Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing

PURPOSE:

Little is known about the long-term implications of neonatal circumcision on the penile sensitivity of adult men, despite recent public policy endorsing the procedure in the United States. The current study assessed penile sensitivity in adult men by comparing peripheral nerve function of the penis across circumcision status.

MATERIALS AND METHODS:

Sixty-two men (18-37y, M = 24.1, SD = 5.1) completed study procedures (30 circumcised, 32 intact). Quantitative Sensory Testing (QST) protocols assessed touch and pain thresholds (modified von Frey filaments) and warmth detection and heat pain thresholds (a thermal analyzer) at a control site (forearm) and 3-4 penile sites (glans penis, midline shaft, proximal to midline shaft, and foreskin, if present).

RESULTS:

Penile sensitivity did not differ across circumcision status for any stimulus type or penile site. The foreskin of intact men was more sensitive to tactile stimulation than the other penile sites, but this finding did not extend to any other stimuli (where foreskin sensitivity was comparable to the other sites tested).

CONCLUSIONS:

Findings suggest that minimal long-term implications to penile sensitivity exist as a result of the surgical excision of the foreskin during neonatal circumcision. Additionally, this study challenges past research suggesting that the foreskin is the most sensitive part of the adultpenis. Future research should consider the direct link between penile sensitivity and the perception of pleasure/sensation. Results are relevant to policy makers, parents of male children, as well as the general public.

Source:  2015 Dec 24. pii: S0022-5347(15)05535-4. doi: 10.1016/j.juro.2015.12.080. 

Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

Background: 

Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre.

Patients and Methods: 

This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed. 

Results: 

A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8 th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively. 

Conclusion:

Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents

Source:

Ekwunife OH, Ugwu JO, Okoli CC, Modekwe VI, Osuigwe AN. Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital. Afr J Paediatr Surg 2015;12:251-6

A 'snip' in time: what is the best age to circumcise?

BACKGROUND:

Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.

DISCUSSION:

We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.

SUMMARY:

Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

Source:BMC Pediatr. 2012 Feb 28;12:20. doi: 10.1186/1471-2431-12-20.

Adult Circumcision

Adult circumcision started at Leyton Healthcare, London. Glue, stitches and revision adult circumcision are available at the clinic by our experienced surgeon for 22 years. 

London Circumcision Clinic, Leyton, London