Saturday, June 16, 2007

Sex, Pleasure, Circumcision and Economics

Ronald Bailey has a post on Sexual Pleasure vs. Sexual Health: The Circumcision Trade-Off. The argument is that circumcision reduces the risk of getting AIDS but also reduces sensitivity and so pleasure.

I have no idea how good the evidence is, but it strikes me that there is a serious logical problem with one step in the argument—from less sensitivity to less pleasure. The limiting factor to duration of sexual intercourse, under most circumstances, is male endurance; one can plausibly model the process as a rising intensity of pleasure up to the point of orgasm, with total utility equal to the area under the curve. If so, greater sensitivity simply means that you reach the same maximum sooner, reducing the area under the pleasure curve.

And that's without even considering the utility of the other participant in the process.

31 Comments:

At 2:03 AM, June 16, 2007, Blogger Gabriel Mihalache said...

The evidence on the health side is somewhat nuanced. It doesn't seem to apply to those in the "developed world" which wash behind their foreskin daily or so. -- At least, that's the opinion of local doctors when discussing circumcision. They see it as a religious practice which is rationalized with such arguments, which really don't make a lot of sense. It's an emotional issue too, I guess, on all sides.

As for the pleasure aspect, it doesn't do it justice to lump it up in an amorphous utility quantity. Plus, there's the debate of orgasm-centric vs. duration-centric pleasure from sex.

But you don't mention one of the important aspects, with comfort, autonomy and pecuniary implications... The circumcised no longer benefit from the gliding action of the foreskin so they're far more likely to have to buy and use lubrication.

 
At 3:07 AM, June 16, 2007, Anonymous Anonymous said...

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At 10:25 AM, June 16, 2007, Blogger jimbino said...

In a just world, mutilation of a child's sex organs, when not indicated by medical necessity, would be severely punished, and so would a rabbi's placing the organ in his mouth, even if wine is used.

But we live in a superstitious and religious world, not a just one.

As far as the pleasure is concerned, it would be great to survey men circumcised as adults, preferably through medical necessity, as to the relative merits.

David seems to think that duration of intercourse is the big deal; if he felt that way about kissing or crapping, there are other sensitive mucous membranes whose surgical removal would enhance the experience.

The surgical remove of the foreskin for reasons of sanitation is a joke; if we were really so concerned about sanitation, especially in hospitals, we'd encourage removal of fingernails.

The Germans, Skandinavians and Japanese are among the longest-lived modern humans and very few are circumcised. I guess the Africans are just too barbaric to be allowed to have intact sex?

When I asked my dad in 50s Amerika about my intact but different-looking organ, he replied that he'd just pass on the advice his mother gave him: "Son, you'll just have to wear it off."

 
At 11:26 AM, June 16, 2007, Blogger ninjadroid said...

I'm always amazed that the circumcision issue is, well, an issue. I'm quite happily circumcised, and am glad the procedure was taken care of long before I could remember it. I don't have a bone to pick with those who feel like they've been wronged, I just can't comprehend it either.

For whatever this is worth, according to the women I've known, circumcised guys get a lot more oral sex since it's easy to keep that area hygenic. I'd say that's pretty fucking important.

 
At 12:16 PM, June 16, 2007, Blogger jimbino said...

Ninjadroid,

A lot of African women are happily circumcised as well. That makes the practice OK? Then why is it illegal here in the USSA?

The big deal, in case you haven't noticed, is that people, mainly men, are in jail for merely slapping women or for touching little twats, and when they get out they aren't allowed to practice law again.

Why should rabbis and penile mutilators get a free pass? You must count among those who value superstition over justice.

 
At 5:26 PM, June 16, 2007, Blogger William Newman said...

I really doubt it's a clear win. Topical anesthetics and mechanical tricks to reduce sensitivity temporarily are not so hard to find. If they tended to enhance the sexual experience for the typical man, I'd expect they'd be pretty popular. If they indirectly increased the satisfaction of the typical woman, the situation seems more complicated, but waving my arms furiously and uttering the Word "Coase" I will divine that they'd end up pretty popular in that situation too. My impression is that instead they are niche/novelty items. How easy is that to reconcile with the hypothesis?

 
At 6:49 PM, June 16, 2007, Blogger Al Montestruc said...

David,

I think you fail to account for some issues.

1. Risks associated with the surgery, this is not zero, and has had some pretty horrific results to some, also some of the effects that are not horrific can be annoying to the boy. Too much taken off can result in painful erections.


