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 penis was thought to be desensitized by the loss of the prepuce. However, “lasting longer” was mentioned in only 1 of the studies in the present review.Avoiding premature ejaculation was also cited as a reason for circumcising a son in 1 study.Curiously, both of the studies from the 1920s cited aboveregarded circumcision as a racial or religious practice, even though by the 1920s, MC was common in both the United States and United Kingdom. The sensitivity factor is still widely discussed, but in surveys including a question about it there was a pretty even split as to whether circumcised or uncircumcised penises are more sensitive, with a significant 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. Yet when shown photographs of men with circumcised and uncircumcised flaccid penises, 89% of US women rated the circumcised penises as more attractive.One explanation offered for this finding is that the glans of the circumcised penis is exposed, as in the erect uncircumcised organ, which adds some sexual attraction to even the flaccid penis.

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.

In a sociosexual sense, stigma against type of penis by MC status, often based on self-reports of preference in the setting of a particular culture, can influence women’s preferences, as can the arguments used by organizations opposed to MC. 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. Increased migration and ease of travel have likely increased women’s exposure to both types of penises, which also may have influenced attitudes.

Women’s opinions regarding such factors as penile appearance, hygiene, and disease risk do not require the women to have experienced sexual activity with both circumcised and uncircumcised men. Although such opinions may influence these women’s choice of sexual partners, it should be noted that only women who have had sexual experience with both circumcised and uncircumcised men can provide valid data on outcomes from such activities. 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. Three such studies in our review received the highest quality rating of 1+.Each found a strong preference by women for MC based on sexual and hygiene considerations, as did those that documented women’s preferences based on appearanceand STI reduction.Those data were generally consistent with most of the studies involving women’s experiences in general population settings.

Women's knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys.

Women's knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys.

Future Research

Available studies in the United States and Australia are outdated, highlighting the need for new, well-designed 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. Ideally, the population studied should have similar proportions of circumcised and uncircumcised men. Although the large RCTs in sub-Saharan Africa of MC and risk of heterosexual HIV infection have provided high-quality data, given the significant benefits found, further RCTs of MC would now likely be deemed ethically unacceptable. Nonetheless, longitudinal studies conducted as part of the large-scale rollout of MC for HIV reduction would be acceptable and useful.

43 Mao L.M.

Templeton D.J.

Crawford J.

et al. Does circumcision make a difference to the sexual experience of gay men? Findings from the Health in Men (HIM) cohort. 61 Krieger J.N.

Mehta S.D.

Bailey R.C.

et al. Adult male circumcision: Effects on sexual function and sexual satisfaction in Kisumu, Kenya. 62 Kigozi G.

Watya S.

Polis C.B.

et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. 37 Zulu R.

Jones D.

Chitalu N.

et al. Sexual satisfaction, performance, and partner response following voluntary medical male circumcision in Zambia: The Spear and Shield project. 63 Brito M.O.

Khosla S.

Pananookooln S.

et al. Sexual pleasure and function, coital trauma, and sex behaviors after voluntary medical male circumcision among men in the Dominican Republic. 37 Zulu R.

Jones D.

Chitalu N.

et al. Sexual satisfaction, performance, and partner response following voluntary medical male circumcision in Zambia: The Spear and Shield project. , 38 Kigozi G.

Lukabwe I.

Kagaayi J.

et al. Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai, Uganda. Outside of HIV epidemic settings, many adult men undergo circumcision for medical reasons. In a study of men who have sex with men, medical circumcision was associated with long-lasting clinical or psychological impairment of sexual function.However, in cases of medically required MC in heterosexual men, there are no data on the sexual sequelae for women that could be resolved post-MC. Healthy uncircumcised men participating in RCTs on MC for HIV protection and longitudinal studies in Kenya,Uganda,Zambia,and the Dominican Republichave reported unchanged or improved sexual satisfaction after MC. In studies surveying the men’s female sexual partners, the women reported improvement in their own sexual experiences after their partners recovered from circumcision.Similar studies should be conducted to evaluate sexual sequelae for women whose male partners have undergone circumcision for medical reasons.

The health needs as well as sociological and religious needs of different populations and different religious and cultural groups within populations and countries call for tailoring future studies to address the specific needs of each group. Large high-quality studies of specific populations of women may provide better insight into the reasons for preferring circumcision or noncircumcision. In addition, research is needed to determine the changes, if any, in perceptions that occur when a woman from a culture where MC is common moves to a location where MC is uncommon and vice versa.

Although women’s preferences for a circumcised penis for reasons of appearance, hygiene, safety, smell, and taste is clear, research is needed on the outcome of this preference for actual sexual partner choice, for casual or more committed sexual activity, for frequency of engaging in sexual activity with a specific partner, and for participation in specific sexual acts once engaged in sexual activity. Also needed is research on whether women have a different sexual response and outcome of sexual activity beyond the aphrodisiac effect of what the woman finds desirable, this being influenced by culture, the woman’s global feelings about her partner, and the sexual script.

17 Williamson M.L.

Williamson P.S. Women's preferences for penile circumcision in sexual partners. 20 Bossio J.A.

Pukall C.F.

Bartley K. You either have it or you don't: The impact of male circumcision status on sexual partners. 17 Williamson M.L.

Williamson P.S. Women's preferences for penile circumcision in sexual partners. 17 Williamson M.L.

Williamson P.S. Women's preferences for penile circumcision in sexual partners. 17 Williamson M.L.

Williamson P.S. Women's preferences for penile circumcision in sexual partners. Although it is clear that most women prefer a circumcised penis, research is needed to understand the reason for this preference. Williamson and Williamson asked “what is sexier about a circumcised penis?”They suggested that “visualizing the glans, the urinary meatus, and the corona without these being hidden under a foreskin is arousing,” and noted that exposure of these structures is the case for an erect penis. In support of this idea, Bossio et alfound that although women preferred the appearance of the circumcised penis when flaccid, their preference for the erect penis was similar whether circumcised or uncircumcised. According to Williamson and Williamson, “while the foreskin of an uncircumcised penis can be retracted, the circumcised penis exists in exposed beauty whether flaccid or erect.”They further noted that “in some uncircumcised men, the foreskin can actually detract from the visual appeal of the penis.”They pointed out that for nude photography and erotic films, when using uncircumcised models or actors, the producers are careful to, “select penises with foreskins that are smooth and free from extra wrinkled skin.”Future studies should help provide answers to these questions.

Better, more relevant, quantitative research is needed on whether a preference for circumcised or uncircumcised penises actually influences life partner or casual sexual partner choice, affects sexual scripts, and can cause a woman to pressure her partner (potential or actual) to undergo circumcision. Studies are also needed to examine whether a mother’s preference for circumcision of a son is related to personal satisfaction with a partner who is circumcised.