CLINICAL ELICITATION OF THE PENILO-CAVERNOSUS REFLEX IN CIRCUMCISED MEN

Authors


Sir,

In a recent issue of the BJUI, Professor Podnar [1] reported his findings concerning the clinical elicitation of the penilo-cavernosus reflex in genitally intact men as compared with circumcised men. Previously, Taylor [2] had reported that, ‘Almost certainly, removal of the prepuce and its ridged band distorts penile reflexogenic functions but exactly how and to what extent still remains to be seen’. While Podnar's study attempted to ascertain the magnitude of this reflexogenic disability, it is notable however that he used different stimulatory techniques in genitally intact vs circumcised men. As reported in his paper, Podnar tested the penilo-cavernosus reflex in intact men by squeezing the glans through the overlying foreskin, thereby stimulating the sensory receptors both within the foreskin itself as well as in the glans, whereas in circumcised men, the stimulus necessarily could only be applied to the glans (which is relatively devoid of fine-touch sensory receptors as compared with the inner foreskin with its dense innervation of Meisners' corpuscles) [2–6]. This procedural discrepancy raises questions as to the validity of Podner's clinical findings reported for circumcised and genitally intact men respectively.

CIRCUMCISION AND PREMATURE EJACULATION (PE)

In regard to PE, Podnar [1] repeated the common myth that ‘the glans is too sensitive’. To the contrary, PE with little or no sensation/feeling would suggest that the glans is not very sensitive at all. Many circumcised young men ejaculate prematurely but feel very little pleasurable sensation [7]. It would appear that PE may occur before there is much build-up of sexual excitement/tension, so that ejaculation is pretty much a ‘non-event’. Anecdotally, in the USA where most males have been subjected to routine neonatal circumcision, many young women have commented to their male partner, ‘Is that it …?’ Is it not more likely that it is precisely the lack of neurological control over the timing of ejaculation resulting from the severed neuronal circuitry after circumcision that is a major causal factor in PE? Indeed, Bollinger and Van Howe [8] pointed out that, ‘… circumcised men are 2.56 times more likely to suffer from premature ejaculation, and, when the data were adjusted to include erectile dysfunction, that risk rose to 4.88 times …’[9]. Moreover, ‘A recent multinational population survey using stopwatch assessment of the intravaginal ejaculation latency time (IELT) found that in Turkish men, the vast majority of whom are circumcised, had the shortest IELT [10,11].

This report is yet another small piece of the puzzle regarding the adverse effects of circumcision on sexual function [12,13], but cross-validation on much larger samples would seem important. There appears to be a paucity of research funds available to objectively investigate foreskin neurology, physiology, anatomy and sexual function, whereas formidable research resources appear to go to projects aimed at finding ‘justifications’ for ablating the male foreskin. The whole area is still shrouded in myths and distorted by the fact that so much research is carried out in ‘foreskin-free zones’ such as the USA.