Foreskin

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In mammals, the foreskin or prepuce is the retractable double-layered fold of skin and mucous membrane that covers the head of the penis, (the glans penis). It serves as a sheath to protect the glans penis. In a female, the clitoral foreskin, or hood, covers and protects the glans clitoris in a similar manner.

The human foreskin

In humans, the foreskin, a part of the penis, is a double-folded tube of innervated skin and mucous membrane [1] (similar to the inside of the mouth) which attaches at the crested end of the glans at the sulcus, and to the body above the pubic bone and scrotum. The skin on most of the body is attached to the underlying tissue. However, like the eyelid, the foreskin is free to move. Smooth muscle fibres keep the foreskin close to the glans penis but make it highly elastic.[2]

The inner surface of the foreskin is usually fused with the glans penis at birth.[3] The fusion gradually breaks down over a period of up to 17 years, releasing the foreskin and allowing it to become retractable.[4] 44 percent of boys have fully retractable foreskins by age ten, 90 percent by age 16, and 99 percent by age 18.

The coverage of the glans by the foreskin in adults is a highly variable characteristic. Some men have abundant overhang when flaccid, while others do not have complete glans coverage. Schoeberlein, in a German study, found that around 50% of uncircumcised young men had full coverage of the glans while 42% had partial coverage while the remaining 8% were both glans and sulcus free. After adjusting for circumcision he established that in 4% of the young men the foreskin atrophied (shrank) spontaneously.

One of the purposes of the foreskin is to protect the glans of the penis. It is normal for the foreskin to be fused with the glans in babies and not to fully retract until around puberty. Forcible retraction of the foreskin should be avoided and the child himself should be the first person to retract the foreskin.[5] Premature retraction, which is painful, can cause infection.

Regular washing under the foreskin becomes important only when the foreskin becomes naturally retractable. Some cultures practice circumcision, which removes the foreskin, for what they believe are reasons of hygiene. The American Academy of Pediatrics no longer recommends infant circumcision, instead stating that parents should decide what is in the best interests of their child.

Function

Also, as noted above, the foreskin protects the glans penis during infancy from irritation by ammoniacal diapers,[6][7] [8], which prevents meatal ulceration and prevents meatal stenosis. The foreskin facilitates intromission.[9][10][11]

Conditions

Phimosis is a condition, usually considered abnormal in an adult, in which the foreskin cannot be retracted fully or at all. Among humans, phimosis is treated through the use of topical steroid ointments, stretching, or circumcision. In some cases, a dorsal slit is made in the foreskin to correct a medical problem. See phimosis for more information on treatment of phimosis. Non-retractile foreskin is a normal condition prior to puberty. [12]

Where the foreskin is partially retractable, a condition called paraphimosis may occur where the foreskin becomes trapped behind the glans. This is a serious condition which must be treated as a medical emergency.

Surgical modification

In addition to its use as a treatment for phimosis, circumcision, among other procedures, is also practiced for religious or aesthetic reasons, or for alleged health benefits (see genital modification and mutilation).

Preputioplasty is now the preferred surgical treatment for non-retractile foreskin among some surgeons.[13] [14]

Religious and Cultural Views

Both Jews and Moslems, in most interpretations of religious doctrine, practice ritual circumcision whereby the foreskin of a young boy is cut away permanently. In Judaism, an expert circumcisor known as a mohel performs the ritual, known as brit milah on an eight day old baby boy. It is considered to be religiously mandated by the Torah as the mark of the Covenant between God and Abraham, the forefather of both the ancient Hebrews, and the sons of Ishmael. The purported foreskin of Jesus Christ has been venerated as a Christian relic in various places at various times. It is known as the Holy Prepuce.

Many infant circumcisions, particularly in the United States, are carried out without a context of religion. As adults, some men undergo circumcision for comfort, appearance, or a sense of completion. Other men may choose foreskin restoration for similar reasons, which provides a man with a replacement of the lost foreskin, usually by non-surgical tissue expansion techniques.

External links

Anatomy and Functions of the Male Foreskin by Marilyn F. Milos, R.N. and Donna Macris, C.N.M.; (1994) includes photos and animations. Note: The website is strongly anti-circumcision.
Fleiss P, Hodges F, Van Howe RS. Sex. Trans. Inf. 74(5): 364-367 (1998). Immunological functions of the human prepuce Note: the authors hold a strong anti-circumcision point of view.
C.J. Cold and J.R. Taylor. British Journal of Urology 83, Suppl. 1: 34-44 (1999) The Prepuce Note: the authors hold a strong anti-circumcision point of view.