Difference between revisions of "Frenulum"

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{{GraphicWarning}}
 
[[File:Frenulum_IntactWiki.jpg|200px|thumb|right|Pictured: Frenulum in the human penis.]]
 
[[File:Frenulum_IntactWiki.jpg|200px|thumb|right|Pictured: Frenulum in the human penis.]]
  
−
A '''frenulum''' (or '''frenum''', plural: '''frenula''' or '''frena''', from the Latin ''frēnulum'', meaning "little bridle") is a small fold of tissue that binds movable structures to non-movable structures in the body. In the human body, examples of frenula include the frenulum linguae, under the tongue, the frenulum labii superioris inside the upper lip, and the ''frenulum labii inferioris'' inside the lower lip. The word ''frenulum'' on its own is often used for the frenulum in the human penis, which is an elastic band of tissue under the [[glans penis]] that connects to the [[foreskin]] to the vernal mucosa, and helps contract the prepuce over the glans. This is sometimes colloquially known as the "banjo string".
+
A '''frenulum''' (or '''frenum''', plural: '''frenula''' or '''frena''', from the Latin ''frēnulum'', meaning "little bridle") is a small fold of tissue that binds movable structures to non-movable structures in the body. In the human body, examples of frenula include the frenulum linguae, under the tongue, the frenulum labii superioris inside the upper lip, and the ''frenulum labii inferioris'' inside the lower lip. The word ''frenulum'' on its own is often used for the frenulum in the human [[penis]], which is an elastic band of tissue under the [[glans penis]] that connects to the [[foreskin]] to the vernal [[mucosa]], and helps contract the prepuce over the glans. This is sometimes colloquially known as the "banjo string".
  
 
The [[frenular artery]] passes though the frenulum.<ref name="damege1">{{REFweb
 
The [[frenular artery]] passes though the frenulum.<ref name="damege1">{{REFweb
Line 21: Line 22:
 
==Sensation and stimulation==
 
==Sensation and stimulation==
  
−
The frenulum and the associated tissue delta on the underside of the [[penis]] below the corona has been described in sexuality textbooks as "very reactive" and "particularly responsive to touch that is light and soft."  The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.”<ref name="hass1993">{{REFbook
+
The frenulum and the associated tissue delta on the underside of the [[penis]] below the [[corona]] has been described in sexuality textbooks as "very reactive" and "particularly responsive to touch that is light and soft."  The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.”<ref name="hass1993">{{REFbook
 
  |last=Hass
 
  |last=Hass
 
  |first=K.
 
  |first=K.
 +
|init=K
 
  |last2=Hass
 
  |last2=Hass
 
  |first2=A.  
 
  |first2=A.  
 +
|init2=A
 
  |year=1993
 
  |year=1993
 
  |title=Understanding Sexuality
 
  |title=Understanding Sexuality
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  |last=Crooks
 
  |last=Crooks
 
  |first=R.
 
  |first=R.
 +
|init=R
 
  |last2=Baur
 
  |last2=Baur
 
  |first2=K.  
 
  |first2=K.  
 +
|init2=K
 
  |year=1993
 
  |year=1993
 
  |title=Our Sexuality
 
  |title=Our Sexuality
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  |accessdate=
 
  |accessdate=
 
  |note=
 
  |note=
−
}}</ref> Repeated stimulation of this structure will cause orgasm and ejaculation in some men. In men with spinal cord injury preventing sensations from reaching the brain, for example, the frenulum just below the glans can be stimulated to produce orgasm and peri-ejaculatory response.<ref>{{REFweb
+
}}</ref> Repeated stimulation of this structure will cause orgasm and ejaculation in some men. In men with spinal cord injury preventing sensations from reaching the brain, for example, the frenulum just below the [[glans]] can be stimulated to produce orgasm and peri-ejaculatory response.<ref>{{REFweb
 
  | quote=
 
  | quote=
 
  | url=http://www.emedicine.com/orthoped/topic425.htm
 
  | url=http://www.emedicine.com/orthoped/topic425.htm
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}}</ref><ref>{{REFjournal
 
