Adult Circumcision for Symptomatic Phimosis in Poland: Six-Month Patient-Reported Sexual Function and Psychosocial Outcomes from a Central European Low-Circumcision Setting.

Background

Adult circumcision is an effective surgical treatment for symptomatic phimosis, but its effects on sexual function and psychosocial outcomes remain incompletely characterized. This study aimed to assess patient-reported motivations for circumcision due to phimosis and to evaluate changes in sexual function, genital self-image, and depressive symptoms after surgery.

Methods

We performed a prospective, single-center observational pre-post cohort study of adult men who underwent circumcision for symptomatic phimosis at a tertiary academic center in Poland between January 2023 and April 2025. Participants completed an author-designed questionnaire and validated patient-reported outcome measures before surgery and at six months after circumcision. The primary endpoint was the change in sexual function measured by the International Index of Erectile Function (IIEF-15). Secondary endpoints included changes in genital self-image assessed using the Male Genital Self-Image Scale (MGSIS-7), depressive symptoms measured with the Beck Depression Inventory (BDI-II), and patient-reported motivations for surgery. Paired comparisons were performed using the Wilcoxon signed-rank test.

Results

A total of 148 men were included in the study. The most common reasons for surgery were pain/discomfort (58/148, 39.2%) and impaired sexual activity (51/148, 34.5%). The total IIEF-15 score increased from 46.4 ± 20.4 to 57.5 ± 21.0 (p < 0.001), with significant improvements across all domains (all p < 0.001). The total MGSIS-7 score improved from 19.9 ± 4.5 to 23.1 ± 4.0 (p < 0.001). Paired BDI-II data were available for 77 men; the total BDI-II score decreased from 1.2 ± 3.8 to 0.3 ± 1.6 (p = 0.004). Most men reported improved sexual life (127/148, 85.8%) and cosmetic satisfaction (124/148, 83.8%), and 119/148 (80.4%) reported no complications.

Conclusions

Circumcision for symptomatic phimosis was associated with improved sexual function and genital self-image, alongside a statistically significant but clinically negligible decrease in subclinical depressive symptoms.