Onset of sexuality is impaired in young men with a persistent congenital phimosis.

Abstract

Phimosis is a narrowing of the preputial orifice that hinders complete and painless foreskin retraction onto the glans. It is physiological in children but should be resolved at puberty. Some men reach adulthood with a persistent congenital phimosis (PCP) that can impair their sexuality. The literature is abundant on circumcision, but little attention is paid to phimosis. We aimed to evaluate the impact of PCP on sexuality in early adulthood. Inclusion criterae: men over 18 years of age who reached adulthood with PCP. Methods: Descriptive study based on an online questionnaire (37 questions), exploring medical history, emotional experience and sexual function (including a personal adaptation of the Sexual Complaint Screener for Males). 435 men were contacted, 80 completed the questionnaire, 67 were included. 79% had impaired sexual onset, 69% had significant anxiety, 66% avoided sex, and 46% avoided a romantic relationship. Desire and arousal were impaired in only 20% and 15%. Sexual function was more impaired during penetration than during masturbation, in the domains of arousal (erectile dysfunction 36% vs 13%) and orgasm (rapid ejaculation 28% vs 20%, delayed ejaculation 18% vs 3%). 67% were dyspareunic. 60% realized they had a problem before 18 years, but 82% did not seek medical advice until after 20, half of them after 25. The mode of revelation was comparison with others (porn and peers) (36%), self-observation (33%), sexual encounter (28%).There was no traumatic experience of foreskin retraction in childhood, and 55% recommended prevention in adolescents. Biases: descriptive study, heterogeneity of the population, declarative nature of the data, absence of a control population. Nevertheless, this study is the first to show that unresolved PCP in adolescence alters penetrative but not masturbatory sexuality, leads to avoidance of romance and penetration, with delay in seeking treatment. Preventive systematic andrological consultation should be proposed to adolescents. The authors declare no conflict of interest