Introduction: Debate still exists regarding the impact of circumcision on penile sensation. This analysis was undertaken to define whether penile sensation changes after foreskin excision.
Methods: For this study, all adult patients (>18 years) undergoing circumcision (sleeve technique) had biothesiometry (BIO) performed preoperatively (within 1 month) and postoperatively (=3 months). Patients with a completely non-retractable foreskin or who had active balanitis clinically were excluded given difficulty with preoperative BIO testing at the glans level. Penile sensation was assessed on the forefinger pulp bilaterally, frenulum, glans bilaterally and mid-shaft bilaterally. The Carson nomogram was used to define age-referenced normalcy in penile sensation with any value at any site >7 indicating abnormal sensation.
Results: A total of 146 men were analyzed. Mean age = 58 ± 20 years. Mean time at postop BIO was 4.5 ± 2 months. 54 men (37%) had diabetes. 24 (16%) had abnormal sensation preoperatively, 22 of whom were diabetic and 2 were post-chemotherapy with a history of glove/stocking neuropathy. For the entire cohort, mean maximum BIO score was 4 ± 3. For those with impaired sensation preop, mean maximum BIO score = 9 ± 3. No patient, including those with impaired preop sensation and those with diabetes, had a =2 point increase in BIO score. 14 (9.5%) men complained of impaired sensation postoperatively, despite having a normal BIO (all were non-diabetics). 8/14 has somatosensory evoked potentials (SSEP), all of which were normal. In 12 of these 14, subjective sensory impairment abated with time (the 2 men with prolonged subjective sensory loss had normal postop SSEP).
Conclusions: Based on these data, circumcision does not have any physical impact on penile sensation, although a minority had subjective sensory loss which in almost men disappeared.