What does high‑quality research say about circumcision and overall sexual function in men?

1. Evidence from randomized trials and large reviews: no consistent adverse effect

The highest‑quality evidence includes randomized trials and systematic reviews that together report no overall adverse effect of circumcision on core measures of male sexual function — erectile function, premature ejaculation, orgasm, and sexual satisfaction — with pooled analyses finding no meaningful differences between circumcised and uncircumcised men ^{[2] [1]}. Large systematic reviews that applied formal quality grading (e.g., SIGN, PRISMA) concluded that when restricted to better‑designed studies the pattern is consistent: no adverse effect, and occasional reports of improved function or satisfaction, particularly where hygiene or partner preference influence perception ^{[6] [1] [3]}.

2. Context from trials in high‑HIV‑burden settings: neutral or improved outcomes

Programmatic randomized trials and longitudinal studies performed in Africa to evaluate voluntary medical male circumcision for HIV prevention tracked sexual function and satisfaction prospectively and found no increase in sexual dysfunction; some participants reported increased penile sensitivity, easier orgasm, or improved satisfaction at follow‑up ^{[7] [8]}. Those trials benefited from control groups and standardized follow‑up, reducing some biases inherent to before‑and‑after studies, and their authors concluded circumcision programs are unlikely to harm male sexual function ^[7].

3. Contrasting findings and apparent harms in specific subgroups or study designs

Not all studies agree: some adult cohorts report declines in masturbatory pleasure, increased difficulty with masturbation, or mixed changes in erection maintenance after adult circumcision ^{[4] [5]}. Systematic reviews that mapped all published data document heterogeneity: of before‑vs‑after studies, a minority show increased erectile dysfunction while others show decreases or no change, indicating inconsistency driven by study design, indications for surgery, and population differences ^{[9] [10]}.

4. Why studies differ: methodology, selection bias, and the role of expectations

Differences track to clear methodological issues: self‑selected adult men seeking circumcision (often for medical or aesthetic reasons) may report different outcomes than population samples, retrospective self‑reports are vulnerable to recall and cognitive bias, and studies seldom separate newborn/cultural circumcision from adult/therapeutic circumcision — a key confounder ^{[10] [11]}. The literature also shows that men’s attitudes toward their circumcision status and body image correlate with reported sexual functioning, suggesting psychological factors and expectation effects shape outcomes in many studies ^[11].

5. Gaps, unresolved questions, and the evidence balance

High‑quality aggregated evidence tilts toward no meaningful long‑term harm to core sexual function metrics and, in some analyses, modest benefits in satisfaction or erectile outcomes ^{[12] [1] [3]}. Nevertheless, specific domains — such as detailed tactile sensitivity mapping, premature ejaculation, effects in sexual minorities, and the experience after adult elective circumcision — remain incompletely resolved and warrant more rigorously controlled, diverse, and long‑term studies ^{[12] [1] [10]}.

6. Bottom line for clinicians, parents, and policy

When assessed by the best available methods, medical male circumcision does not appear to reduce overall sexual function or satisfaction for most men and in many large, well‑conducted studies shows no adverse effect or modest improvements; however, individual outcomes can vary, and some adult men report reduced masturbatory pleasure or other changes, underscoring the need to weigh medical benefits, cultural values, and personal preferences on a case‑by‑case basis ^{[2] [4] [7]}.