Abstract
We disagree with Boyle's recent article questioning our systematic review in Journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed quality ranking we assigned to 7 of 36 articles that met our inclusion criteria. These had been ranked for quality by Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction. This conclusion was supported by two ran- domized controlled trials, regarded as high-quality (1++) evidence and majority of surveys and studies involving physiological measurements comparing uncircumcised and circumcised men. Here we explain why 2 randomized controlled trials merit a 1++ ranking and why 4 re- ports that Boyle believes merit a higher ranking only meet criteria set down for low quality (2−) evidence according to SIGN system. We therefore stand by our conclusions. These are supported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of histological correlates of male sexual sensation.
Highlights
Circumcision is the surgical removal of the foreskin, a small fold of skin that covers the head of the penis
“the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction.”
After evaluation of all research studies containing original data and rating each of these for quality we concluded that male circumcision had no adverse effect on sexual function, sensitivity or sensation [1]
Summary
Circumcision is the surgical removal of the foreskin, a small fold of skin that covers the head (glans) of the penis. After evaluation of all research studies containing original data and rating each of these for quality we concluded that male circumcision had no adverse effect on sexual function, sensitivity or sensation [1]. Gregory Boyle, a psychologist with a track record of opposition to male circumcision, recently published a critique [2] of our systematic review In essence, he disputed our high rating for two randomized controlled trials by scientists with strong track records and objected to the low rating we gave several studies with flawed study design, data interpretation and one-sided arguments. The 1++, 2++ and 2+ studies found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration Support for these conclusions was provided by a meta-analysis of all common forms of sexual dysfunction in men [3]. Circumcision and retraction of the foreskin of an uncircumcised man each expose the glans and these critical receptors
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