Circumcision and the Relationship With Ejaculation Time

In This Article

Abstract and Introduction

Abstract

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26–307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67–300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1–12) before, and 2.63±1.82 and 2 (0–7) after circumcision. Improvement was statistically significant (P<0.0001). No correlation could be found between ejaculation time and PEDT scores. Circumcision during adulthood does not adversely affect ejaculatory function; it may slightly improve. However, it could not be interpreted as a justification for circumcision in men with premature ejaculation (PE).

Introduction

Circumcision is a surgical procedure that has been performed through the ages for medical, cultural or religious purposes.^[1,2] About 33% of the world's male population is circumcised.^[3] The effect that the circumcision has on sexual functions has been a subject of discussion for a long time because of circumcision being such a commonly performed surgical operation. Circumcision's effects on erection,^[4–6] premature ejaculation (PE)^[5,7–9] as well as sexual and visual satisfaction^[10–12] have been questioned in various studies. One of the ongoing discussions is the relationship between circumcision and PE.

The diagnosis of PE is very difficult due to the several overlapping definitions of PE. The diagnosis of PE is self-reported and is based on sexual and medical history, which should be assessed: latency time, perceived control, duration and frequency of PE, relationship with partners, degree of stimulus, nature and frequency of sexual activity, distress and interpersonal difficulty due to the ejaculatory dysfunction, aggravating or alleviating factors, and relationship with drug use. Although the definition of PE has not universally been accepted, the International Society for Sexual Medicine (ISSM) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), have adopted a new evidence-based definition of PE.^[13,14] In 2008, the ISSM committee proposed the following: 'Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy'.^[13] In 2010, the Diagnostic and Statistical Manual committee adopted criteria similar to those adopted by the ISSM. It was proposed that PE in heterosexual men be defined as 'a repetitive pattern of ejaculation occurring within approximately 1 minute on 75% of occasions for at least 6 months'. Thus, the use of Iintravaginal ejaculatory latency time (IELT) alone is not sufficient to define PE. A sufficient and multidimensional diagnosis of PE can be provided by combining IELT with a premature ejaculation diagnostic tool (PEDT).

To our knowledge, there is no study that investigates the effect of circumcision on ejaculation using both IELT and PEDT. In this study, our goal is to investigate whether there is an effect of circumcision on ejaculation parameters and to research the relationship between IELT and PEDT.

Table 1. Mean ±s.d./median (range) values of intravaginal ejaculatory latency time (IELT) and premature ejaculation diagnostic tool (PEDT) scores, consisting of total PEDT scores (TPES) and the scores of five questions described in Appendix, before and 3 months after adult circumcision.
Parameters	Pre-circumcision	Post-circumcision	P value
Parameters	Mean ±s.d./median (range)		P value
IELT (s)	104.36±66.21/88 (26–307)	123.56±54.44/107.5 (67–300)	0.001
PEDT
TPES	4.26±2.91/3 (1–12)	2.63±1.82/2 (0–7)	<0.0001
Question 1	1.47±1.1/1 (0–4)	0.83±0.6/1 (0–2)	0.003
Question 2	1±0.9/1 (0–3)	0.67±0.7/1 (0–2)	0.026
Question 3	0.46±0.9/0 (0–3)	0.37±0.6/0 (0–2)	0.417
Question 4	0.46±0.8/0 (0–2)	0.3±0.5/0 (0–1)	0.129
Question 5	0.86±0.9/1 (0–3)	0.47±0.8/0 (0–3)	0.006

Appendix

Questions in the premature ejaculation diagnostic tool (PEDT) questionnaire:^[15]

Questions		Not difficult at all	Somewhat difficult	Moderately difficult	Very difficult	Extremely difficult
1	How difficult is it for you to delay ejaculation?	0	1	2	3	4
		Never or almost never (0%)	Less than half the time (25%)	About half the time (50%)	Over half the time (75%)	Always or almost always (100%)
2	Do you ejaculate before you want to?	0	1	2	3	4
3	Do you ejaculate with very little stimulation?	0	1	2	3	4
		Not at all	Slightly	Moderately	Very	Extremely
4	Do you feel frustrated because of ejaculating before you want to?	0	1	2	3	4
5	How concerned are you that your time to ejaculation leaves your partner unfulfilled?	0	1	2	3	4