The results from the survey by Kim and Pang [1] is misleading in so many respects I wonder to what threshold the editors are exceeding to publish anything that elevates the foreskin to almost magical status. First, the use of ‘sexuality’ in the title is incorrect, as circumcision has not yet been invoked as a cause of sexual orientation or sexual expression. More correctly, the title should have said ‘male sexual response’.

The design flaws are: no details on the recruitment of participants; a very limited and unrepresentative fraction of the whole group for evaluation, in that only 138 of 373 men were recruited for the survey; using masturbatory indices only and not researching responses about sexual intercourse so narrowing the focus to an area of sexual expression that might well be considered secondary to a male’s typical sexual expression, i.e. vaginal intercourse, that no sensible conclusions on circumcision and its sensory effects on intercourse can be inferred.

In that regard we do not know the sexual inclination nor sexual expression of the participants, which could severely bias the results if masturbation were the participants’ main or sole means of sexual relief, vs vaginal or anal intercourse, or any other means for that matter.

The respondents should have shown severe loss of penile sensation during intercourse if the adverse sensory and mechanical effects that were described in masturbation were equally distributed among those who masturbate and have intercourse. As the latter group was not questioned, the results are distorted and do not reflect a typical male population. Furthermore, we do not know what sort of techniques for circumcision were used, and it might be that removal of the frenulum, all of the mucosal layer, a ‘tight’ vs a ‘loose’ result, as examples, might lead to significant differences in sensations among the circumcised men. None of this was addressed.

The definition of severe scarring was not given, although all the men would have a scar, and it is certain that some would have more visible scarring than others, but that does not make it ‘severe’ or disfiguring. The authors state that all Korean men are circumcised, although the numbers in the study add to >100%. From what pool did the uncircumcised participants come; presumably not from Korea.

There are too many questions raised by this poorly designed and biased study. Increasingly it seems that many journal reviewers are showing biases that subvert the facts about the healthy and improved sexual effects of circumcision, favouring ‘there is no foreskin that I have ever met that I have not liked’ survey, to those that show that circumcision improves the quality of life for those fortunate enough to have had their penises improved by routine circumcision.