I warmly agree that American medical and sexual research has not honestly examined the possibility that routine circumcision can have adverse effects on adult sexual pleasure and functionality that worsen with age. To circumcise routinely in the absence of such studies is, IMHO, blatantly unethical. I strongly suspect that many American couples stop having sex in their 40s and 50s, thinking that that is a normal consequence of his aging and her menopause.

The high consumption rate of Viagra in the USA stems, to some extent, from the USA being a society where many patients are well off, and where health insurance is often willing to cover the cost of Viagra.

America can deceive itself about this problem because the sexual sensitivity of most young men is surplus to requirements. It is evident that millions of circumcised young men have no difficulty falling in love, marrying, and fathering children. The adverse effects of circ on sexual pleasure and functionality mostly emerge in later life. I am 62 years old and intact. Even I have experienced in recent years a decline in glans sensation. Almost everything I feel during intercourse, I feel thanks to tender moving bits I would not have, had I been routinely circumcised like nearly all middle class white boys of my place and time.

That said, the interpretation of cross-national ethical drug consumption rates has to be interpreted with care. For starters, in the Third World, there are manufacturers that copycat drugs without paying royalties, and drugs are often sold in bazaars without prescriptions. Most advanced societies have varying degrees of socialised medicine. This means that a national agency sets the wholesale price at which drugs may be imported, and the conditions under which the drug may be prescribed. Nations may vary considerably in the degree to which the taxpayer is on the hook for ED. There are ways blatant and subtle in which doctors can be discouraged from prescribing Viagra. Keep in mind that ED is a subjective affair, based on oral self-report; there is no lab test or hospital procedure that can "prove" that a man has ED.

A major problem is that the classic American research on human sexuality, that of Masters and Johnson, was pathetically naive and ignorant about foreskin and sexual sensitivity. Their work was done 30 years before Cold & Taylor reported their electron microscope study of the neuroanatomy of the foreskin, and 40 years before the landmark penis sensitivity study by Sorrells et al.