2. As others have pointed out the benefits are not as large as some claim, especially in a society where one can bath often as in the USA.

3. In other societies which are not advanced enough to have regular bathing, the risk of surgery is much larger.

My father- before I was born - had a Jewish friend who complained to him about painful erections due to too much tissue being taken. As a result he was adamant with the doctor attending my birth that he was not to do any such thing.

Supposedly when the doctor was still trying to sell him on it, he said "you cut my son, I'll cut you" which ended the argument.

I have not had any problems, though I am unusual among American men in not having this done.

 
At 6:57 PM, June 16, 2007, Anonymous William H. Stoddard said...

If you want to lower your sensitivity, you can always wear a condom.

 
At 7:30 PM, June 16, 2007, Anonymous a.b. said...

FMHE, a simple experiment without a condom, with a condom, and with a desensitizing condom invalidates the build-up theory. Results may vary though.

 
At 10:53 PM, June 16, 2007, Anonymous Anonymous said...

The AIDS/circumcision issues is specific to a certain immune system cell type found in large numbers in the foreskin. It has nothing to do with hygiene.

 
At 12:52 AM, June 17, 2007, Anonymous phi1 said...

Where Aids originates from:
http://video.google.com/videoplay?docid=5064591712431946916

Healthy = free of sin

 
At 9:31 AM, June 17, 2007, Anonymous R said...

Wait, what other participant?

 
At 1:11 PM, June 17, 2007, Blogger jimbino said...

One interesting thing about sex is that, besides Genghis Khan and Wilt the Stilt, no guy has coupled with all women under all circumstances. Another is that we can't really do a controlled experiment to determine the truth, because of privacy concerns coupled with a kind of Uncertainty Principle of Sex that tends to cause performance, at least in males, to be arrested by observation.

So we have to rely on anecdote, which is difficult to do, particularly once we have learned to discount, if not disregard entirely, all that our popes, presidents, parents, preachers and professors have conspired to tell us.

But all wisdom about sex is nowadays, like anything else, available on the Web. So is all the foolishness, and we have no way to distinguish the two. Hell, I just tried Googling to query the efficacy of acupuncture: no map exists for that labyrinth. Imagine a teenager Googling "sexual satisfaction"!

"Rumor has it" that the best source of decent information on sex is the venerable Playboy Advisor, though I do know from my sister, who worked there, that when things were slow the secretarial staff made up both questions and answers. Still, it's not so bad an idea to learn sex from young women conspiring to give you both the important questions and their answers!

There are a couple of things I'd like to point out to David, however:

First, consider that the clitoris, sensitive like the intact foreskin, will often ("rumor has it") transmit pain, not pleasure, if directly stimulated. I'm curious to know the analog and its effect in the intact male.

Second, consider that you (around my age--we were classmates in physics at Chicago) might now, if you were intact, consider heightened sensitivity a true g-dsend.

 
At 7:48 PM, June 18, 2007, Blogger Mike Huben said...

Whenever I see discussion of this ritualized tribal mutillation called circumcision, I think of Michael Shermer, who says:

"Smart people believe weird things because they are skilled at defending beliefs they arrived at for non-smart reasons."

 
At 9:23 PM, June 18, 2007, Blogger Patri Friedman said...

I think the more interesting and important question is the morality of such irreversible superficial surgery. If the upside is protection against STDs, why not wait until the child is old enough to make an informed decision?

 
At 12:00 PM, June 19, 2007, Blogger ninjadroid said...

A lot of African women are happily circumcised as well. That makes the practice OK? Then why is it illegal here in the USSA?

Sounds like a moral question, and in that regard, you've got the wrong guy. I'm disinclined to moral debate generally, and particularly as it applies to children --- it's an extremely thorny issue.

I am open to proposed resolution for conflicting beliefs, however.

 
At 12:16 PM, June 19, 2007, Blogger ninjadroid said...

As for being impugned as "one who values superstition over justice," here's an idea: suck on my fat circumcised cock.

 
At 12:56 PM, June 19, 2007, Anonymous Matthew C. said...

Wow, Mike Huben and Patri Friedman (and me also) all agree on something!

 
At 4:04 PM, June 20, 2007, Blogger Milhouse said...

why not wait until the child is old enough to make an informed decision?

Because adult circumcision is physically painful, and even contemplating it is likely to be painful for a lot of men. Infant circ, at least when done by a mohel, seems to be painless; the babies don't seem to notice - they often start crying as soon as their nappy is removed, but the volume doesn't seem to increase when the cut is made, and those that weren't crying before the cut don't seem to start crying then.

