Although guidelines for adult circumcision are unclear, discussion with patients should include unbiased information about the effects of the procedure. Aspects important to adults are sexual function and satisfaction. Fink and associates studied the effect of adult circumcision on erectile function, penile sensitivity, sexual activity, and overall satisfaction by surveying men who had experienced sexual intercourse in both uncircumcised and circumcised states.

Men who had been circumcised at 18 years or older completed an anonymous questionnaire that included demographic information and questions extracted or adapted from a variety of validated survey instruments in the field of sexual activity. With 43 questionnaires completed, the response rate was 44 percent. The indication for circumcision in most men was phimosis, followed by balanitis, condyloma, redundant foreskin, and “other,” which included a combination of indications.

Participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity. Overall, 62 percent of respondents were satisfied with their circumcision.

The authors conclude that in this preliminary study, adult circumcision appears to cause worsened erectile function, decreased penile sensitivity, and greater satisfaction. Perhaps circumcision is psychologically traumatic to some men, negatively affecting erectile function. The majority of men are satisfied with their circumcision, suggesting that factors other than sexual function may affect satisfaction with the procedure. This information may help physicians counsel adults who are considering circumcision, but further studies with more objective measurements are needed. These results cannot be generalized to neonatal circumcision.