Indian Journal of Urology
UROSCAN
Year
: 2011  |  Volume : 27  |  Issue : 4  |  Page : 562--563

Complete foreskin removal in adult circumcision: Is it a new direction to definitive cure of premature ejaculation?


Neeraj Kumar Goyal 
 ,

Correspondence Address:
Neeraj Kumar Goyal
,




How to cite this article:
Goyal NK. Complete foreskin removal in adult circumcision: Is it a new direction to definitive cure of premature ejaculation?.Indian J Urol 2011;27:562-563


How to cite this URL:
Goyal NK. Complete foreskin removal in adult circumcision: Is it a new direction to definitive cure of premature ejaculation?. Indian J Urol [serial online] 2011 [cited 2020 Oct 22 ];27:562-563
Available from: https://www.indianjurol.com/text.asp?2011/27/4/562/91458


Full Text

 Summary



Circumcision is a common surgical procedure performed for different medical, cultural, religious, and social reasons. The aim of the current study was to investigate the effect of removal of prepuce remnants on premature ejaculation (PE) in already circumcised adults. [1]

It was a prospective study of 47 adult men from the general population of Iran, aging 18-50 suffering from PE that had remnants of foreskin. They had a PE history from 3 to 27 (11.52 ± 0.9) years. Patients were evaluated for the hypersensitivity of foreskin remnants by touching. Those who did not have enough foreskin remnants or sensitive part of remnants were not included in the study. Then these foreskin remnants were removed under local anesthesia. All patients were asked to fill an investigating questionnaire on follow up, that included over 35 questions. These questions covered domains related to PE history, change of intercourse frequency after surgery, intravaginal ejaculation latency time (IVELT), partner orgasm frequency, penis and glans sensitivity, control over ejaculation, men and their partners overall satisfaction, and sexual life before and after operation, and also penis appearance and diameter after operation. Open-ended questions to gather descriptive information about perceived benefits and harms were also included. The mean IVELT was recorded by the patients using a stopwatch technique. Data from all responders was analyzed together to find the overall effect of removal of foreskin remnants on PE. Many of them had tried various drug therapies for the treatment of PE before surgery.

This surgery had profound positive effect on the sexual health of the patients. It significantly improved sex satisfaction both in men and their partners. Removal of foreskin remnants in adults significantly decreased penis sensitivity in comparison to that before surgery. The frequency of intercourse and partner orgasm frequency per week increased significantly after surgery. The mean calculated IVELT before treatment was 64.26 s, but after surgery it significantly increased to 731.49 s (P<0.001). Sexual life level of the patients as a whole improved after surgery by around three times on a measurable scale. Most of the patients who answered open ended questions called this surgery to be excellent, suggesting it to others also. None of the patients had reported any complications yet.

 Comments



PE is the most common male sexual disorder in every community and country. [2] Lifelong PE can have a profound negative impact on self-confidence, relationships, sexual functioning, and the ability to relax during sexual intercourse and can cause anxiety, feeling of inferiority, and depression. [3] Different hypotheses are prevalent, as the etiology of PE is not clear. [2] Previously thought to be a psychological problem, most authors now believe PE to be a neurobiological phenomenon. [4] The biological causes of PE considered are 5-hydroxytriptamine receptor sensitivity in the hypothalamus and brain medulla and penile hypersensitivity. Like etiology, there are many different and controversial methods for the treatment of PE. Unfortunately, the effectiveness of most of the therapies is suggested only in case reports or small case series and is not universally accepted. To date, there is no real cure for lifelong PE. Currently most popular pharmaco-therapeutic approach to treat PE is selective serotonin-reuptake inhibitors (SSRI) which are reported to be effective for treating PE. But, their main limitations are short-time effectiveness and recurrence of PE with withdrawal of medication. [4],[5]

One of the conflicting issues is the effect of circumcision on ejaculation. The human foreskin is an erogenous tissue and is highly sensitive because of abundance of myelinated as well as nonmyelinated nerve fibers. So circumcision, i.e., surgical amputation of the prepuce removes many of these free-touch corpuscular receptors from the penis. In Muslim and Jewish communities, circumcision is generally done in the neonatal period or during childhood. In majority of the circumcisions, foreskin has not been completely removed and prepucial remnants are usually left behind. This residual foreskin may be a cause of persistent penile hypersensitivity leading to early ejaculation. In the current study, complete removal of prepuce lead to the nearly 10 times increase in IVELT and significant improvement in frequency of intercourse and partner orgasm frequency suggesting increased sex-liking. As a whole, sexual life of patients changed to better level after removal of foreskin. As this study was performed on already circumcised adults, it rules out the psychological effect of circumcision as cause of this improvement as suggested by some authors. Therefore, after careful assessment of the prepuce for hypersensitivity, complete circumcision can prove to be a wonderful cure for lifelong PE in selected patients as suggested by this study.

References

1Namavar MR, Robati B. Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation. Urol Ann 2011;3:87-92.
2Jannini EA, Lenzi A. Epidemiology of premature ejaculation. Curr Opin Urol 2005;15: 399-403.
3Wylie KR, Ralph D. Premature ejaculation: The current literature. Curr Opin Urol 2005;15:393-8.
4Waldinger MD. The neurobiological approach to premature ejaculation. J Urol 2002;168:2359-67.
5Safarinejad MR. Analysis of association between the 5-HTTLPR and STin2 polymorphisms in the serotonin-transporter gene and clinical response to a selective serotonin reuptake inhibitor (sertraline) in patients with premature ejaculation. BJU Int 2010; 105: 73-8.