 
At 8:03 PM, June 22, 2007, Anonymous Anonymous said...

People who oppose circumcision will say it's unnecessary if good hygiene is practiced.

Ha!

My pediatrician friend says that a substantial percentage of young boys do NOT, despite being told to do so by him and by their parents, practice good hygiene.

You've got to factor in the likelihood that people are imperfect.

 
At 8:58 PM, July 05, 2007, Blogger mayisay said...

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At 9:01 PM, July 05, 2007, Blogger mayisay said...

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At 11:50 AM, July 13, 2007, Anonymous michael sullivan said...

Just for reference if anyone is still reading this old thread: female "circumcision" is a vastly different animal, and would be more closely akin to removing the entire glans (head) of the penis.

The principle seems similar, but the magnitude of the mutilation is quite different. That I was circumcised without my consent seems a bit odd, and I certainly wouldn't do it for my own child if I had one, but I can't really get angry about. The equivalent of female circumcision would probably not feel the same.

Also note that female circumcision takes place around menarche, which cuts two ways. In many cases, the subjects consent. While that consent is generated largely by cultural pressure and is fairly suspect, it's consent. OTOH, in very many cases, the subjects explicitly do *not* consent, and are forced to undergo the procedure.

I can tell you right now that if my parents and doctors had held me down and cut off half my penis against my explicit wishes at age 12, I would absolutely consider them criminals, no matter how many people were having the procedure done by consent.

 
At 9:49 AM, July 20, 2007, Blogger Caliban said...

There is a major flaw in the sensitivity fallacy advanced in the original post.

Male arousal follows a different curve than female. It rises quickly, then falls off even more rapidly; female arousal rises and falls slowly. A more sensitive penis is not just more sensitive to the pleasure of stimulation, but also to the irritation of friction. This irritation encourages (and, indeed, FORCES) uncircumcised males to SLOW DOWN at intervals, allowing their stimulation to fall off repeatedly in a sawtooth pattern, while the female's arousal is only mildly diminished. This prolongs intercourse significantly, and the end result is rather like a male multiple orgasm - coupled with a significantly higher probability of the female reaching orgasm.

I'd say that's worth protecting.

I'm not going to join the debate over whether we should cut pieces off our infants to reduce the likelihood that they will communicate a disease they do not already have, because I simply don't see what there is to debate. If you want to prevent communication of a disease, you circumcise the people that have it. Circumcising them as infants because there's a miniscule chance they may get it twenty years down the road is just retarded.

 
At 1:20 AM, September 10, 2007, Anonymous Anonymous said...

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At 10:34 PM, January 08, 2008, Anonymous Spacediver said...

what a naive view of sexuality friedman has. A completely plausible model of sexual pleasure is that the more erogeous tissue you have, the more neural modulation you have which can build up a deeper and stronger orgasm over a longer period of time.

It is completely likely that the cortical real estate devoted to genital sensation is remapped so that remaining tissue stimulates all of it (neural plasticity research certainly suggests so -e.g. see study of amputated fingers of monkeys where neighbouring fingers stimulate areas of the cortex previously stimulated by amputated finger). Nevertheless the richness and complexity of sensation and orgasmic modulation is necessarily reduced.

My own experience is that satisfying sexual experiences are derived by deriving the buildup to orgasm from diverse sensory platforms (i.e. not only glans, but also frenular region). In fact, stimulation from only one area builds me up to orgasm faster than desired - the best orgasms are those derived holistically.

Reducing the neural bandwidth though which sexual sensation is chanelled may actually speed up the buildup to orgasm.

Circumsision completely screws around with the sensory topology of the penis by severing parts of the peripheral network and interfering with their local communication.

Furthermore, not all circumcisions are equal - many males are fortunate enough to be spared significant portions of the frenular tissue (all you circ'd males out there, check the sensitive area around the scarline - intact males have a triangularly tapering array of sensitive tissue extending all the way up to the meatus (hole in the glans) - consider yourselves lucky if you have a decent amount of these remnants - the sexual hardware in these regions is quite wonderous.

Finally, it is important to reflect upon the features of female circumcision which are considered minimally sufficient to cause moral outrage, and see if they map onto male circumcision.

Male genital cutting (MGC) and FGC are certainly not identical. For one, the subjects of the procedure are of different sexes. MGC largely takes place in relatively sterile conditions, using anaesthetic and surgical technologies, while FGC is primarily associated with dangerous circumstances. MGC may offer health benefits that are not to be found with FGC.

