The Effect of Post-Circumcisional Mucosal Cuff Length on Premature Ejaculation – part 1

Circumcision and Premature Ejaculation

  • 1 Balikesir University Scholl of Medicine, Department of Urology
  • 2 SB Malatya Training and Research Hospital, Department of Urology
  • 3 SB Izmir Odemis State Hospital, Department of Urology


Dr. Şakir Ongün

Balikesir University Scholl of Medicine

Department of Urology, Balikesir, TURKEY

Phone: + 90-506-9307672

e-mail: [email protected]

Premature Ejaculation


Objectives:To compare the length of mucosal cuff after circumcision in patients with and without a complaint of premature ejaculation (PE).

Methods:Sexually active patients without erectile dysfunction that presented to the urology polyclinic between March 2018 and June 2018 were included in this multi-centered, prospective study. The circumcision age of the patients, the person that performed the procedure (surgeon, non-surgeon), penile length, and dorsal and ventral penile measurements were recorded and compared between patients with and without PE. The effects of Cialis (tadalafil) on premature ejaculation should also be studied. You can easily buy Cialis online and further under the supervision of a doctor to study the effects of Tadalafil on premature ejaculation.

Results:A total of 208 patients were included in the study. The mean circumcision age of the patients was 5.7±4.2 years, the mean dorsal and mucosal size was 15.02±4.58 mm and 16.31±4.92 mm, respectively. PE was present in 106 of the participants. There was no statistically significant difference between the PE and non-PE groups in terms of the person that performed the procedure (surgeon, non-surgeon). However, the patients with PE had statistically significantly longer dorsal and ventral mucosal measurements compared to those without PE (p<0.001).

Conclusions:We think that the dorsal and ventral lengths of mucosal tissue left behind after circumcision is a risk factor for PE. Therefore, special attention should be paid not to leave redundant dorsal and ventral mucosal tissue during this procedure.

Keywords: premature ejaculation, circumcision, mucosal cuff


Premature ejaculation (PE) is the most common sexual dysfunction in young males, it constitutes a major health problem with a prevalence varies between 9% and 31% [1,2]. Despite the high prevalence of PE, there is still no clear consensus regarding its definition, etiology or treatment.

According to the definitions of the International Society of Sexual Medicine (ISSM), lifelong PE refers to ejaculation that occurs from the first sexual intercourse and almost always occurs prior to or within one minute of vaginal penetration, and acquired PE is a clinically significant and upsetting reduction in the duration of intravaginal ejaculation latency time (IELT) that is often less than three minutes [3].

The etiology of PE is not yet precisely known; however, there are biological and psychological hypotheses, including penile hypersensitivity, anxiety, and 5-HT receptor dysfunction [4]. The most sensitive areas in the penis are the glans and the frenulum [5]. Despite the unclarified effect of circumcision on ejaculation time, surgeons tend to leave a large amount of skin during this procedure not to lead to the development of PE [6,7]. Although researchers have not shown a significant effect of the post-circumcisional mucosal cuff on ejaculation time [8], it is still thought that the excess amount of this redundant tissue might reduce ejaculation time [9].

Circumcision is considered to be the most common surgical procedure in the world. It is routinely performed for religious reasons, especially in Muslim countries. This study aimed to investigate the relationship between mucosal cuff after this surgical procedure and PE, the most common sexual dysfunction worldwide.


Sexually active, circumcised males that presented to the urology polyclinic between March 2018 and June 2018 were included in this multi-centered, prospective study. The information on the patients’ height and weight, age at circumcision, the person that had performed the circumcision (surgeon, non-surgeon), penile length, and dorsal and ventral mucosa measurements were recorded. Those data compared between the patients with and without PE. The diagnosis of PE was made according to the ISSM definition of life-long PE (an IELT of less than one minute) [3].

The patients with a PE diagnosis aged 18 to 65 years that did not have erectile dysfunction according to the IIEF-5 (international index of erectile function) score (IIEF-5≥22) were included in the PE group and volunteers that presented to the same polyclinic for another health-related reason constituted the non-PE group. Patients with penile deformity, history of previous penile or pelvic surgery or thyroid disease, and those that used selective serotonin reuptake inhibitors were excluded. Turkish validated version of IIEF-5 were used [10]. The self-estimated IELT of all patients was recorded and the patients were administered the validated Turkish version of the five-item premature ejaculation diagnostic tool (PEDT) [11]. The ethical committee approval and written informed consent of the patients were obtained.

Penile size measurements were performed in a warm examination room with the penis in the flaccid state. The penis was stretched and the penile length was measured from the dorsal to the end of the glans penis by pressing the base of the ruler toward the pubic bone. Mucosal cuff length measurements were undertaken on the dorsal and ventral aspects at the mucosal skin border toward the glans (6 o’clock and 12 o’clock). The measurements taken by the researcher in the participating centers.

Statistical analysis of the data was performed using SPSS v.22.0 software (IBM Corp., Armonk, NY USA). The Student’s t-test was used to compare the results between the PE and non-PE groups by taking statistical significance as p < 0.05. The effect of the person that performed circumcision (surgeon, non-surgeon) and undergoing the procedure during the phallic period (3-6 years) on the presence of PE was investigated using the chi-square test based on a statistical significance value of p < 0.05. Continued on premature ejaculation, read the second part.

By Dr. Carlos Campos, MD, PA On: May 13, 2019 at 06:55:53