Acquisition of Erectile Dysfunction from Circumcision

A new study in the International Journal of Men’s Health shows 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 vector. Researchers Dan Bollinger and Robert S. Van Howe, M.D., M.S., FAAP found a strong association between circumcision and ED in their survey of 300 men (OR = 4.53, p=.0058). What other studies support this finding and what could be an 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 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 the glans sensitivity, including an overall penis sensitivity reduction by 75%. A recent study discovered that premature ejaculation is five times more likely when adjusted for erectile dysfunction and circumcision. A new Danish study also found that circumcised men are three times more likely to have sexual 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, ostensibly resulting in entirely favorable outcomes, but this is not the case, as these failure rates illustrate. In one such 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 their erectile functioning. In a third study, the number of men reporting erectile dysfunction almost doubled after circumcision, and ED severity increased, too. A fourth before-and-after study found that 35% of participants had a worsened sex life after circumcision and that their partners had a 46% reduction in satisfaction. The study implicated loss of nerve endings as a reason—addressed below. The true dissatisfaction rate is probably higher than these failure rates since all of the men elected circumcision, and would naturally be biased toward the outcome being beneficial even when it wasn’t.

An exhaustive case study of five impotent men circumcised as adults involved giving them complete physical and laboratory examinations, including 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 keto-steroids and hydroxysteroids tests. None of these test results were significant, and in the end, circumcision was the only common factor.

Circumcision is a risk factor for both physiological and psychosomatic aspects for ED since it is a sexual trauma and damages the penis. There are many possible causes for ED including the traumatization from the procedure’s pain, which is thought to be particularly damaging to an infant, whose brain is still developing.

One obvious cause, truncating the perineal nerve—which is responsible for the majority of sexual sensory input—must be considered. 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 and females (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. Perineal nerve injuries are known to cause permanent sexual dysfunction.

The perineal nerve runs the length of the penis on the underside and terminates in the frenulum. This “little bridle,” which attaches the underside of penis shaft to the inner foreskin, is one of the most sensitive portions of the penis and is solely innervated by the perineal nerve. During intercourse, the foreskin retracts exposing the frenulum, and therefore the 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 the fact that there are other, compounding risk factors, might explain why not all circumcised men suffer from ED.

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, which, when this new data is considered, calls elective circumcision into question.

An earlier version of this article misquoted the results of a recent Danish study. This study found that circumcised men are three times more likely to have sexual dysfunction.

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