But let us imagine a procedure, thousands of years old, which involves scraping away the inner walls of the vagina, and trimming down the infant's vulva. Suppose that it has become medicalized, and is done using sterile equipment by trained professionals, and causes little to no pain. Suppose that the resulting scar tissue and loss of delicate mucosal surfaces renders the female significantly less likely to transmit and receive infectious pathogens, including HIV. Furthermore, suppose the risks of the procedure are of little significance.

Imagine this procedure has taken place for thousands of years, and is an important cultural aspect, and a source of pride in the millions of women which undergo it. They consider an intact vulva to be a dirty and ugly object in need of trimming. Very few women complain about it, and much of the sexual research done, which largely involves verbal self report, doesn't show any consistent loss of sexual function.

In order to be consistent, many people in favour of male circumcision would have to concede that such a procedure is not an abuse of human rights.

Others would disagree. They would claim that it is very hard to objectively measure the sexual effects of the procedure, and until physiologic measures are taken (such as measuring the strength of a cut woman's sexual response via measures such as changes in blood pressure, skin conductance, heart rate, strength and duration of orgasmic contractions, and release of hormones associated with orgasm), it would be foolish to rely on verbal self reports, which are extremely limited in their methodological power.

Instead, they would argue, there is a prima facie case to be made that the removal of erogenous tissue decreases the range of sexual sensation, and that it is better to err on the side of caution and assume that it is sexually detrimental, regardless of what the vast majority of cut woman claim.

They would appeal to the sound judgement that the removal of sexual tissue from a nonconsenting female, unless absolutely medically necessary, is fundamentally horrifying.

The step that many have not yet taken is to understand that it is fundamentally horrifying to do so from a nonconsenting human, female or male.

 
At 12:51 AM, January 10, 2008, Anonymous Hugh said...

Your use of the integral of the graph of increasing arousal ('the area under the curve') as a measure of pleasure is a good one, but your assumption that "sensitivity" is one-dimensional and that decreasing it will increase the time to orgasm is faulty. The sensitivity of the foreskin not only helps to trigger the ejaculatory reflex, it sends sensory data that helps to enable a man to control what is going on, and hence to delay his ejaculation while keeping his level of stimulation high, thus maximising the area under the curve. (These sensations are also highly pleasurable in themselves.)

Circumcision is akin to ripping the accelerator pedal out of a car and leaving an on-off switch.

 
At 12:56 AM, June 02, 2008, Blogger AnuP said...

This is a very absurd discussion; people without realising effects saw their biased thoughts.
I enjoyed the sexual pleasure of my natural penis till the age of 39. Its (of glans and foreskin) sensitivity is amazing. The best way I experienced this was by having sex by pulling the foreskin towards the base of penis to make the penis fully taut while my sits on top of me. I can't tell the excitement I enjoyed. Same was true when I masturbate while holding foreskin taut in one hand and rubbing only from glans towards the base with the other hand. But the sensitivity while giving me extreme pleasure brought orgasm quickly.
I decided to circumcise after seen a lot of porn guys' performance and also to give my wife a greater control of my penis; to suck, stoke, cuddle or do anything which was not possible with foreskin intact. (had it done on 39 and now I am 43).
I am really proud of my cut penis which has made me very horny. True it's sensitivity is lost but my pleasure is increased. I love my wife to caress it, suck it, and rub it before diving in her love canal. Masturbation is also highly satisfying. I either have sex or masturbate every other day. It's true that cut penis is dry, but when going inside vagina it gets lubricated. Masturbation has not affected by the procedure any way. My wife doesn't feel much conceivable difference. Its appearance also gives me a great pride. I must admit circumcision has largely increased my sexual desire and horny-ness.
I think before circumcision I was more concerned about the pleasure I derive from sex but now I am much more concerned to give as much pleasure as possible to my wife and I satisfy from it. This is a great shift in the sexual pleasure paradigm.
I love it>

 
At 7:35 PM, December 02, 2009, Anonymous George J. Kinsey said...

Do circumcised men last longer? Are they less prone to PE?

If having a foreskin is unhealthy, that fact would be revealed by comparing USA urological and epidemiological data, with comparable data from western Europe and Japan. I have been waiting 25 years for such a comparative study, and am not holding my breath. Where soap, hot showers, and condom access can be taken for granted, there is no evidence that the intact penis is unhealthy. We do know that HIV and other STDs are more common in the USA than in Europe and Japan.

