Adding Insult to Injury:
Acquisition of Erectile Dysfunction from Circumcision
Our study published in the International Journal of Men’s Health showed that circumcised men
have a 4.5 times greater chance of suffering from erectile dysfunction (ED) than intact men,
revealing what appears to be a significant acquisition factor.
Robert S. Van Howe, M.D., M.S.,
FAAP and I found a surprisingly strong secondary finding between circumcision and ED in our
survey of 300 participants (OR = 4.53, p=.0058). It was outside the scope of our article to delve
deeper into this topic, but our finding does raise some questions: Are there other studies
showing a similar connection? What could be the underlying cause?
Eighteen percent of adult American men—three-fourths of whom are circumcised—have ED,
affecting 18 million men.
Circumcision’s role as a risk factor may be anecdotally reflected in ED
drug sales; while the United States represents 5% of the world’s population, it also accounts for
46% of Viagra sales.
Other studies have previously observed that circumcision’s damage results
in worsened erectile functioning,
inability to maintain an erection,
and reducing overall penis
sensitivity by an alarming 75%.
Premature ejaculation, ED, and circumcision are inextricably
linked; a recent study revealed that premature ejaculation is five times more likely when
adjusted for ED and circumcision.
A Danish study
found that circumcised men are three times
more likely to have sexual dysfunction.
Yet another study, this one from Portugal, found that
circumcision resulted in a 266% increase in erectile dysfunction.
Case studies of men circumcised as adults are revealing since they compare sexual function and
satisfaction before and after the surgery. They are also alarming. Circumcision was supposed to
correct a problem and ostensibly resulting in entirely favorable outcomes, but this is not the
case as these failure rates illustrate. In one study, circumcision worsened erectile function and
decreased penile sensitivity, and 38% reported sexual harm.
Another survey found that 27%
of recently circumcised adult men reported dissatisfaction with erectile functioning.
In a third
study, the number of men reporting erectile dysfunction almost doubled after circumcision, and
ED severity increased, too.6 A fourth study found that 35% of participants and 46% of partners
had a worsened sex life after circumcision.
The study implicated loss of nerve endings as a
reason—addressed below. The true dissatisfaction rate is probably higher since all of the men
elected circumcision, and would naturally be biased toward the outcome being beneficial.
An exhaustive case study of five impotent men circumcised as adults involved a complete
workup, including a thorough examination of genitalia, neurological examination, complete
blood counts, oral glucose tolerance tests, and protein bound iodine and T-4 uptake, serum
electrolytes, VDRL, sperm counts, and 24-hour urinary steroid tests. None of these tests were
significant, and in the end, circumcision was the only common factor between the subjects.
Circumcision is a risk factor for both physiological and psychosomatic aspects for ED since it is a
sexual trauma and damages the penis.
The traumatization from the procedure’s pain is
thought to be particularly damaging to an infant, whose brain is still developing.
One obvious cause for ED from circumcision—truncating the perineal nerve—must be
considered since injuries to this nerve are known to cause permanent sexual dysfunction.
perineal nerve is critically important to sex, lovemaking, and orgasms in both males and
females. Dubbed the “sex nerve,” it serves some of the most sensitive erogenous zones in the
human body. It is responsible for initiating and maintaining an erection in males
(yes, females get erections, too).
Without the perineal nerve’s input, intercourse and sexual
satisfaction will be limited. In males, it contributes not only to obtaining an erection, but for
ejaculation and feelings of orgasm, too. In females it contributes to clitoral erection, feelings of
orgasm, and closes the vagina after orgasm.
The perineal nerve runs the length of the penis on the underside and terminates in the
The frenulum—or “little bridle”—attaches the underside of penis shaft to the inner
foreskin, is one of the most sensitive portions of the penis,6 and is solely innervated by the
During intercourse the foreskin inverts and the frenulum is exposed,
presenting a great number of perineal nerve endings to repeated stimulation every time the
penis enters and withdraws from the vagina. Circumcision partially or completely excises the
frenulum, always severing the nerve at this point. This variable frenular aspect, and because
there are other risk factors, might explain why not all circumcised men suffer from ED or other
sexual dysfunctions, including satisfaction loss.
This news that circumcision, once considered as beneficial to a man’s sexual health, is now
connected to sexual dysfunction is disheartening. Every man has the right to good sexual health
and to feel sexual pleasure for full psychophysical wellbeing. Erectile dysfunction is devastating
to the lives of so many men and their partners. This new research now calls elective and infant
circumcision into question.
November 17, 2011; Revised March 15, 2016
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