}}</ref><ref>{{REFjournal
 
  |last=Pryor  
 
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  |last2=Leroy
 
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  |pages=59-64
 
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  |url=
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  |url=https://www.archives-pmr.org/article/S0003-9993(95)80044-1/pdf
 
  |quote=
 
  |quote=
 
  |pubmedID=7811177
 
  |pubmedID=7811177
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  |DOI=10.1016/S0003-9993(95)80044-1
 
  |DOI=10.1016/S0003-9993(95)80044-1
 
  |date=1995
 
  |date=1995
−
  |accessdate=
+
  |accessdate=2021-03-11
 +
}}</ref> <ref name="taylor2003">{{REFjournal
 +
|last=Taylor
 +
|first=John R.
 +
|init=
 +
|author-link=John R. Taylor
 +
|etal=no
 +
|title=Evidence sketchy on circumcision and cervical cancer link
 +
|trans-title=
 +
|language=
 +
|journal=Can Fam Physician
 +
|location=
 +
|date=2003-12
 +
|volume=49
 +
|issue=
 +
|article=
 +
|page=1592
 +
|pages=
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|url=http://www.cirp.org/library/sex_function/taylor3/
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|archived=
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|quote=
 +
|pubmedID=14708921
 +
|pubmedCID=2214164
 +
|DOI=
 +
|accessdate=2021-03-11}}
 +
</ref>
 +
 
 +
Cepeda-Emiliani et al (2023) state:
 +
<blockquote>
 +
One circumcision technique [91] has been proposed to protect
 +
as much tissue as possible ventrally due to the sexual functions
 +
attributed to this region. Concerningly and antithetically to the
 +
former technique, the frenular area has been intentionally
 +
targeted during [[adult circumcision]] by some urologists in
 +
the belief that its total and permanent denervation using
 +
monopolar current might be a definitive treatment for lifelong
 +
premature ejaculation. These urologists concluded that
 +
their circumcision technique resulted in “a consistent reduction
 +
in penile sensitivity” and “is a strong weapon in the hands of
 +
urological surgeons, which must be used very carefully, as its
 +
effects on male sexuality can be devastating and irreversible
 +
if performed in the wrong patient. Thus, the caveat must be
 +
right circumcision in the right patient using the correct
 +
surgical technique’”. To the extent that
 +
this type of circumcision may impair sexual function by
 +
denervating a neurologically permissive substrate through which
 +
sexual sensation enters the central nervous system, we agree
 +
with Jannini [93] that denervation of the frenular region is a
 +
potentially dangerous intervention.<ref name="cepeda2023">{{REFjournal
 +
|last=Cepeda-Emiliani
 +
|first=
 +
|init=A
 +
|author-link=Alfonso Cepeda-Emiliani
 +
|last2=Gándara-Cortés
 +
|first2=
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|init2=M
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|author2-link=
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|last3=Otero-Alén
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|first3=
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|init3=M
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|author3-link=
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|last4=García
 +
|first4=
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|init4=H
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|author4-link=
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|last5=Suárez-Quintanilla
 +
|first5=
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|init5=J
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|author5-link=
 +
|last6=García-Caballero
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|first6=
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|init6=T
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|author6-link=
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|last7=Gallego
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|first7=
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|init7=R
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|author7-link=
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|last8=García-Caballero
 +
|first8=
 +
|init8=R
 +
|author8-link=
 +
|etal=no
 +
|title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis
 +
|trans-title=
 +
|language=
 +
|journal= Int J Impot Res
 +
|location=
 +
|date=2023-05-02
 +
|volume=35
 +
|issue=3
 +
|article=
 +
|page=
 +
|pages=286-305
 +
|url=https://www.nature.com/articles/s41443-022-00561-9
 +
|archived=
 +
|quote=
 +
|pubmedID=35501394
 +
|pubmedCID=
 +
|DOI=10.1038/s41443-022-00561-9
 +
|accessdate=2023-11-21
 
}}</ref>
 
}}</ref>
 +
</blockquote>
  
 
==Pathology==
 
==Pathology==
−
[[Frenulum breve]] is a condition in which the frenulum is short and restricts the movement of the [[foreskin]], which may or may not interfere with normal sexual activity. Frenulum breve may be treated by manually [[tissue expansion| expanding]] the shaft skin by stretching. The condition may also be treated by [[frenuloplasty]], or [[frenectomy]]. Frenulum breve may contribute to frenular chordee, where the glans is pulled toward the vernal body of the penis.  
+
[[Frenulum breve]] is a condition in which the frenulum is short and restricts the movement of the [[foreskin]], which may or may not interfere with normal sexual activity. Frenulum breve may be treated by manually [[tissue expansion| expanding]] the [[shaft skin]] by [[stretching]]. The condition may also be treated by [[frenuloplasty]], or [[frenectomy]]. Frenulum breve may contribute to frenular chordee, where the glans is pulled toward the vernal body of the penis.  
  
 
The frenulum may be entirely missing in cases of first degree [[hypospadias]].
 
The frenulum may be entirely missing in cases of first degree [[hypospadias]].
  
−
It is possible for the frenulum to tear during sexual activities. The [[frenular artery]], a branch of the dorsal artery, may be severed, causing significant bleeding.
+
It is possible for the frenulum to tear during sexual activities. The [[frenular artery]], a branch of the dorsal artery, may be severed, causing significant [[bleeding]].
  
−
In the event of [[frenulum breve]] or frenular chordee, or to ensure that the glans can be freely and completely exposed, the frenulum may be partially or totally removed. It is also often removed in a [[circumcision]].<ref name="Griffin-Kroovand1990">{{REFjournal
+
In the event of [[frenulum breve]] or frenular chordee, or to ensure that the [[glans]] can be freely and completely exposed, the frenulum may be partially or totally removed. It is also often removed in a [[circumcision]].<ref name="Griffin-Kroovand1990">{{REFjournal
 
  |last=Griffin
 
  |last=Griffin
−
  |first=A.S.
+
  |init=AS
 
  |last2=Kroovand
 
  |last2=Kroovand
−
  |first2=R.L.
+
  |init2=RL
 
  |title=Frenular chordee: implications and treatment
 
  |title=Frenular chordee: implications and treatment
 
  |journal=Urology
 
  |journal=Urology
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  |last=Preiser
 
  |last=Preiser
 
  |first=Gary
 
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 +
|init=G
 
  |last2=Herschel
 
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−
  |first2=M.
+
  |init2=M
 
  |last3=Bartman,
 
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−
  |last5=Andersson
+
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−
  |first5=C.
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  |init4=C
−
  |last6=Bailis
+
  |last5=Bailis
−
  |first6=S.A.
+
  |init5=SA
−
  |last7=Shechet
+
  |last6=Shechet
−
  |first7=R.J.
+
  |init6=RJ
−
  |last8=Tanenbaum
+
  |last7=Tanenbaum
−
  |first8=B.
+
  |init7=B
−
  |last9=Kunin
+
  |last8=Kunin
−
  |first9=S.A.
+
  |init8=SA
−
  |last10=Hodges
+
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−
  |first10=F.M.
+
  |init9=FM
−
  |last11=Fleiss
+
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  |first11=P.M.
+
  |init10=PM
−
  |last12=Antonopoulos
+
  |last11=Antonopoulos
−
  |first12=J.
+
  |init11=J
−
  |last13=Rockney
+
  |last12=Rockney
−
  |first13=R.
+
  |init12=R
−
  |last14=Taylor
+
  |last13=Taylor
−
  |first14=A.
+
  |init13=A
−
  |last15=Stang
+
  |last14=Stang
−
  |first15=H.
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  |init14=H
−
  |last16=Snellman
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  |last15=Snellman
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  |first16=L.
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  |init15=L
−
  |last17=Fontaine
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  |last16=Fontaine
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  |init16=P
−
  |last18=Condon
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−
  |first18=L.M.
+
  |init17=LM
−
  |last19=Lannon
+
  |last18=Lannon
−
  |first19=C.M.
+
  |init18=CM
 
  |etal=yes
 
  |etal=yes
 
  |title=Circumcision - The Debates Goes On
 
  |title=Circumcision - The Debates Goes On
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  |DOI=10.1542/peds.105.3.681
 
  |DOI=10.1542/peds.105.3.681
 
  |accessdate=
 
  |accessdate=
−
}}</ref><ref>{{REFweb
+
}}</ref> It has been noted that the wound where the frenulum was amputated is usually slower to heal than the wound where the [[foreskin]] was amputated.
−
|url=http://med.stanford.edu/newborns/professional-education/circumcision.html
 
−
|title=Neonatal Circumcision: An Audiovisual Primer
 
−
|last=
 
−
|first=
 
−
|publisher=Stanford School of Medicine
 
−
|website=
 
−
|date=
 
−
|accessdate=2019-10-01
 
−
|format=
 
−
|quote=
 
−
}}</ref> It has been noted that the wound where the frenulum was amputated is usually slower to heal than the wound where the foreskin was amputated.
 