We do not know the risks of circumcision because there is, as yet, no careful study of a randomly chosen sample of American penises, with a view of identifying possible damage arising from circumcision and from lack of circumcision. The sample would have to be fairly large (at least 5000) because serious damage is likely to be fairly rare. But if the million odd routine circumcisions carried out every year in the USA result in, say, 500 sexual cripples, that should give one pause.

Sexual pleasure. The following a priori reasoning has fair intuitive appeal. Circumcision discards about 20,000 nerve endings present in the foreskin and frenulum. After circumcision, the surface of the glans is likely to dry out and otherwise toughen. In short, circumcision makes the pleasure of vaginal intercourse less thrilling. Hence circumcised men are likely to last longer.

Unfortunately, sexual arousal is a complex dynamical system whose quantitative properties are still not well understood. (The work of Masters and Johnson only elucidated the qualitative properties of vaginal intercourse with a cut penis.) Hence the questions at the head of this post are fair ones, that should be addressed by the standard empirical methods of medicine and social science.

The ideal would be to have couples engage in foreplay and copulate while in the bowels of a scanning machine. That device would quantify their sensations, and write a record thereof to computer readable file. I am confident that the IT needed to do this will emerge one day, but that day hasn't arrived yet. Until such technology arrives, the bits that circumcision removes should enjoy the benefit of the doubt. I happily assume that Mother Nature knows more than we do.

David, the pleasure both parties derive from vaginal intercourse has more than one dimension, duration. Here are some possibilities. Women climax more quickly on average with intact partners; simultaneous orgasm is easier when he's intact; women find it easier to have multiple orgasms with intact partners. There are a fair number of posts on various forums, claiming to be by women who have experienced both kinds of men, and who say they prefer intact. There are women who publicly agitate against circumcision, and who have told me by private Email that brief intimacy with 1-2 intact men years before put fire in their bellies. One thing is fairly certain: intact makes masturbation and foreplay with the fingers easier and more pleasant. Another thing: most American gay men very much value intact partners.

To believe that circumcision is likely to improve sex most of the time is like believing that public sector regulation will improve industrial performance. The universal circumcision policy of American maternity wards, 1940-80, was akin to central planning. It probably had a venal motivation: the price charged substantially exceeded average variable cost. I did a PhD in economics at Chicago, have been married for 20 years, am raising daughters, have defended intact for a quarter century, and am intact myself.

 
At 7:50 PM, December 02, 2009, Anonymous George J. Kinsey said...

"My pediatrician friend says that a substantial percentage of young boys do NOT, despite being told to do so by him and by their parents, practice good hygiene."

The way forward here is not to snip boys, but to set traditional parental prudishness aside. Periodically, a father should very gently check his intact son's progress towards full retractability. Once that is achieved, he should occasionally inspect and wash the preputial sack. The son will take the hint.

Milhouse: Jewish ritual circumcision is not painless, because Jewish tradition is taken as baring the use of local anesthesia. (While the Bible mandates that Jewish boys be circumcised when they are a week old, I can find nothing requiring that it be painful.)

American routine neonatal circumcision is not painless because at least half of such circs are still done without lidocaine. This despite a clinical trial published in the 1997 JAMA, conclusively demonstrating that routine neonatal circ is intensely painful.

To circumcise a baby without a prior injection of lidocaine should be deemed an assault, and as actionable. It is blatantly unethical and must cease immediately. I do not wish to maintain that lidocaine abolishes all pain; I can only assert that it reduces pain.

 
At 8:01 PM, December 02, 2009, Anonymous George J. Kinsey said...

jimbino:

"The surgical remove of the foreskin for reasons of sanitation is a joke; if we were really so concerned about sanitation, especially in hospitals, we'd encourage removal of fingernails."

I can do you one better. A simple operation, done on infant girls under local anesthesia, would assure that their breasts would never develop. Hence no more breast cancer, which kills 85,000 American women every year. Breasts are completely inessential to life. Being flat chested has a number of practical advantages, starting with athletic participation. I was breast fed, but it is not at all evident that my bottle-fed Baby Boom peers are any worse off.

This is unthinkable, because women are entitled to keep the breasts Nature grants them, until a serious problem emerges. If a woman wishes to discard her breasts (a very small number of women do so each year, because of a family history of breast cancer), that should be an adult decision. The male foreskin deserves the same respect.

 

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