Penile Sensitivity and Sexual Satisfaction after Circumcision: Are We Informing Men Correctly?

Abstract

Objectives: Currently no consensus exists about the role of the foreskin or the effect circumcision has on penile sensitivity and overall sexual satisfaction. Our study assesses the effect of circumcision on sexually active men and the relative impact this may have on informed consent prior to surgery. Materials and Methods: One hundred and fifty men between the ages of 18 and 60 years were identified as being circumcised for benign disease between 1999 and 2002. Patients with erectile dysfunction were excluded from the study. The data was assessed using the abridged, 5-item version of the International Index of Erectile Function (IIEF-5). Questions were also asked about libido, penile sensitivity, premature ejaculation, pain during intercourse and appearance before and after circumcision. IIEF-5 data was analysed using two-tailed paired t test to compare pre-operative and post-operative score changes across the study group. For the rest of the questions, data was analysed using ‘Sign Test’, calculating two-sided p values and 95% confidence intervals. Results: Fifty-nine percent of patients (88/150) responded. The total mean IIEF-5 score was 22.41 ± 0.94 and 21.13 ± 3.17 before and after circumcision, respectively (p = 0.4). Seventy-four percent of patients had no change in their libido levels, 69% noticed less pain during intercourse (p < 0.05), and 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. Penile sensation improved after circumcision in 38% (p = 0.01) but got worse in 18%, with the remainder having no change. Overall satisfaction was 61%. Conclusions: Penile sensitivity had variable outcomes after circumcision. The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process.

Effects of circumcision on male sexual functions: a systematic review and meta-analysis

“…Conversely, Masood et al 28 reported a 38% improvement in penile sensation after circumcision. An overall 61% satisfaction rate was considered as a poor outcome of circumcision.…”

“…12,13,28 The relatively short, post-circumcision follow-up period may not accurately reflect sexual function at a later time, resulting in risk of bias for this meta-analysis. 26,28,29 Furthermore, the study validity may be affected by several factors, including subjective selfreporting, lack of physiological or laboratory indicators of sexual dysfunction or consensus on what constitutes sexual dysfunction for individuals with different education levels, cultures and religions. Moreover, operative methods, participants' ages and any coexisting medical conditions were not analysed by subgroup, and these could also contribute to study bias.…”

Why circumcision is a biomedical imperative for the 21stcentury

“…(118,119) Erectile function scores were unchanged after circumcision of adult men. (120) And intravaginal latency times were no different (6.7 versus 6.0 min in circumcised versus uncircumcised men, respectively) in a study of 500 couples in the USA, UK, Netherlands, Spain and Turkey.…”

“…(122) Women's preference for the circumcised penis for sexual activity, appearance and hygiene is one reason. (120,122,123) Males in higher socio-economic-educational categories in the USA, UK and Australia have higher rates of circumcision. (10,122,123) Circumcision methods Various devices are used to protect the penis during excision of the prepuce in infants.…”

Pathophysiology of Acquired Premature Ejaculation

“…Some international epidemiologic studies demonstrated lower prevalence for PE in Middle East, confirming this presumption (36). However, clinical studies regarding the penile sensitivity, PE status and sexual satisfaction report conflicting results are not conclusive (11,(141)(142)(143)(144)(145).…”