Effect of neonatal circumcision on penile neurologic sensation

Bleustein, Clifford B.; Fogarty, James D.; Eckholdt, Haftan; Arezzo, Joseph C.; Melman, Arnold

doi:10.1016/j.urology.2004.11.007

Cited by 54 publications

(37 citation statements)

References 20 publications

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“…Some large nationally representative cross-sectional surveys24, 25 have included countries with high and low male circumcision rates, controlling for demographic factors that might influence attitudes toward circumcision. Several studies have compared intravaginal ejaculatory latency time11, 24, 25, 26, 27, 28 and a few small studies have reported direct physiologic measurements of penile sensitivity and sexual response27, 29, 30, 31 in circumcised and uncircumcised men, finding no evidence for detrimental physiologic effects of male circumcision. Two cohort studies using data from RCTs12, 13 in Africa offer the best evidence to date on the effects of VMMC on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.…”

Section: Discussionmentioning

confidence: 99%

Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

Nordstrom

Westercamp

Jaoko

et al. 2017

The Journal of Sexual Medicine

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BackgroundTwo cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.AimTo assess the effects of VMMC on sexual function and satisfaction in a large population-based cohort of men circumcised as adults and uncircumcised controls in Kenya.MethodsSexual function and satisfaction of young (median age = 20 years) sexually active men (1,509 newly circumcised men and 1,524 age-matched uncircumcised controls after 5% loss to follow-up) were assessed at baseline and 6, 12, 18, and 24 months, with data collected in 2008 to 2012. Self-reported data on lack of sexual interest or pleasure, difficulty getting or maintaining erections, orgasm difficulties, premature ejaculation, pain during intercourse, and satisfaction with sexual intercourse were analyzed with mixed-effect models to detect differences between circumcised and uncircumcised men and changes over time.OutcomesChanges over time in sexual interest, desire and pleasure, erectile and ejaculatory function, and pain during intercourse (dyspareunia) in circumcised and uncircumcised men; group differences in time trends; satisfaction with sexual performance; and enjoyment of sex before and after circumcision.ResultsSexual dysfunctions decreased in the two study groups from 17% to 54% at baseline to 11% to 44% at 24 months (P < .001), except dyspareunia, which decreased only in circumcised men (P < .001). Sexual satisfaction outcomes increased in the two study groups from 34% to 82% at baseline to 66% to 93% at 24 months (P < .001), with greater improvements in circumcised men (P < .001). On average, 97% of circumcised men were satisfied with sexual intercourse and 92% rated sex as more enjoyable or no different after circumcision compared with before circumcision.Clinical TranslationResults are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.Strengths and LimitationsLarge-scale population-based longitudinal data restricted to sexually active individuals and adjusted for differences in baseline levels of outcomes and potential confounders are used. The questionnaire used, although not a standardized survey instrument, includes all major domains of male sexual function and satisfaction used in the most common standardized tools.ConclusionsResults are consistent with large cohort studies of VMMC using data from randomized controlled trials and indicate that VMMC has no significant detrimental effect or might have beneficial effects on male sexual function and satisfaction for the great majority of men circumcised as adults.Nordstrom MPC, Westercamp N, Jaoko W, et al. Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya. J Sex Med 2017;14:601–612.

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Section: Discussionmentioning

confidence: 99%

Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

Nordstrom

Westercamp

Jaoko

et al. 2017

The Journal of Sexual Medicine

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“…Studies of histological correlates of sexual sensation concluded that the glans, not the foreskin, is involved in sexual sensation 30 , 54 . C-fibers (activated by thermal stimuli and punctate pain) may be involved in erotic sensation and sexual arousal 55 .…”

Section: Does An “Intact Sexual Organ” Have Any Value?mentioning

confidence: 99%

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

Morris

Krieger

Klausner³

2017

Glob Health Sci Pract

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“…There is both good and fair evidence that no statistically significant differences exist between circumcised and uncircumcised men in terms of sexual sensation and satisfaction. [128][129][130][131] Sensation end points in these studies included subjective touch and pain sensation, response to the International Index of Erectile Function, the Brief Male Sexual Function Inventory, pudendal nerve evoked potentials, and Intravaginal Ejaculatory Latency Times (IELTs).…”

Section: Sexual Satisfaction and Sensitivitymentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

295

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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Effect of neonatal circumcision on penile neurologic sensation

Cited by 54 publications

References 20 publications

Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

Male Circumcision

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