Effect of circumcision on intromission and sexual satisfaction

Rapid Response:

Effect of circumcision on intromission and sexual satisfaction

Author Dalton JD, NORM-UK Stone, Staffs, UK ST15 0SF

I am writing to develop the points made by Wilkinson and Sigismond regarding the effects of circumcision on intromission and
sexual satisfaction.

The intromission function of the foreskin has been documented by Taves.[1] The foreskin also has a sensory function with a
possible role in the afferent limb of the ejaculatory reflex.[2] It is no longer acceptable to deny that the foreskin is required for
normal sexual function.

Four recent studies have previously reported on the effect on sexual satisfaction following adult circumcision for clinical
indications.[3-6] The results of these are summarised in the table together with a pooling of the data from the four studies.

The four studies reveal a remarkably consistent picture. The pooled data reveal a split into three roughly equal groups of men
having circumcision where there is some reason for them to seek treatment. Only one third report improved satisfaction following
circumcision with a further third reporting worsened sexual satisfaction and the remaining third reporting no effect.

Circumcision can no longer be regarded as insignificant with regard to sexual function. The potential for detriment to sexual
satisfaction must now be disclosed if valid informed consent to the surgery is to be obtained. Children should be protected from
therapeutically unecessary circumcision without prejudice in respect of race, religion or gender.

Table:-

Authors	Year	n	No > Sat	% > Sat	No = Sat	% = Sat	No > Sat	% <Sa	End-Point
Coursey JW, Morey AF, McAninch JW, Summerton DJ, Secrest C, White P, Miller K, Pieczonka C, Hochberg D, Armenakas N	2001	22	16	73%	NR*	NR*	6	27%	Validated Questionnaire
Fink KS, Carson CC, DeVellis RF	2002	123	50	50%	25	12%	48	38%	Items taken from various existing questionnaires
Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK	2005	88	33	38%	39	44%	16	18%	5-item version of the International Index of Erectile Function (IIEF-5)
Solinis I, Yiannaki A	2007	123	20	16%	60	49%	43	35%	questionnaire about the quality of their sexual life and the sexual enjoyment before and after circumcision.
Pooled data	2008	356	119	33%	124	35%	113	32%
*Coursey and Colleagues pool the results for men reporting Improved satisfaction or no change. For this purpose I have assumed all these to belong to the improved category.