title: Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Medway Maritime Hospital, Gillingham, UK. shikohe@doctors.org.uk
authors.forename: S
authors.initials: S
authors.lastname: Masood
authors.forename: H R H
authors.initials: HR
authors.lastname: Patel
authors.forename: R C
authors.initials: RC
authors.lastname: Himpson
authors.forename: J H
authors.initials: JH
authors.lastname: Palmer
authors.forename: G R
authors.initials: GR
authors.lastname: Mufti
authors.forename: M K M
authors.initials: MK
authors.lastname: Sheriff
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology*; D006801:Humans; D007989:Libido / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection / Q000523:psychology*; D010413:Penis / Q000502:physiology*; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology*; D019529:Sexuality / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome