in the final decision.

Thus, despite religion and culture, MC was highly acceptable among this broad range of mothers in India. Both non-Muslim Benefits cited included prevention of bladder or kidney infection A study of parents Multiple choice responses showed parents thought that MC was beneficial to 39 male looking for ladys texting sexing or more The study found In Tokyo semistructured, in-depth 60 minute recorded interviews of mothers of boys aged 4—15 years found a willingness, counteracted by cultural norms, embarrassment, 39 male looking for ladys texting sexing or more a desire to avoid their son being discriminated against in the Japanese noncircumcising society, to have their sons circumcised, hygiene being a major reason.

The age at which most Pacific Islander males are circumcised is between 6 and 10 years. The AAP suggested that parents should be provided with accurate evidence of the benefits and risks early in a pregnancy and should be free to either consent to having their son circumcised or to decline circumcision. The idea that women have a preference for circumcised male partners has a long history.

A century ago the prevailing wisdom was that circumcised men could last longer during intercourse and thereby provide greater satisfaction to their partner. The sensitivity factor is still widely discussed, but in surveys including a question about it there was a pretty even split 39 male looking for ladys texting sexing or more to whether circumcised or uncircumcised penises are more sensitive, with a ificant proportion of respondents citing no difference. One factor influencing female preference is the relatively recent discovery that MC offers some protection against HIV infection.

All of our cited African studies were predicated on this knowledge. A reduced risk of HIV infection is naturally quite a powerful factor influencing female choice; however, what was striking was the other benefits of MC cited by African women, even those in traditionally noncircumcising settings.

There was a strong vote for the circumcised penis as looking more attractive, even in populations in which MC is not the norm. One reviewer commented that the flaccid penis is not sexually arousing to a woman, a frequently expressed opinion. Moreover, population data for men of each penis type can be subject to confounding owing to, for example, ethnic factors that may influence sexual behavior. Only from objective studies, including RCT or longitudinal follow-up studies in which the same women provide data on sexual pleasure and experience with the same male partner before and an adequate time after his circumcision, can reliable data be obtained.

Women in countries with a higher socioeconomic status may make choices for different reasons. The influence of anti-MC lobby groups and outmoded medical policies not based on current scientific evidence of net health benefits have made MC difficult to access in hospitals except for medical need. This has adversely affected the teaching of MC to medical students, resulting in loss of MC skills and diminished post-MC management by medical practitioners. Changes in MC rates, attitudes, and policies over time, both upward and downward in different geographical locations, may limit the generalizability of earlier studies to the current era.

The data obtained from those studies involving focus group discussions were qualitative. Although this presents certain limitations, such studies are of considerable value because they are able to explore issues in greater depth. Internet surveys were rated 2—, because they are prone to attract participants with extremist views, making the data unreliable. Available studies in the United States and Australia are outdated, highlighting the need for new, well-deed studies.

For other countries, the current data are of mixed quality or lacking, and high-quality studies would be informative in those countries as well. New research should strive to ensure well-matched cohorts of women differing only by partner MC status.

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Chapter Gender, Sex, and Sexuality