title: Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction.
abstract: OBJECTIVE
  Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states.
  
  
  METHODS
  Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision.
  
  
  RESULTS
  A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.
  
  
  CONCLUSIONS
  Our findings may help urologists better counsel men undergoing circumcision as adults. Prospective studies are needed to better understand the relationship between circumcision and sexual function.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program and Division of Urology, School of Medicine, and the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, USA.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Fink
authors.forename: Culley C
authors.initials: CC
authors.lastname: Carson
authors.forename: Robert F
authors.initials: RF
authors.lastname: DeVellis
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000523:psychology*; D006801:Humans; D007989:Libido; D008297:Male; D017060:Patient Satisfaction; D010410:Penile Erection / Q000523:psychology*; D012189:Retrospective Studies; D019529:Sexuality / Q000523:psychology*; D016896:Treatment Outcome