Reduced Penile Sensitivity and Delayed Orgasm

Welcome! If you have any penile sensitivity issues this may be a great place for you to find a solution. We start with the question of a lack of sensitivity.

As the author of www.the-penis.com I’ve received many emails over the years on aspects of penile function. However, I haven’t had many on this subject:

Email from A Man With Reduced Penile Sensitivity

This input is in response to your request for experience or feedback ona particular problem, that of PENILE INSENSITIVITY. I think it probably affects many more men than we realize, but there is no real information I can find on the Web regarding the physical causes and treatment for low penile sensitivity. I have not “cured” mine, but I have so far been able to optimize what sensitivity I have. Once I recognized my problem for what it was, I made an effort to learn as much as I could about it, and what I could do to improve it. However, I am always looking for new ideas, types of treatment or drugs that might help – If you have any ideas, I would very much appreciate hearing them. Anyway, here is my experience with apparently the same problem as your correspondent.
My response is really a reaction to a prior email, which you quote in your web page at your site www.The-Penis.com “Penis Problem Page”:

“I am a 23 year old gay male. My partner can have an orgasm very quickly, but it takes me a long, long time. Also, my penis is not very sensitive. In fact the only sensitive part seems to be a bit on the underneath of the head. Can I do anything? I am even willing to consider surgery: in fact – I am looking for a cosmetic surgeon now, but with little success. It makes love-making so very hard! Please help.”

I have had the same problem, life-long. I was always a little slow, and sometimes as a teenager, I would even make my penis sore while masturbating to achieve climax. I thought it was just me, and as long as I was functional, it didn’t seem to matter too much. Then after I turned 50, the problem became so pronounced that I was becoming sexually non-functional. I could get a good erection, but I could not stimulate it enough to achieve orgasm, and eventually the discomfort factor won out, and I would lose my erection. I then decided I would learn more about the problem, and I also finally found an enlightened urologist who helped me experiment with ideas and drugs to alleviate the problem. Now some 12 years later, I am still functional, and even though I still do have less than ideal sensitivity, most of the time I do achieve ejaculation.

I would estimate my success rate is probably about 70+% for virginal intercourse, 80+% for masturbation, and near 0% for oral sex without some help (which, though is the most erotic feeling kind of sex, just doesn’t have quite a high enough level of stimulation to get me to the “takeoff” point…I have found that before it goes on too long, if I use some hand masturbation to get me close, I can then enjoy being finished off with oral sex).

What has worked and what has not

Two aspects of my approach have helped significantly:

(1) My urologist informed me that circumcision reduces the sensitivity of the penis. He put me in touch with a group of men who are “restoring” their foreskins through non-surgical methods, using some form of penile skin stretching. Using tape, weights, elastic bands and other methods, you can stretch the “tube” of penile skin over time. It typically takes about 2-3 years to reform a foreskin, some do it in a year, and some like me take longer (I have spent about 7 years off-and-on to gain a fully covering foreskin when flaccid). Restoring the foreskin, of course, doesn’t restore all the nerves, blood vessels, sensitive frenulum and inner ridged mucosa with Meissner’s corpuscles (the most sensitive parts of the intact male penis), but it does provide the protection to allow the remaining inner foreskin and glans to de-keratinise and return to a naturally-occurring mucous membrane. This made a significant improvement to my residual sensitivity. (Click here to read a detailed account of how this man restored his foreskin.)

What I also found out, is that I was circumcised very tightly, so whatever remaining sensitive inner foreskin of my penis was just below the underside of the glans where the frenulum originally terminated…this is exactly the comment from your reader who asked the question above. In my case, I was so tightly circumcised that when I had an erection the shaft skin was drum tight. That tended to pull my testicles up into my body durings ex to the point of pain. Since restoration, besides better sensitivity, I no longer have the tight shaft skin pulling up my testicles. Another problem I had, of the annoying sometimes painful rubbing of my bare glans during athletic activity, is also gone forever. Restoration takes some dedication and discipline, but is well worth it. I just wish I could also restore all those erogenous nerves which were destroyed by circumcision.

(2) I have tried a number of drugs and supplements, but the only one that made significant improvement in my sensitivity is YOHIMBINE. I take 4 x 5.4mg tablets per day as a therapeutic treatment, and that makes a very clear difference. I found it took about 3-4 weeks for the sensitivity improvement to be fully realized. I do NOT need to time it before sex. It does have side effects, and my limit of 4 tablets per day is based on the tolerance of the side effects, which are minimal for me at or below that dosage. They include exaggerated urgency in bowel and urination, feeling of shivery cold, slight muscular shaking on occasion, and the feeling of “being wired”, like caffeine. Some have headaches, but that has not bothered me. I have stopped taking Yohimbine for up to a month on several occasions, and after a few weeks I can clearly tell that my sensitivity has diminished.

My suggestions to anyone with this problem (you will find this a rather common problem with men who are restoring their foreskin):

(1) Find an enlightened urologist with some experience in sexual problems, who is willing to work with you on the problem, to find unique solutions for an often misdiagnosed problem. It can be physical just as easily as mental.

(2) Look into non-surgical foreskin restoration to preserve the little sensitivity still remaining. As you noted in your comments, do not try surgery…it will almost certainly result in further decreased sensitivity.

Other resources on the web for foreskin restoration:
www.norm.org National Organization of Restoring Men
www.cirp.org Circumcision Information Resource Pages or look under “foreskin restoration” in your search engine.

(3) Without a doubt, you need the cooperation of your partner to figure out what works.

Overview of Reduced Penile Sensitivity

If you have significant libido (desire for sex), have the capability of an erection (even if it takes some help from pornographic media), but you have difficulty in gaining sufficient physical arousal of your penis to reach orgasm, you very likely have reduced penile sensitivity.

Reduced penile sensitivity (from here, referred to as RPS) may be severe enough to cause erectile dysfunction (ED), and will almost certainly result in delayed/retarded orgasm (delayed ejaculation), or possibly even in anejaculation (inability to ejaculate). Most research and methods of treatment on delayed/retarded ejaculation or anejaculation, (from here on referred to as delayed ejaculation) have focused on psychological effects rather than physical effects. It is true that psychological effects are often the dominant reason for delayed ejaculation, and frequently there are no distinct physical reasons, so sexual therapy and treatments detailed elsewhere on this website should be thoroughly explored. If you actually have physical reasons for RPS and/or ED, you will probably be well aware of symptoms which persist over time in all situations.

Unfortunately, the only medical approaches historically provided for physical RPS are to evaluate and modify unrelated medication use, and recommend steps to improve physical conditioning. Otherwise, the medical profession has provided few definitive approaches to the problem.

The email above is a good example of one man’s quest to overcome his reduced penile sensitivity. It is not a clear-cut problem where you go to the doctor and receive medication to alleviate it. In the several years since the letter was written, new medications and methods of treatment have evolved for a host of sexual problems. Unfortunately, there are still no specific medications and no prescribed methods of treatment for RPS. There are only a few legitimate studies on penile sensitivity. The database on this subject is primarily anecdotal, and treatments are based on individual experimentation. The medical profession is only beginning to recognize RPS as a significant problem.

However, there are ways to treat RPS and some medications for other problems do also have the side effect of improving penile sensitivity. Since there are different causes for RPS, these medications and methods of treatment may not be universally helpful, but in some combination will almost certainly improve penile sensitivity. In dealing with problems of RPS / ED / delayed ejaculation, it is always important to include your partner in dealing with the problem and how you work together to promote the best possible solution.

There also may be ways to improve penile response or reduce the impact of RPS without medications. Before applying the information in this webpage, you should optimize all other factors in your life:

  • Take steps to optimize your health, by quitting smoking, reducing alcohol and drug usage, starting an exercise program, and losing weight, as applicable.
  • Evaluate medications taken for other conditions to see if substitutions with fewer side effects are available.
  • Try one or more of the following exercises (which you can do without any outside help):
  • Kegel exercises – up to a couple of hundred contractions performed several times per day to strengthen the pubococcygeus muscles of the pelvic floor. (You contract the muscles with an action like stopping the flow of urine during urination.)
  • Stimulation to the penis and genital areas to create an erection several times a day. Such stimulation helps increase the natural testosterone level, and may also help sexual response.
  • Visualization of your most exciting and forbidden sexual fantasies during sex, which may enhance your ability to reach climax.
  • Work with your partner to enhance your mutual experience, and develop understanding of how the problem affects you, as covered in other pages of this website.

Reduced Penile Sensitivity or Erectile Dysfunction?

To some of those who have reduced penile sensitivity, there is no doubt that this condition is different from ED, although in the extreme RPS can inhibit the ability to get erections However, both these conditions can be responsible for causing delayed ejaculation, and indeed sometimes they occur together. Nerve damage, depending on where it occurs can be responsible for either or both conditions, as can diseases and circulatory disorders. With RPS, you may not be able to get an erection from physical stimulation alone.

If you wish to try to determine if you have RPS or ED, there are several ways which can usually answer the question.

  • Your urologist can perform a test with a device which momentarily pops a tiny needle into your penis which injects a drug to simulate arousal to cause an erection. If your vascular system or neural pathways are sufficiently damaged, no erection will occur. If you simply have RPS, the erection will occur.
  • You can very simply test whether you get nocturnal erections, an indication whether or not you have ED. If you have nocturnal erections, you do not have ED, and your inability to gain an erection from physical stimulation is likely due to RPS. You can perform a modern version of the “stamp test”. The test name originated in a day when postage stamps came in rolls with perforations between them and with a glue which had to be licked to attach them. Several of these stamps from a roll could be wrapped snugly around your flaccid penis before bedtime with the stamp glue holding the ends together in order test if you got nocturnal erections. In the morning, if the stamps were still snugly in place, it indicated no nocturnal erections. If the stamps have torn along the perforations, you have likely had nocturnal erections (or maybe you just move around a lot.) A modern version requires fabrication of a strip of paper about 1 inch wide, and long enough to wrap completely around your flaccid penis. Trim an area in the middle to about 1/8 inch wide, wrap it around your flaccid penis and tape the ends in place before bedtime. If you have nocturnal erections, the narrow area will tear.
  • A third indication to separate ED and RPS is to determine when you can get erections. If you cannot get an erection from physical stimulation, but you can get a significant erection from visual stimulus (such as pornographic videos, pictures or stories), you probably have a problem with RPS.

If you determine that you simply have ED, you are lucky: there are many effective medications and treatment options available for ED.

Effect of reduced penile sensitivity to delayed ejaculation

The process of sexual stimulation, erection, continuing sexual stimulation and eventually ejaculation may seem to be quite simple, but on the contrary, different neural pathways are utilized, linked to different response centers in the spinal cord and brain. Some of the responses are from the parasympathetic division of the autonomic nervous system (ANS), and others are from the cortex of the brain. The ANS connects to and responds to an area of the spinal cord called intermediolateral cell column and operates without the intervention of conscious thought or any input from the brain. Stimulation of normal penile nerves with a normal circulatory system will automatically cause an erection. Stimulation of the brain from other sexual sensory input is also capable of initiating an erection, just as negative stimulation from the brain can terminate an erection.

With continued physical stimulation of a normal penis there will be a build up of sensation and pleasurable feelings peaking at orgasm. Ejaculation normally occurs at or near the point of orgasm. The initial step in ejaculation, the emission phase, begins with a “point of no return” wherein the ejaculation response will automatically follow through to the emission of semen. The complex process includes sperm from the testes, which passes through ejaculatory ducts and mixes with fluids from seminal vesicles, the prostrate gland, and the bulbourethral glands to make up the final ejaculatory fluid. All these coordinated neural responses are a part of the autonomic ANS.

In the final phase, ejaculation proper, the semen is ejected through the urethra with rhythmic contractions by the bulbospongiosus muscle under the control of a spinal reflex at the level of the spinal nerves S2-4 via the pudendal nerve. The typical male orgasm lasts several seconds, typically with 8-10 contractions. If any part of the ejaculation process does not proceed as normal, there may be limited or no ejaculation at all. If there is insufficient arousal for any reason, including reduced penile sensitivity, the triggering of the ejaculation response will be delayed or may not occur at all (anejaculation).

Physical causes for reduced penile sensitivity

Reduced penile sensitivity has a number of causes, but the causes break down into two major categories: nerve damage and circulatory problems. Interestingly enough, ED and RPS have causes which can usually be attributed to the same broad categories, and indeed, some level of RPS and ED may occur together. RPS is uniquely a problem of nerve damage or desensitizing the nerves in the penis. This discussion really relates to permanent nerve damage, not desensitized nerves for reasons such as excessive stimulation or cold temperatures.

Nerve damage can occur in the penis itself from causes such as trauma directly to the penis, or from damage caused by removing part of the penis, as in circumcision. Studies have generally indicated that ED and delayed ejaculation are increased in men with circumcised penises. (Additional detail can be found at the Circumcision and Information Pages, www.cirp.org)

Damage can also occur in the nerves in the groin area which lead into the penis, around the prostate gland, particularly in prostatectomy surgery, and in injuries to the back, especially around the S-4 vertebra. Nerves to the penis pass from the spine, under the groin area between the anus and testicles (the perineum). Trauma in that area, even bicycle riding on a seat which applies excessive pressure, can cause damage to those nerves. Severe vascular disease can also decrease the sensitivity of penile nerves, but usually vascular problems have a greater impact on the ability to get an erection (ED). Some diseases, such as diabetes may affect both vascular integrity and function of nerves.

It is the opinion of this author that the majority of RPS victims have neural damage primarily due to circumcision, which by its definition removes an integral part of the penis. The foreskin is not “just skin”, but includes an inner foreskin of special kind of tissue with (1) a density of soft-touch erogenous nerves found nowhere else in the male body, (2) smooth mucosa cells which secrete various immunological secretions (3) apocrine glands secreting feromones.

(For a detailed list of foreskin functions, go to the website www.the-penis.com) The inner foreskin in an adult intact male is about 7.5 square inches (1.5 by 5 inches circumference). A circumcision therefore crushes and destroys 50-90% of the nerve endings which lend pleasure to sex. Yet it was not until the late 1990s that anyone decided to study the foreskin in detail, and it was the accepted theory that circumcision did not damage the penis or reduce sensitivity. (The studies are explored in the next section.) For most men, the reduction of sensitivity goes unnoticed until poor circulation or decreased hormone levels aggravate the condition. Since most circumcisions are done neonatally within 2 days of birth, there is no basis of comparison for intact verses circumcised sensitivity.

Studies and knowledgebase information relating to reduced penile sensitivity

This section reviews six significant published medical studies of penile sensitivity, published mainly in the 1990 and 2000 decades. These studies have come up with two answers about penile sensitivity relating to circumcision (1) that circumcision does not affect penile sensitivity, and (2) that circumcision does significantly affect penile sensitivity. Interestingly, both answers are correct – it depends on what the studies measured, and where on the penis the measurements were made. Studies which focus exclusively on the glans suggest no effect. Studies which include the foreskin show significant losses.
These studies are briefly discussed below.

  • Masters and Johnson, 1964
  • Taylor-inner foreskin, 1996
  • Taylor-ridged bands, 1999
  • Fink, 2001
  • Bleustein, 2005
  • Sorrells, 2006


Review of the intact penis anatomy

In order to understand the studies, it is instructive to discuss the anatomy of the intact (uncircumcised) penis, and show the foreskin segments which are amputated in a circumcision. The drawings below show the penis with retracted foreskin, viewed from the top and bottom.

1 Glans 2 Sulcus 3 Muco-cutaneous junction 4 Inner foreskin – ridged bands 5 Frenulum at muco-cutaneous junction
6 Outer foreskin 7 Shaft skin

When the intact penis is flaccid, the foreskin is pulled forward by the frenulum to cover the glans. During an erection, the foreskin will normally slide back enough to expose or partially expose the glans with sufficient slack to allow the foreskin “tube” to slide. During sexual activity, the intact foreskin slides back and forth against the glans, providing erogenous neural responses from the extremely sensitive ridged bands of the inner foreskin.

Contrary to old wisdom, the glans is not very sensitive. As will be discussed in this section, the ridged bands and frenulum of the inner foreskin have extremely sensitive light-touch tactile nerve endings. Additionally, there are pressure-sensitive nerves internally at the tip of the penis beneath the glans, which are believed to have a part in the ejaculation response. Most circumcised men admit to a “sweet spot”, typically just below the “V” of the glans on the underside of the penis, or sometimes an area just below the sulcus. These small areas of sensitivity are in fact the remnants of their original foreskins.

In circumcision, the tissue from the sulcus to the junction with the shaft skin is removed. The procedure is usually performed on the folded foreskin (not retracted) typically by cutting the foreskin at both ends and suturing the ends together. In the case of “medical” neonatal circumcisions, the foreskin (bonded to the glans in infants) is torn from the glans, cut with a slice from the tip to the corona of the glans, and a clamp slid under and over the now loose foreskin, which is screwed tight to crush the foreskin. All of the tissue from the glans to the junction with the shaft skin is therefore destroyed. Neo-natal circumcisions are usually more extreme than adult circumcisions, since the fully positioned clamps leave little or no inner foreskin from the glans.

The following studies chronicle the understanding of the functions and arousal of the penis during sex, in roughly chronological order.

Masters and Johnson, Human Sexual Response, Published 1966, Little, Brown & Company: “No clinically significant difference could be established between the circumcised and the uncircumcised glans during these examinations.”

As a part of their comprehensive book on male sexuality, Masters and Johnson included short synopsis wherein they describe a study of comparative sensitivity of circumcised and non-circumcised men based mainly on the glans. The study itself was never published, and the methods and controls of the study were never subject to peer scrutiny.

The study focused mainly on the circumcised population, and on the glans as an area of sensitivity. The authors noticed but failed to grasp the significance of different masturbation techniques in intact and circumcised men, which would have held a clue that the foreskin has sensitive nerves not found elsewhere in the penis. In a section discussing “automanipulation”, that is masturbation, they stated: “Uncircumcised males have not been observed to concentrate specifically on the glans area of the penis. Normally they follow the usual pattern of confining manipulative activity entirely to the penile shaft. Stroking techniques rarely move sufficiently distal on the shaft of the penis to encounter more than the coronal ridge of the glans even late in plateau phase just before ejaculation”.

Taylor et al: Specialized mucosa of the penis and its loss to circumcision, British Journal of Urology, Volume 77, February 1996: “We postulate that the ‘ridged band’ with its unique structure, tactile corpuscles and other nerves, is primarily sensory tissue and that it cooperates with other components of the prepuce.”

This was the first in-depth study which investigated the anatomy of the prepuce (foreskin), and from that investigation postulated the role which the foreskin plays in the functioning of the penis. The foreskin anatomy was studied with samples taken from deceased males.

“Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner’s corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa…Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.”

“We postulate that the ‘ridged band’ with its unique structure, tactile corpuscles and other nerves, is primarily sensory tissue and that it cooperates with other components of the prepuce. In this model, the ‘smooth’ mucosa and true skin of the adult prepuce act together to allow the ‘ridged band’ to move from a forward to a ‘deployed’ position on the shaft of the penis. In short, the prepuce should be considered a structural and functional unit made up of more and less specialized parts.”

Cold and Taylor: The prepuce, British Journal of Urology, Volume 83, January 1999: “Excision of normal, erogenous genital tissue from healthy male or female children cannot be condoned, as the histology confirms that the external genitalia are specialized sensory tissues.”

This study was really a review of published papers and evaluation of the knowledge base on genital anatomy and sensitivity, particularly with respect to the prepuce, for both males (the male foreskin) and for the comparative structures in females (the female prepuce is the clitoral hood). The review clearly indicates that the ridged bands and frenulum of the inner foreskin to be the most sensitive erogenous tissue of the penis, and the glans itself to be relatively insensitive.

“The prepuce is a common anatomical structure of the male and female external genitalia of all human and non-human primates; it has been present in primates for at least 65 million years, and is likely to be over 100 million years old, based on its commonality as an anatomical feature in mammals.”…

“The prepuce is primary, erogenous tissue necessary for normal sexual function. The complex interaction between the protopathic sensitivity of the corpuscular receptor-deficient glans penis and the corpuscular receptor-rich ridged band of the male prepuce is required for normal copulatory behaviour.”…

“Surgical amputation of the prepuce removes many of the fine-touch corpuscular receptors from the penis and clitoris. In males, circumcision is essentially a partial penile mucosectomy…”

“Excision of normal, erogenous genital tissue from healthy male or female children cannot be condoned, as the histology confirms that the external genitalia are specialized sensory tissues.”

Fink et al, Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction, Journal of Urology, v167(5), 2001: “We found that circumcised men were instead more likely to have erectile dysfunction…”We found a statistically significant decrease in penile sensation following circumcision in men but our respondents had mixed feelings.”

This study consisted of a survey, questionnaire and follow-up discussions for a group of men, who were circumcised as adults for a medical condition or for personal reasons preferred to be circumcised. It was rather unique, as it looked at before and after conditions to assess perceived changes by these men.

“We found that circumcised men were instead more likely to have erectile dysfunction. Our study populations differ in that we evaluated men circumcised as adults but the worsened erectile function remained when adjusted for age and the presence of diabetes, depression and cardiovascular disease.”…

“We found a statistically significant decrease in penile sensation following circumcision in men but our respondents had mixed feelings. Some responders appeared to be better able to satisfy their partners after circumcision but some men were not satisfied with the decreased sensation of physical stimulation. It seems that sexual pleasure means different things to different men and should be more specifically defined in future studies.”…

Bleustein et al., Effects of Circumcision on Male Penile Sensitivity, Paper read at the American Urological Association 98th Annual Meeting at Chicago Illinois, 2003: “We demonstrated that there are no significant differences in penile sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds in both patients with and without erectile dysfunction.” [ based on measurements of the glans penis –ed.]

This study attempted to establish the sensitivity difference between circumcised and non-circumcised adult men. The study tested different sensory thresholds on the dorsal midline glans of the penis. For intact (uncircumcised) men, the foreskin was retracted and held back behind the glans to allow equal tests on the glans of both circumcised and uncircumcised men. The results showed no significant difference between the two groups at the glans penis; the inner foreskin of intact men was retracted and excluded from the study.

“Patients were subsequently tested on the dorsal midline glans of the penis. In uncircumcised males, the foreskin was retracted for testing. Vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2) were measured.”

“We present a comparative analysis between uncircumcised and circumcised men using a battery of quantitative somatosensory tests that evaluate the spectrum of small to large axon nerve fibers. We demonstrated that there are no significant differences in penile sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds in both patients with and without erectile dysfunction.” [as measured on the glans penis – Ed.]

Sorrells et al.: Fine-touch pressure thresholds in the adult penis, British Journal of Urology International (BJUI), V99(4), April, 2007: “The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.”

This study was a landmark study because for the first time it measured fine-touch sensitivity of all areas of the intact and circumcised penis, rather than just the glans, which was found to be significantly lower in sensitivity than other parts of the organ. The results clearly showed that any future sensitivity studies must include the entire penis.

[The objective of this study was] “To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations.”…”When compared with the most sensitive area of the circumcised penis, several locations on the uncircumcised penis, which are missing from the circumcised penis, were significantly more sensitive.”

“Despite the controversy over the long-term impact of male circumcision, no thorough, objective, quantitative studies measuring the long-term sensory consequences of infant circumcision have hitherto been reported. The present study provides the first extensive mapping of the fine-touch pressure thresholds of the adult penis…”

Synopsis of Reduced Penile Sensitivity studies

While these studies focus on different aspects of the penis, there are several conclusions which can be reached after reviewing them.

  • Because the medical profession (mostly circumcised) universally believed the glans was the defining element of penile sensitivity for many years (and even today large segments of the population believe this), some studies of penile sensitivity have focused on the glans, and ignore other parts of the penis. Studies which focus only on the glans do not accurately determine sensitivity effects of circumcision. Any intact man knows his foreskin is the most sensitive, erogenous part of his penis, and even most circumcised men have a “sweet spot” of sensitivity just below the “V” on the underside of the glans (the last remnant of the frenulum remaining from the inner foreskin), or some left with a larger remnant of the inner foreskin also feel sensitivity just outside the corona of the glans
  • Studies which concentrate on the glans to make comparative measurements seem to miss the point that the glans is relatively insensitive. Therefore, studying the sensations of the glans to heat, cold, pressure, touch and pain fails to include the most erogenous nerves of the foreskin, which of course, are almost entirely missing in circumcised men.
  • It is only in the last few years that studies have begun to recognize that different areas of the penis have different types of sensitivity, and it is still not fully understood which distinctive areas of the penis play the greatest part in stimulating an ejaculation and in sexual satisfaction.

Treatments and medications for reduced penile sensitivity

To my knowledge, there are no defined medical treatment procedures nor any medications specifically developed or prescribed for reduced penile sensitivity. Therefore, there are no medical studies on the effectiveness of any procedures or medications which might be used to treat this condition. This means that the medications covered in this section have only anecdotal evidence, no scientific evidence derived from rigorous medical studies. Nevertheless, there are medications and treatments which do improve the condition. This section explores a number of prescription drug and non-prescription drugs and treatments which in some combination will help improve penile sensitivity and /or mitigate its effect in virtually any man with the condition.

Every man is different in metabolism, chemistry and receptors which respond to medications. Therefore, the effectiveness of medications is not uniform. In most cases, you will find that two or more medications, used together in some combination, prove to be most effective.

First, a word of caution: Any man who is taking medications for high blood pressure, heart problems, diabetes, liver disease, depression and other brain or nerve disorders, or drugs for liver and glandular disorders, should always check with his appropriate physician to be sure that there will be no serious side-effects affecting his prescriptions. This goes for both prescription and non-prescription medications covered in this section. Secondly, be careful not to waste your money on many supplements which offer incredible claims of solving every possible sexual problem. There are actually a few independent testing groups, which may not have rigorous scientific testing, but nevertheless can separate out supplements which are ineffective.

This author’s personal experience and gathered information on the effectiveness of the medications listed below, is oriented toward treating reduced penile sensitivity from circumcision. The studies discussed above do indicate that circumcision reduces penile sensitivity, probably from 50% to 90% of the intact penis – depending largely on the “tightness” of the circumcision, or the amount of penile foreskin removed. Additionally, there can be other damage to other areas of the penis in the case of poorly-executed circumcision. Similar damage can occur by unintended trauma to the genitals. Any reduced penile sensitivity will almost inevitably further degrade as we age and the body adjusts to lower hormone levels, reduced neural response, and often reduced physical condition. Reduced penile sensitivity due to other neural or disease causes will also likely respond to some extent, as well.

Treatment procedures

Foreskin restoration: will restore a significant amount of sensitivity, by protecting the glans and remnants of the inner foreskin, and allowing these areas to revert to mucosal tissues. The fine-touch sensitivity will increase beneath the new foreskin, and the remaining sensitive areas will be protected from external abrasion. The process requires wearing weights or an elastic strap attached to the foreskin with surgical tape or a device to grip the foreskin. Such an arrangement applies continuous pressure to stretch and eventually to grow new skin cells to form a lengthening foreskin tube. There are numerous websites and internet support groups relating to this process, and its specific techniques.

Cost: very low
Effectiveness: Significantly improves the sensitivity of the glans and foreskin-protected areas.
Time to provide results: Typically 2-6 years of tugging

Additional information: Read a man’s experience with foreskin restoration with numerous links to other sites, found on this site: www.male-orgasmic-disorder.com; or for support information go to the National Organization of Restoring Men (NORM) website:
www.norm.org.

Testosterone Hormone Replacement Therapy (HRT): This is artificial replacement of the male hormone testosterone, which typically declines with age or from certain diseases or hormone abnormalities. This hormone effects male sexuality, libido, energy, muscle development and many other functions in men. Low testosterone alone can contribute considerably to perceived low penile sensitivity. In some cases, “normal” age-appropriate testosterone levels for older men are in fact too low for optimum functioning, and HRT can improve a man’s life both sexually and in general well-being.

HRT programs are provided by male-enhancement clinics and specialized urologists. Testosterone treatment can be achieved by injections, dermal creams, gels or patches, or by imbedded time-release pellets. The most favored and least expensive treatment is with dermally-absorbed (through the skin) bio-identical testosterone cream, which has fewer side-effects such as prostate enlargement. Sometimes long-term HRT is combined with Human Chorionic Gonadotropin (HCG) injections, to offset HRT effects of shutting down the body’s production of testosterone. Testosterone HRT therapy should always be closely followed by a physician, since side effects could include increased Prostate-Specific Antigen (PSA) level, aggravated existing prostate cancer condition, or disrupted body chemistry.

Cost: Clinic or urologist programs from about $300 to $2000 per year
Testosterone – cream from a formulary pharmacy, from about $80-$160 for 6 months; injectable testosterone about $200-$600 for 6 months.
HCG injectable only, about $250 – $500 for 6 months, alternately used about 30% of the time.
Effectiveness: Usually very effective for low testosterone effects, including erectile ability and some boost in sensitivity. Most effective in combination with other medications, discussed below.
Time to provide results: 7-14 days for dermal creams, 2-6 days for injections.
Additional information: There are numerous male enhancement clinics with websites, and specialized urologists are often available around metropolitan areas.

Treatment medications and supplements

Alcoholic beverages: may provide some relaxation and reduction in anxieties, but they do not provide any improvement in penile sensitivity. In fact, the effects of alcohol are to degrade neural response, and are likely to further reduce perceived penile sensitivity. If you have RPS, it is better to avoid alcoholic beverages entirely before attempting sex.

Cost: various
Effectiveness: Negative

Arginine: is a conditionally nonessential amino acid, so that generally it can be manufactured by the human body, and usually does not need to come from diet or supplementation. It is a precursor of nitric oxide, which is needed for body muscles to function properly and in getting an erection. Arginine has been used with in combination with Yohimbine to treat erectile dysfunction, but newer medications are much more effective for ED. In most cases, there is no need to supplement arginine, but if taken it may add to the perceived energy level and possibly marginally help erections. Dosage should be on the order of 4 grams/day, best accomplished by the use of arginine powder, which is bitter by nature and needs a buffer or mix to improve the taste. Arginine seems to be helpful in combination with Yohimbine for improving RPS and delayed ejaculation. (See section on Yohimbine.)

Cost: About $20 for a 2-month supply of arginine powder
Effectiveness: Minimal when used alone, but helpful with Yohimbine.

Caffeine: does improve mental and neural performance, but does not appear to be at all helpful in improving RPS or delayed ejaculation.

Cialis (Tadalafil): is one of the three big erectile dysfunction drugs, and is the only one which is helpful in treating RPS. All of the big three drugs are PDE-5 inhibitors, that is, a drug which activates enzymes which lead to smooth muscle relaxation of blood vessels to the penis, increasing blood flow and enhancing the ability to get an erection. Unlike Viagra, Cilais requires stimulation to start this process (Viagra may actually cause spontaneous erections). When using Cialis , you will find penile sensitivity is enhanced, leading to an erection, and helpful in maintaining the sensitivity to an ejaculation. My experience is that it benefits all stages of having sex. Cialis also has the longest “half life” of the PDE-5 drugs, about 18 hours, verses about 4 hours for the others.

Cost: About $15 for a single Cialis 20mg tablet. Generic tadalafil tablets made mostly in India are widely available for $3-4 per 20mg. tablet from on-line pharmacies, and seem to be almost as effective as the branded Cialis.
Effectiveness: Positive effect on RPS, delayed ejaculation and ED.
Time to provide results: Cialis takes at least an hour to become effective even when taken on an empty stomach. My experience is that it typically takes 4-6 hours to peak in effectiveness, but the effect can last 36 or more hours. Sublingual “Softgel” tablets act in about half the time as regular Cialis (tadalafil).

Additional Information: Note: many online pharmacies sell diluted or bogus versions of the drug.
Finding a reliable pharmacy for generic tadalafil may take some searching. Any reputable pharmacy requires a doctor’s prescription. I have had good results with an online pharmacy called BestNationalPharmacy.com, under their “Weekly Specials”.

DHEA (5-Dehydroepiandrosterone): is a natural steroid hormone, produced in the body of humans and other mammals secreted mainly from the adrenal glands, and to a lesser extent, the sexual organs and the brain in both males and females. It plays a part in the production of testosterone and estrogens. Regular exercise appears to naturally increase DHEA in the human body. As humans age the DHEA plasma (blood) levels frequently decrease, as do a host of other hormones. However, the marketing claims of DHEA as a performance enhancer or longevity supplement are unproven.

Studies have indicated an increase in testosterone in older males with DHEA supplementation, but the extent would probably depend on the DHEA and testosterone levels existing before taking the supplement. It is also possible over-consuming DHEA can excessively increase estrogen, with a negative overall effect on male hormone balance. It is available in tablet form from 25 to 50 mg, or as a trans-dermal cream. I found no improvement in RPS while taking DHEA.

Cost: Approximately $5-20 for 100 tablets.
Effectiveness: Not generally effective for RPS, but might be helpful in the case of subnormal DHEA levels.
Time response: Unknown.

Dostinex (Cabergoline): is a so-called dopamine receptor agonist on dopamine D2 receptors, primarily used to treat Parkinson’s Disease, high prolactin and other endocrinological disorders. The drug has also been reported to shorten the refractory (recovery) period in males after sex. I have tried this medication at the minimum dosage of 0.5mg for several months, and found no benefit for either RPS or delayed ejaculation. Once the point of ejaculation is reached, it may have marginally increased the intensity of the climax, but otherwise had no definable effect. I was hesitant to increase the dosage to the 2-6mg. used by Parkinson’s patients because of unknown effects on a normal brain at that dosage, and because the increased side-effects of mostly nausea, constipation and psychiatric disturbances.

Cost: Approximately $13 per 0.5mg tablet generic cabergoline
Effectiveness: Not effective for RPS at 0.5mg level
Time response: Effects begin 0.5-4 hours after ingestion, and the half life is estimated from 60-80 hours.

Horny Goat Weed (Epimedium): is extracted from the plant, located originally in China and Asia. Icariin is the “active ingredient” in Horny Goat Weed, and the supplement is typically found in capsules with standardized extracts from 10% to 20% potency. Icariin is a PDE-5 inhibitor as the popular ED drugs on the market, but also seems to increase the sensitivity in the genital area as Yohimbine. In fact, the overall positive effects of this supplement seem mirror those of Yohimbine, but for the most part it doesn’t have the array of Yohimbine side-effects. I have only noticed some bowel upset when taken on an empty stomach. It does seem to help RPS, but not to the extent of Yohimbine. Horny Goat weed is not a stimulant such as Viagra, and is most effective as a supplement taken every day. Usually the effects will not be noticed for 1-2 weeks, and after that it does not require increasing amounts to maintain the effects.

Cost: $25 – $100 for a two-month supply
Effectiveness: This supplement is effective in improving RPS, and additionally helps erectile response and libido.
Time to results: 1-2 weeks at normal dosage
Additional information: When purchasing this supplement, ensure that the percentage of the Icariin extract is shown – the higher the Icariin, the more potent the capsule.

High-potency Niacin (Vitamin B-3): is a vitamin supplement available typically in 500mg-1000mg time release tablets. Niacin improves blood circulation and increases HDL cholesterol. When combined with Yohimbine, it can improve ED. However, when used alone for RPS and delayed ejaculation, it has no noticeable effect. It typically causes a face-flush 15-30 minutes after ingesting a tablet, and at levels above 2g per day, could cause serious side-effects, including liver toxicity.

Cost: Typically about $20 for a two-month supply of time release tablets.
Effectiveness: Not effective for RPS.

Human Chorionic Gonadotropin (HCG): is a natural protein hormone which mimics the natural male Luteinizing Hormone (LH) nearly identically. LH is a precursor to testosterone production, and HGC will stimulate the testes in the same way to enhance the production of testosterone and sperm. HCG may be used alone, but is more often combined with testosterone HRT (See the Treatment Procedures section above on this page)

Cost: injectable only, about $250 – $500 for 6 months, alternately used about 30% of the time.
Effectiveness: Very effective at maximizing natural testosterone production.

Levitra (Vardinafil): is one of the popular PDE-5 drugs sold for ED. This medication seems to be marketed particularly for men with diabetes and the circulatory problems typical of the disease. I found no effect from the drug for RPS, but also found no significant effect on erectile function. My circulatory system is in good condition from years of exercise, and I am able to obtain an erection without drugs, albeit somewhat slower than in my prime years. This medication has a half-life of about 4-5 hours.

Cost: About $20 per tablet, available in sizes from 2.5mg to 20mg, generic about $3.50 and up.
Effectiveness: Not effective for RPS.

Marijuana (Cannabis): is a slightly legal / illegal drug with psychoactive properties used for medical and recreational purposes, typically taken by inhaling the smoke. I must admit that I have not personally tested this drug, although I could have obtained a prescription for medical marijuana here in California. From testimony by others, having sex after marijuana adds the feeling of being high and an added sexual euphoria, but it also delays ejaculation. Unfortunately, this is the reverse of what’s needed to improve RPS and delayed ejaculation …the euphoria does not help if you never get there!

Cost: Market cost
Effectiveness: The reverse or the desired effect for with RPS and delayed ejaculation.

P-Boost: is a supplement of natural ingredients designed to enhance erections. (A partial list of ingredients is provided on their website at p-boost.com.) At first, this product sounds like so many others guaranteed to enhance sexuality in some way, but never work. However, this product does work. I found it when I was seeking information on a competing product which sounded encouraging. I found a website which tests non-prescription “male sexual health” products with a reliable panel of men (SexHealthReview.com). The product I was seeking tested at near a “0″, but I found this product P-Boost which had the highest score of any product they ever tested. My personal testing rated it almost as effective as Viagra – it, too, will even cause spontaneous erections. Unfortunately, like Viagra, it does not seem to help penile sensitivity, but it can serve as a help to maintain an erection better during a delayed ejaculation session when penile sensations begin to fade. Unlike Viagra, it has few side effects, but it will still cause flushing in the face.

Cost: less than $3.00 per capsule, depending on quantity purchased.
Effectiveness: Definitely increases erectile response.
Time to results: Effective within 60 minutes on an empty stomach, with an estimated half-life of about 8 hours.
Additional information: Available only from the website P-Boost.com.

Testosterone: is the primary male hormone, and plays a major role in sexuality, libido, fertility, and development of male characteristics. As a supplement, it is very powerful, and should only be used under a physician or a clinic as described under the Treatment Procedures on this page, with frequent blood tests to evaluate its effect on your metabolism. If you have a lower than ideal testosterone level, testosterone hormone replacement therapy can improve libido, erectile function and penile sensitivity.
Testosterone can be administered by oral tablets, injections, imbedded pellets, or trans-dermal creams, gels or patches. Oral testosterone works poorly, since most of the hormone ingested is captured and processed by the liver. It is also dangerous, since excessive oral testosterone can become toxic to the liver.

Testosterone injections are uncomfortable with a rather large needle, and must use an artificial testosterone formula to assure gradual absorption. Shots are required about every 2-3 weeks, so that the absorption rate and effectiveness cycle vary over that time period, causing uneven results. Trans-dermal patches require frequent changing, and commonly cause skin irritation problems. Gels and creams are the easiest to administer, and are generally the preferable bio-identical testosterone. Gels are manufactured by pharmaceutical companies, and creams are typically made by formulary pharmacies.

Cost and Effectivreness: See Testosterone Hormone Replacement Therapy (HRT) in the Treatment Procedures section above.

Tongkat Ali (Eurycoma longifolia): is an extract from a flowering Eurycoma longifolia tree, originally found in Indonesia, Malaysia, and Southeast Asia. The Tongkat Ali extract has been used for centuries to treat fertility, strength and libido, as well as other maladies in folk medicine. This medication is a hormonal modulator, and needs to be taken consistently in sufficient quantity to effect natural hormone production (including testosterone). It works most effectively with scheduled breaks, for example five days on and two days off, to ensure that the body does not develop a resistance pattern to the supplement. Like other effective supplements, it must be at a certain strength to be effective.

Assurance of this strength should be on the label: the Indonesian plant is considered most potent, and the label must also state the “production ratio”. A ratio of 1:50 indicates that 50 grams of the plant root were used to make 1 gram of extract, so the higher the number, the stronger the extract. Detailed information about the effects of this extract verses other medications, and ordering advice, is available at the website AsiaTour.com, and other Tongkat Ali informational websites.

Cost: Approximately $200-300 for a 100 day supply, at the level of supplement recommended in “Effectiveness” below.
Effectiveness: The results with respect to RPS seem to be similar to those of Horny Goat Weed, but the medication must be taken a level of medication well in excess of Horny Goat Weed. To be effective, the daily dose should be the equivalent about two 300 gm. Capsules with a 1:200 ratio (200 gm. of plant root for 1 gram of the capsule extract).
Time to results: Typically 2-4 weeks with a buildup to higher dosages. Effective dosage level varies significantly with the individual.
Additional information: Ensure that the extract ratio is given on the label.

