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Adding Insult to Injury: Acquisition of Erectile Dysfunction from Circumcision

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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.
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Adding Insult to Injury:
Acquisition of Erectile Dysfunction from Circumcision
Dan Bollinger
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.
1
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 menthree-fourths of whom are circumcisedhave ED,
affecting 18 million men.
2
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.
3
Other studies have previously observed that circumcision’s damage results
in worsened erectile functioning,
4
inability to maintain an erection,
5
and reducing overall penis
sensitivity by an alarming 75%.
6
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.
7
A Danish study
8
found that circumcised men are three times
more likely to have sexual dysfunction.
9
Yet another study, this one from Portugal, found that
circumcision resulted in a 266% increase in erectile dysfunction.
10
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.
11
Another survey found that 27%
of recently circumcised adult men reported dissatisfaction with erectile functioning.
12
In a third
study, the number of men reporting erectile dysfunction almost doubled after circumcision, and
2
ED severity increased, too.6 A fourth study found that 35% of participants and 46% of partners
had a worsened sex life after circumcision.
13
The study implicated loss of nerve endings as a
reasonaddressed 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.
14
Circumcision is a risk factor for both physiological and psychosomatic aspects for ED since it is a
sexual trauma and damages the penis.
15
The traumatization from the procedure’s pain is
thought to be particularly damaging to an infant, whose brain is still developing.
16
One obvious cause for ED from circumcisiontruncating the perineal nervemust be
considered since injuries to this nerve are known to cause permanent sexual dysfunction.
17
The
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
18
and females
(yes, females get erections, too).
19
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
frenulum.
20
The frenulumor “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
perineal nerve.
21
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
3
References:
1
Bollinger D, Van Howe, RS. Alexithymia and circumcision trauma: A preliminary investigation. Int J Men’s Health,
2011;10:18495.
http://www.mensstudies.com/content/2772r13175400432/?p=37c6807c53804d5a878d863042b95d6f&pi=3
2
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the U.S. Am J Med, 2007;120(2):1517.
3
Pfizer. Pfizer, Inc. 2008 Annual Report, 2008; p. 17.
4
Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: A prospective study of complications in clinical and
traditional settings in Bungoma, Kenya. Bull World Health Organ, 2008; 86: 66977.
5
Shen Z, Chen S, Zhu C, Wan Q, Chen Z. Erectile function evaluation after adult circumcision. Zhonghua Nan Ke Xue,
2004;10:189.
6
Sorrells ML, Snyder ML, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int, 2007;99:8649.
7
Tang WS, Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: A preliminary cross-
sectional study. J Sex Med,2011;8:20718.
8
Christensen BS, Grønbæk M, Frisch M, et al. Sexual dysfunctions and difficulties in Denmark: Prevalence and associated
sociodemographic factors. Arch Sex Behav, 2011;40:12132.
9
M. Frisch speaking about his study at a press conference. Available online at:
http://www.israelwhat.com/2011/10/16/norwegian-mens-rights-group-compares-male-circumcision-to-female-genital-
mutilation/
10
Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L. Adult circumcision and male sexual health: A retrospective
analysis. Andrologia. 2014;46(5):45964.
11
Fink KS, Carson CC, DeVillis RF. Adult circumcision outcomes study: Effect on erectile function, penile sensitivity, sexual
activity and satisfaction. J Urol, 2002;167:21136.
12
Coursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol, 2001;166:22736.
13
Solinis I, Yiannaki A. Does circumcision improve couple's sex life? J Men's Health and Gender, 2007;4:361.
14
Stinson JM. Impotence and adult circumcision. J Natl Med Assoc, 1973;65:161,179.
15
Cold CH, Taylor JR. The prepuce. BJU Int, 1993;83(Suppl. 1):344.
16
Taddio A, Katz J, Ilersich AL, et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination.
Lancet, 1997;349(9052):599603.
17
Yucel S, Baskin LS. Neuroanatomy of the male urethra and perineum. BJU Int, 2003;92:62430.
18
Shafik A. Perineal nerve stimulation: role in penile erection. Int J Impot Res, 1997;9(1):116.
19
Martin-Alguacil N, Pfaff DW, Shelley DN, et al. Clitoral sexual arousal: An immunocytochemical and innervation study of
the clitoris. BJU Intl, 2008;101:140 713.
20
Uchio EM, Yang CC, Kromm BG, Bradley WE. Cortical evoked responses from the perineal nerve. J Urol, 1999;162:19836.
21
Yang CC, Bradley WE. Innervation of the human glans penis. J Urol, 1999;161:97102.
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