The prevalence of an excessive prepuce and the effects of distal circumcision on premature ejaculation

Abstract

Objective: To investigate the prevalence of an excessive prepuce in patients with premature ejaculation (PE) and to evaluate the effectiveness of distal circumcision in reducing the penile hypersensitivity, which is thought to be a cause of PE.

Patients and methods: Men were considered to have an excessive prepuce if the foreskin exceeded the external urethral meatus by ≥1 cm in the flaccid state. The diagnosis of PE was based on the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire score and on the intravaginal ejaculatory latency time (IELT). These features were evaluated at baseline and at 6 months after circumcision.

Results: Lifelong PE was diagnosed in 352 patients of whom 208 (59.1%) had an excessive prepuce. We offered those with an excessive prepuce a circumcision, as a potential definitive treatment for their PE, and 27 (13%) men accepted. At 6 months after circumcision, there was an increase in the mean (SD) IELT from 40.4 (16.5) to 254 (66.8) s (P < 0.001) and the mean (SD) PEDT score decreased from 17 (2) to 6.6 (1.9) (P < 0.001). Overall, 26 of the 27 (96%) patients that had a circumcision reported an IELT increase.

Conclusions: An excessive prepuce is very common in patients affected by PE. Although accepted by only 13% of our patients, distal circumcision was shown to be a very effective surgical treatment for definitive treatment of PE. We therefore recommend assessing patients complaining of lifelong PE for an excessive prepuce and if they have an excessive prepuce to suggest that they undergo distal circumcision.

Keywords: Circumcision; Excessive prepuce; IELT, intravaginal ejaculatory latency time; PE, premature ejaculation; PEDT, Premature Ejaculation Diagnostic Tool; Penile hypersensitivity; Premature ejaculation; Risk factor; SSRI, selective serotonin reuptake inhibitor.

Fig. 1

Left, typical presentation of an excessive prepuce. Right, aspect of a circumcised penis: a residual portion of foreskin was left to cover the corona glandis when the penis was in a flaccid state.

Fig. 2

Sequence of images illustrating our surgical technique. The frenulum and the penis raphe were demarcated. The proximal incision was made at the frenulum in figure of ‘V’. The distal incision was performed very close to the corona glandis.

Fig. 3

Ventral aspect of the circumcised penis: the frenulum area was perfectly reconstructed using a V-shaped proximal incision.

Fig. 4

The mean IELT before and after circumcision (s). EP, excessive prepuce; SF, short frenulum.

Fig. 5

The mean PEDT score before and after circumcision. EP, excessive prepuce; SF, short frenulum.

Fig. A1

English version of the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire.