Clinical elicitation of the penilo-cavernosus reflex in circumcised men

• To test clinical observations that the penilo-cavernosus reflex is much more difficult to elicit in circumcised men.

• Men consecutively referred for uro-neurological or uro-neurophysiological examination were prospectively included. • Those with possible sacral neuropathic lesions were excluded. • A history was obtained, and a clinical neurological examination was performed. • The penilo-cavernosus reflex was tested clinically and neurophysiologically using electrical and mechanical stimulation. • Reflex elicitability scores in groups of circumcised men, men with foreskin retraction and a control group of uncircumcised men were compared using the Mann-Whitney U test.

• The reflex was clinically non-elicitable in 73%, 64% and 8% of 30 circumcised men, 15 men with foreskin retraction, and 29 control men, respectively. • The scored reflex elicitability was significantly (P < 0.001) higher in control men than in the other two groups clinically, but not neurophysiologically.

• The study confirmed the lower clinical and similar neurophysiological elicitability of the penilo-cavernosus reflex in circumcised men and in men with foreskin retraction. This finding needs to be taken into account by urologists and other clinicians in daily clinical practice.