Uprima (Apomorphine): is a new type of ED medication which works directly through the brain, rather than with the use of PDE-5 inhibitors found in the other major ED drugs. Uprima works by targeting an area of the brain known as the hypothalamus, which stimulates the production of a brain chemical called dopamine, in part responsible for sexual response and initiating erections. Having en ED drug which works through the nervous system is an exciting possibility for those with RPS which has resulted from nerve damage.

The drug was approved by the European Union (EU), but refused by the US FDA, so it is not legal in the USA. While it is legal in the EU, it does not seem to be available at this time. Unfortunately, an evaluation will have to wait for availability of the drug.
Cost: Last listed price EUR80.00 for 4-3mg tablets

Viagra (Sildenafil): is the first and best known of the three popular ED medications. It is also a PDE-5 inhibitor, that is, a drug which acts to activate enzymes which lead to smooth muscle relaxation of blood vessels to the penis, increasing blood flow and enhancing the ability to get an erection. Unlike Cialis, Viagra requires no stimulation to initiate an erection, and so spontaneous erections are likely to occur once the drug takes effect. While it is highly effective in enhancing erections for most men, it does not seem to help penile sensitivity. However, it can serve as a help to maintain an erection better during a delayed ejaculation session when penile sensations begin to fade, and so it may be beneficial when used in combination with other medications..

Cost: About $21 for a single Viagra 100mg tablet. Generic sildenafil tablets made mostly in India are widely available for $3-4 per 100mg. tablet from on-line pharmacies, and seem to be almost as effective as the branded Viagra.
Effectiveness: Very effective in enhancing the ability to get an erection, but ineffective in treating RPS.
Time to results: Viagra normally becomes effective in less than 60 minutes., and has a half-life of about 4 hours.
Additional Information: Note: many online pharmacies sell diluted or bogus versions of the drug.
Finding a reliable pharmacy for generic sildenafil may take some searching. Any reputable pharmacy requires a doctor’s prescription. I have had good results with an online pharmacy called BestNationalPharmacy.com, under their “Weekly Specials”.

Yohimbine: an alkaloid with stimulant and aphrodisiac effects derived from the bark of the Pausinystalia yohimbe tree. It is used both as an ingredient in non-prescription male supplements and as a prescription medication. The prescription drug was one of the first drugs to treat ED, particularly with the combined use of high potency niacin, but was effective with only about one-third of men with ED.

However, Yohimbine also acts as an aphrodisiac, improves penile sensitivity, and has been shown to be effective in the treatment of orgasmic dysfunction (delayed ejaculation) in men. My personal experience verifies all these qualities of Yohimbine, when used as a supplement taken every day. It seems like the perfect drug for RPS!

Unfortunately, Yohimbine has numerous side-effects. These include headaches, insomnia, rapid heart beat, anxiety reactions, skin flushing, increased urgency for urine and bowel elimination, shivering, loose bowels and sometimes diarrhea, and dizziness. Usually the headaches, dizziness and insomnia will fade out after taking the drug for a few weeks. Moreover, if the daily dosage is low and spaced out, the side effects will be mild. As the body becomes accustomed to the medication, you will have to gradually increase the dosage to maintain the benefits, and as the dosage increases the side effects tend to increase as well. I originally started with two 5.4mg tablets per day and after about 8 years I was up to six per day. Six per day is about the maximum: greater than about 30mg. per day can cause liver damage. The final problem with Yohimbine is the cost. As late as 2004, Yohimbine tablets cost about $0.10 for a 5.4mg tablet. By 2008, the price was more than $0.50 per tablet. At 6 tablets per day, the annual bill for Yohimbine was over $1000! The supplement Horny Goat Weed, discussed earlier, has many of the benefits of Yohimbine albeit a milder form, without the many side effects and without the liver toxicity issues.

Cost: About $0.50 per tablet, or about $1000 per year at 6 tablets per day
Effectiveness: The most effective single medication I have experienced for RPS, but with many side effects
Time to results: About 3 weeks from the start of daily medication.
Additional information: If you wish to try Yohimbine, do use the prescription pills. Supplements using Yohimbine bark extract do not have a controlled amount of the extract and are unreliable for establishing the effectiveness of the medication.

Other medications: are available which are untested by me, but according to the literature have been prescribed at some time to treat delayed ejaculation. This group of drugs is normally prescribed to treat Parkinson’s Disease or other brain dysfunctions, such as depression or anxiety attacks. There is little or no information on their effectiveness in treating RPS or delayed ejaculation. For additional information, I recommend consulting Wikipedia.org.

  • Amantadine (Symmetrel) There have been anecdotal reports that low-dose amantadine has been successfully used to treat ADHD. Limited data has shown that amantadine may help to relieve SSRI-induced sexual dysfunction.
  • Bupropion (Wellbutrin, others) Bupropion is one of few antidepressants that does not cause sexual dysfunction. According to a survey of psychiatrists, it is the drug of choice for the treatment of SSRI-induced sexual dysfunction, although this is not an FDA-approved indication.
  • Buspirone (BuSpar, Vanspar) Buspirone (brand name BuSpar) is a psychoactive drug and pharmaceutical medication of the piperazine and azapirone chemical classes. It is used primarily as an anxiolytic, specifically for generalized anxiety disorder.
  • Cyproheptadine (Periactin) Cyproheptadine has been used in the management of moderate to severe cases of serotonin syndrome. Cyproheptadine can also be used as a preventive measure against migraine in children and adolescents. Cyproheptadine can relieve SSRI-induced sexual dysfunction and drug-induced hyperhydrosis (excessive sweating).

Future Treatments for Reduced Penile Sensitivity

The future will certainly bring better medications and more effective treatments for RPS. As these become available, this Web page will be updated to include them.

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