Across different cultures, women’s preferences generally favor the circumcised penis for sexual activity, hygiene, and lower risk of infection

Morris BJ, Hankins CA, Lumbers ER, et al. Sex and Male Circumcision: Women’s Preferences Across Different Cultures and Countries: A Systematic Review. Sex Med 2019;XX:XXX–XXX. https://doi.org/10.1016/j.esxm.2019.03.003

Abstract
Introduction: Women’s choices for a sexual partner are influenced by numerous personal, cultural, social, political and religious factors, and may also include aspects of penile anatomy such as male circumcision (MC) status.

Aim: To perform a systematic review examining (i) whether MC status influences women’s preference for sexual activity and the reasons for this, and (ii) whether women prefer MC for their sons.

Methods: PRISMA-compliant searches were conducted of PubMed, Google Scholar, Embase, and the Cochrane Database of Systematic Reviews. Articles that met the inclusion criteria were rated for quality using the SIGN system.

Results: 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. In studies that assessed mothers’ preference for MC of sons, health, disease prevention, and hygiene were cited as major reasons for this preference. 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.

Conclusion: Women’s preferences generally favor the circumcised penis for sexual activity, hygiene, and lower risk of infection. The findings add to the already well-established health benefits favoring MC and provide important sociosexual information on an issue of widespread interest.

Introduction

Precopulatory mate choices by females based on male genital traits occur in diverse species.1 In early naked Homo sapiens, upright body posture and protruding nonretractile male genitalia made for a particularly conspicuous penis, even when flaccid. 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.2 Tallness and greater shoulder-to-hip ratio also are associated with male 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.3 Although in recent millennia the adoption of clothing covering the genitals has precluded women’s perception of a potential partner’s penile features at first encounter, those would likely become evident once intimacy occurs.

Another feature of the human penis is male circumcision (MC) status. MC is an ancient practice3, 4 that may have emerged in Africa and accompanied the radiation of H sapiens out of that continent3, 5 approximately 220,000 years ago.6 For example, evidence from portable art and rock art suggests that MC was practiced in Europe during the Upper Paleolithic (38000–11000 BCE).4

Privation stemming from Ice Ages and other forces may explain why MC subsequently ceased in European, northern Asian, and some other cultures.3 In the nineteenth century, the perception of health benefits, such as improved hygiene and protection against syphilis,7 balanitis, and phimosis,8, 9 is the likely explanation for the reemergence of MC in some Anglophone countries, particularly the United States.3 The US occupation of South Korea may explain why MC became popular there after World War II, whereas in the Philippines it was already an accepted practice before the US presence.10, 11 Globally, MC is common in diverse cultures, driven largely by religious and social customs, with an overall prevalence of 37%–39%.12

MC is just one of many factors that influence a woman’s choice of a male partner, others being religion, race, social class, personality, overall attractiveness, ability to provide for the woman and her offspring, ability to satisfy the woman sexually, and basic hygiene. Nevertheless, the attitudes and sexual experience of women regarding MC is an important research question. This is especially true given the health benefits provided by MC for men and their sexual partners, as well as women’s important influence in deciding whether their sons will be circumcised.

In the present study, we aimed to provide a systematic review of the scientific evidence examining women’s attitudes and preferences for MC in their male partners and male children.