The foreskin is the double-layered fold of smooth muscle tissue, blood vessels, neurons, skin, and mucous membrane part of the penis that covers and protects the glans penis and the urinary meatus. The foreskin is mobile, fairly stretchable, and acts as a natural lubricant. The foreskin is also described as the prepuce, a technically broader term that also includes the clitoral hood in women, to which the foreskin is embryonically homologous.
|Precursor||Genital tubercle, urogenital folds|
|Artery||Dorsal artery of the penis|
|Vein||Dorsal veins of the penis|
|Nerve||Dorsal nerve of the penis|
The foreskin of adults is typically retractable over the glans. Coverage of the glans in a flaccid and erect state varies depending on foreskin length. The foreskin is attached to the glans at birth and is generally not retractable in infancy. Inability to retract the foreskin in childhood should not be considered a problem unless there are other symptoms. The highly innervated mucocutaneous zone of the penis occurs near the tip of the foreskin.
The foreskin may become subject to a number of pathological conditions. Most conditions are rare and are easily treated. In some cases, particularly with chronic conditions, treatment may include circumcision, a procedure where the foreskin is partially or completely removed.
The outside of the foreskin is a continuation of the skin on the shaft of the penis, but the inner foreskin is a mucous membrane like the inside of the eyelid or the mouth. The mucocutaneous zone occurs where the outer and inner foreskin meet. Like the eyelid, the foreskin is free to move after it separates from the glans, which usually occurs before or during puberty. The foreskin is attached to the glans by a frenulum, a highly vascularized tissue of the penis. The World Health Organization states that "[t]he frenulum forms the interface between the outer and inner foreskin layers, and when the penis is not erect, it tightens to narrow the foreskin opening.
The human foreskin contains a sheath of muscle tissue just below the skin, formerly known as the peripenic muscle and now called the dartos fascia, most of which is contained in the foreskin. Elastic fibers are contained in the dartos fascia, which form a whorl at the tip of the foreskin. The whorl of fibers acts as a sphincter in infants, which opens to allow the passage of urine, but closes to protect the glans penis from foreign matter and contaminants. The dartos fascia is sensitive to temperature and expands and contracts with temperature changes. The dartos fascia is only loosely connected with the underlying tissue so it provides the skin mobility and elasticity of the penile skin.[medical citation needed]
According to the histological findings of the British Association of Urological Surgeons based on a research conducted on the autopsy of 22 foreskins, "the prepuce provides a large and important platform for several nerves and nerve endings", The College of Physicians and Surgeons of British Columbia has written that the foreskin is "composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings and erogenous tissue."
In 1996, following a study of 22 cadavers, retired pathologist John Taylor published an influential paper in which he proposed that the pleated skin of the foreskin was a distinct anatomical structure called the "ridged band", and that it played an important role in male sexual function. A 2015 review by Cox and colleagues said that the feature was particular to some men and that illustrations of the "ridged band" had been inconsistent in what they pointed to.
In children, the foreskin usually covers the glans completely but in adults it may not. During erection, the degree of automatic foreskin retraction varies considerably; in some adults, the foreskin remains covering all or some of the glans until retracted manually or by sexual activity. This variation was regarded by Chengzu (2011) as an abnormal condition named 'prepuce redundant'. Frequent retraction and washing under the foreskin is suggested for all adults but particularly for those with a long, or 'redundant' foreskin. When the foreskin is longer than the erect penis, it will not spontaneously retract upon erection.
Some males, according to Xianze (2012), may be reluctant for their glans to be exposed because of discomfort when it chafes against clothing, although the discomfort on the glans was reported to diminish within one week of continuous exposure. Guochang (2010) states that for those whose foreskins are too tight to retract or have some adhesions, forcible retraction should be avoided since it may cause injury.
In 2007 The World Health Organization (2007) said that there was "debate about the role of the foreskin, with possible functions including keeping the glans moist, protecting the developing penis in utero, or enhancing sexual pleasure due to the presence of nerve receptors". The foreskin helps to provide sufficient skin during an erection.
The foreskin protects the glans. The foreskin protects the glans of infants from ammonia and feces in diapers, which reduces the incidence of meatal stenosis, and continues to protect the glans from abrasions and trauma throughout life. The fold of the prepuce maintains sub-preputial wetness, which can cause smegma when proper hygiene is not performed.
The foreskin contains Meissner's corpuscles, which are nerve endings involved in fine-touch sensitivity. A study of skin samples found that, compared to other hairless skin areas on the body, the Meissner's index was highest in the finger tip (0.96) and lowest in the foreskin (0.28) suggested that the foreskin has the least sensitive hairless tissue of the body. Histological studies research into the sensory properties of the penis have found that the foreskin has "no role in sexual sensation".
In primates, the foreskin is present in the genitalia of both sexes and likely has been present for millions of years of evolution. The evolution of complex penile morphologies like the foreskin may have been influenced by females.
In modern times, there is controversy regarding whether the foreskin is a vital or vestigial structure. In 1949, British physician Douglas Gairdner noted that the foreskin plays an important protective role in newborns. He wrote, "It is often stated that the prepuce is a vestigial structure devoid of function... However, it seems to be no accident that during the years when the child is incontinent the glans is completely clothed by the prepuce, for, deprived of this protection, the glans becomes susceptible to injury from contact with sodden clothes or napkin." During the physical act of sex, the foreskin reduces friction, which can reduce the need for additional sources of lubrication. "Some medical researchers, however, claim circumcised men enjoy sex just fine and that, in view of recent research on HIV transmission, the foreskin causes more trouble than it’s worth." In the March 2017 publication of the Global Health Journal: Science and Practice, Morris and Krieger wrote, "The variability in foreskin size is consistent with the foreskin being a vestigial structure."
The foreskin can be involved in balanitis, phimosis, sexually transmitted infection and penile cancer. The American Academy of Pediatricians' 2012 technical report on circumcision found that the foreskin tends to harbor micro-organisms that can lead to urinary tract infections in infants and tend to contribute to the transmission of sexually transmitted infections in adults.
Phimosis is a condition where the foreskin of an adult cannot be retracted properly. Phimosis can be treated by using topical steroid ointments and using lubricants during sex; for severe cases circumcision may be necessary. Posthitis is an inflammation of the foreskin.
A condition called paraphimosis may occur if a tight foreskin becomes trapped behind the glans and swells as a restrictive ring. This can cut off the blood supply, resulting in ischemia of the glans penis.
Lichen sclerosus is a chronic, inflammatory skin condition that most commonly occurs in adult women, although it may also be seen in men and children. Topical clobetasol propionate and mometasone furoate were proven effective in treating genital lichen sclerosus.
Some birth defects of the foreskin can occur; all of them are rare. In aposthia there is no foreskin at birth,: 37–39 in micropathia the foreskin does not cover the glans,: 41–45 and in macroposthia, also called and congenital megaprepuce, the foreskin extends well past the end of the glans.: 47–50
It has been found that larger foreskins place uncircumcised men at an increased risk for HIV infection most likely due to the larger surface area of inner foreskin and the high concentration of Langerhans cells.
Society and culture
Preputioplasty is the most common foreskin reconstruction technique, most often done when a boy is born with a foreskin that is too small;: 177 a similar procedure is performed to relieve a tight foreskin without resorting to circumcision.: 181
Circumcision is the removal of the foreskin, either partially or completely. For newborns, it may be done for religious requirements or personal preferences surrounding hygiene and aesthetics.: 257 Circumcision may also be performed on children or adults to treat phimosis, balanitis, or to prevent transmission of sexually transmitted infections.: 166 The ethics of circumcision in children is a source of controversy. As of 2012, no successful technique to reconstruct a circumcised foreskin had been published.: 181 Some men have used weights to stretch the skin of the penis to regrow a foreskin; the resulting tissue does cover the glans but does not replicate the features of a foreskin.
Foreskins obtained from circumcision procedures are frequently used by biochemical and micro-anatomical researchers to study the structure and proteins of human skin. In particular, foreskins obtained from newborns have been found to be useful in the manufacturing of more human skin.
In ancient Greece, foreskins were valued, especially prepuces that were longer in length. The earliest known illustrative depiction of the foreskin dates back to Egyptian kingdoms. The foreskin can be seen depicted in art from different ages.
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The Paediatrics and Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of infants and boys to assist parents who are considering having this procedure undertaken on their male children and for doctors who are asked to advise on or undertake it. After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups.…In recent years there has been evidence of possible health benefits from routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.…The complication rate of neonatal circumcision is reported to be around 1% and includes tenderness, bleeding and unhappy results to the appearance of the penis. Serious complications such as bleeding, septicaemia and may occasionally cause death (1 in 550,000). The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law. If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarizing the evidence should be widely available to parents. Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.
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|Wikimedia Commons has media related to Foreskin.|
- Foreskin.org – Many detailed pictures of the human male foreskin
- Infant foreskin care at Kidshealth.org.nz
- "Care for an Uncircumcised Penis". Healthy Children. American Academy of Pediatrics. 19 June 2017. Retrieved 9 September 2018.
- Management of foreskin conditions – Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists (2007).