Post-Circumcision Erectile Dysfunction: Causes and Solutions

Erectile dysfunction after circumcision?

Hello Dr.
Hsu! I underwent a circumcision surgery in early December, and the wound has completely healed.
However, I have recently not experienced morning erections, and I am unable to achieve an erection during intercourse, which makes it difficult to engage in sexual activity.
Prior to the surgery, I had never experienced these issues, and I have not been under any significant work-related stress recently.
I kindly ask for your guidance on this matter.
Thank you! Wishing you a Happy New Year!!!

Dàguān, 30~39 year old female. Ask Date: 2010/01/07

Dr. Xu Weikai reply Urology

Hello, generally speaking, the chance of injuring the erectile nerves during circumcision is very low, almost impossible.
Most post-operative erectile difficulties are primarily due to the wound not being fully healed, which may still cause some mild pain.
Additionally, morning erections do not signify much; in clinical practice, we inquire about morning erections to determine if the nerves are intact.
If there are no morning erections, further examinations are needed to confirm the integrity of the nerve pathways.
Morning erections typically occur when the bladder is full; if you wake up with an empty bladder, it will not lead to an erection and is unrelated to erectile dysfunction.

Returning to your question, I recommend that you return for a follow-up to check if the wound is healing properly.
I have my doubts about that.
In my experience, it takes about two months for the surgical site to fully heal, so I advise my patients to wait at least two months before resuming sexual activity.
I have had patients who were eager and engaged in sexual activity about a month post-surgery, resulting in the wound reopening, requiring a return visit for re-stitching.
Of course, this is a more unusual case.
If there are any unclear points, feel free to ask again, and we can discuss and research further.

Sincerely,
Dr.
Hsu Wei-Kai
Director, Urology Department
Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2010/01/07

More Info

Post-circumcision erectile dysfunction (ED) can be a concerning issue for many men who have undergone this procedure. While circumcision is generally considered a safe and routine surgical intervention, it can sometimes lead to unexpected complications, including changes in erectile function.
There are several potential causes for erectile dysfunction following circumcision, and understanding these can help in finding appropriate solutions.

1. Psychological Factors
One of the most common causes of erectile dysfunction after circumcision is psychological. The experience of surgery, even if it is minor, can lead to anxiety or stress about sexual performance. This is particularly true if the patient is concerned about changes in sensation or the appearance of the penis post-surgery. Psychological factors can significantly impact libido and erectile function, leading to difficulties in achieving or maintaining an erection.

2. Physical Changes
Circumcision alters the anatomy of the penis, which can affect sensitivity. Some men report changes in sensation, particularly if the glans (the head of the penis) becomes more exposed and less sensitive due to the removal of the foreskin. This change can lead to difficulties in achieving erections or a decrease in sexual arousal.

3. Nerve Damage
Although rare, there is a possibility of nerve damage during the circumcision procedure. If the nerves that are responsible for erections are affected, this could lead to erectile dysfunction.

4. Hormonal Changes
Surgery can sometimes lead to hormonal changes, particularly if there is significant stress or anxiety associated with the procedure. Stress can increase cortisol levels, which may negatively impact testosterone levels, leading to decreased libido and erectile function.

5. Vascular Issues
Erectile function is heavily reliant on proper blood flow to the penis. If there are any vascular issues, such as reduced blood flow due to surgery or other underlying conditions, this can lead to difficulties in achieving an erection.

Solutions and Recommendations
1. Consult a Specialist: It is crucial to discuss these symptoms with a healthcare provider, preferably a urologist or a sexual health specialist. They can perform a thorough evaluation to rule out any underlying medical conditions.

2. Psychological Counseling: If psychological factors are suspected, speaking with a therapist or counselor who specializes in sexual health can be beneficial. Cognitive-behavioral therapy (CBT) can help address anxiety and improve sexual confidence.

3. Medication: In some cases, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis) may be prescribed to help improve erectile function. These medications work by increasing blood flow to the penis and can be effective for many men experiencing ED.

4. Lifestyle Modifications: Maintaining a healthy lifestyle can improve overall sexual health. This includes regular exercise, a balanced diet, avoiding smoking, and limiting alcohol consumption.

5. Follow-Up Care: Regular follow-up with your healthcare provider is essential to monitor your recovery and address any ongoing issues. They can provide guidance on what to expect and how to manage any complications.

In conclusion, while post-circumcision erectile dysfunction can be distressing, it is important to remember that it is often treatable. By addressing both the psychological and physical aspects of this condition, many men can regain their sexual function and confidence. If you are experiencing these symptoms, do not hesitate to seek professional help.

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