The Prepuce or the foreskin on the penis, characterized as “primary erogenous tissue necessary for normal sexual function”, itself explains its role in natural, mechanical and sensory capacities of the penis. Hence, Circumcision, the procedure of removing the foreskin covering the head of the penis is inferred to necessarily reduce sensitivity and has been erotically controversial. Not surprisingly, it is general assumption that amputation of the penile foreskin and exposure of the glans penis thus reducing penile sensitivity could be a cure for Premature Ejaculation.
Circumcision, presupposed to reduce penile sensation should also reduce the odds of premature ejaculation is the argument that has been in the fore front. Penile hypersensitivity thought to be one of the pathological mechanisms of Premature Ejaculation seems to be the basis for such arguments. It’s important to note that biological correlations between penile hypersensitivity and Premature Ejaculation are not established and lacks scientific evidence. In fact, some studies have clearly revealed that penile hypersensitivity is not a contributing factor but somatic and cognitive factors are critical contributors to Premature Ejaculation.
Male infertility, over the years worldwide has been attributed to lifestyle disorders, stress, communicable diseases, chronic health problems, trauma and injury resulting in low sperm count, abnormal sperm structure and/or low sperm motility. In certain cases, the cause or underlying etiology is unknown.
As a highlight, Indian society’s paradigm of “ideal marriage” is observed to play a significant role in occurrence of male infertility in India. Indian system of marriages within closed communities (Endogamy) is recently viewed as a more frequent cause for deficient sperm parameters and infertility among Indian men.
The International Society of Sexual Medicine defines Premature Ejaculation as “a male sexual dysfunction characterized by ejaculation which always or nearly always occurs within about 1 minute of vaginal penetration; an 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.”
A number of Psychological and Biological factors interplay the complexity of Premature Ejaculation. Factors such as age, recent frequency of sexual activity, sexual partner and situation play a significant role in clinical assessment of Premature Ejaculation. It requires physical examination, detailed health history and sexual history to understand the aetiology of the individual male and ensure appropriate assessment on ejaculatory dysfunction.
Premature Ejaculation is quantitatively assessed by Intravaginal Ejaculatory Latency Time (IELT) that is the time between vaginal penetration and ejaculation during sexual intercourse. Normative data suggests that men with consistent Intra vaginal Ejaculatory Latency Time of less than 1 minute suffer from Premature Ejaculation. The pathophysiology of ejaculatory dysfunction appears to be both neuro biogenic and psychogenic. Studies further suggest that IELT is a biological variable and largely depends upon neurotransmitters and hormones and less likely on penile sensitivity.
So, rewinding back to the argument of whether the procedure of circumcision is linked specifically to Premature Ejaculation, it is necessary to note that a review based on various studies on the link between ejaculatory dysfunctions and circumcision status was conducted. The review involved over 20,000 men combined from 12 different studies where, indicators such as IELT were used to analyze the effects of circumcision on Premature Ejaculation. The review revealed that there was no significant statistical differences in Premature Ejaculation between circumcised and uncircumcised men.
In line with consistent studies and review results, circumcision appears to have no correlation to Intravaginal Ejaculatory Latency Time which is a clinically approved marker to assess Premature Ejaculation. This clearly puts away the prospect of considering Circumcision as a cure for Premature Ejaculation. Rather, Circumcision be considered purely for medical reasons that seem to be also the root cause for following the procedure as a customary ritual in selective communities.
Though several theories propose origin of male circumcision as religious sacrifice, established cultural practice, as a marker of passage in to adulthood, as a means of discouraging masturbation and other tabooed sexual behaviours, there are historic evidences to suggest that hygiene and health could be the actual reason behind this practice. Indigenous male population of the dessert regions may have found circumcision to be the practical solution to prevent urinary tract infections that could have been common due to hot, dry, sandy environments. Other evolved reasons for circumcision acclaimed as customary practice and/or as treatment option could be:
- Easy hygiene in adverse lifestyle conditions
- Prevention of repeated urinary tract infections
- Protective measures against sexually transmitted diseases
- Safeguard from penile problems
- Decreased risk of penile cancer
There are possibilities that one or more of the above reasons are also underlying factors for the development of Premature Ejaculation. Therefore, clinically, circumcision in men may be advisable to encounter such probable underlying factors as primary concern but not for men with Premature Ejaculation as the only problem.
To reiterate, circumcision does not clinically prove to be a treatment option to cure Premature Ejaculation. To ensure appropriate assessment and treatment, Premature Ejaculation having multi factorial determinants, needs to be understood as individualized male sexual dysfunction. Having ruled out any primary medical condition, a combination of approaches involving psychological, behavioural and pharmacological therapies would be efficient in the treatment of Premature Ejaculation. Medical management of male sexual dysfunctions wherein along with drug therapy, men and couples can learn sexual skills, communicate intrapsychic, interpersonal and cognitive issues that may precipitate or exacerbate the dysfunction are far more beneficial with long term positive results.