  
−
Song ''et al''. (2015) report that the frenulum may need to be lengthened after a circumcision amputates skin tissue from the penis.<ref>{{REFjournal
+
Song et al. (2015) report that the frenulum may need to be lengthened after a [[circumcision]] amputates [[skin]] tissue from the [[penis]].<ref>{{REFjournal
 
  |last=Song
 
  |last=Song
−
  |first=B.
+
  |init=B
 
  |last2=Hou
 
  |last2=Hou
−
  |first2=Z.H.
+
  |init2=ZH
 
  |last3=Liu
 
  |last3=Liu
−
  |first3=Q.L.
+
  |init3=QL
 
  |last4=Qian
 
  |last4=Qian
−
  |first4=W.P.
+
  |init4=WP
 
  |title=[Penile frenulum lengthening for premature ejaculation]
 
  |title=[Penile frenulum lengthening for premature ejaculation]
 
  |journal=Zhonghua Nan Ke Xue  
 
  |journal=Zhonghua Nan Ke Xue  
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The frenulum may be missing in some males for a few reasons.  
 
The frenulum may be missing in some males for a few reasons.  
  
−
Rarely, boys are born without a frenulum. This condition causes no issues and permits unusually full retraction of the foreskin.
+
Rarely, boys are born with a foreskin but without a frenulum. This condition causes no issues and permits unusually complete retraction of the [[foreskin]].
  
−
It may be missing in men who were circumcised at birth, as it is often crushed and cut away, or broken during infant circumcision. Men who are circumcised as adults may specify whether or not they wish to preserve their frenulum. The frenulum was reported to be cut in 26.7%, 20%, and 33.33% of circumcised patients in various surveys.<ref name="Griffin-Kroovand1990"/><ref name="Gary2000"/>
+
It may be missing in men who were [[circumcised]] at birth, as it is often crushed and cut away, or broken during infant [[circumcision]]. Men who are circumcised as adults may specify whether or not they wish to preserve their frenulum. The frenulum was reported to be cut in 26.7%, 20%, and 33.33% of [[circumcised]] patients in various surveys.<ref name="Griffin-Kroovand1990"/><ref name="Gary2000"/>
  
−
Some men choose to have the frenulum removed as a form treatment for [[frenulum breve]], a condition in which the frenulum of the penis is short and restricts the movement of the prepuce, which may or may not interfere with normal sexual activity. Yet, others may choose to have the frenulum removed purely out of cosmetic reasons.
+
Some men choose to have the frenulum removed as a form of treatment for [[frenulum breve]], a condition in which the frenulum of the penis is short and restricts the movement of the prepuce, which may or may not interfere with normal sexual activity. Yet, others may choose to have the frenulum removed purely out of cosmetic reasons.
  
 
[[File:Frenulum_comparison.jpg]]
 
[[File:Frenulum_comparison.jpg]]
  
−
Comparison of an intact frenulum vs. the frenulum remnant on a circumcised penis. Image used with permission of artist.
+
Comparison of an [[intact]] frenulum vs. the frenulum remnant on a [[circumcised]] [[penis]]. Image used with permission of artist.
  
 
{{SEEALSO}}
 
{{SEEALSO}}
 
* [[Circumcision]]
 
* [[Circumcision]]
 
* [[Foreskin]]
 
* [[Foreskin]]
 +
* [[Frenulum breve]]
 +
* [[Frenuloplasty]]
 +
* [[Phimosis]]
 
* [[Ridged band]]
 
* [[Ridged band]]
−
 
  
 
{{LINKS}}
 
{{LINKS}}
−
 
 
* {{REFbook
 
* {{REFbook
−
  |last=Ken
+
  |last=McGrath
−
  |first=McGrath
+
|first=Ken
 +
  |init=K
 
  |author-link=Ken McGrath
 
  |author-link=Ken McGrath
 
  |year=2001
 
  |year=2001
Line 229: Line 326:
 
  |url=http://www.cirp.org/library/anatomy/mcgrath1/
 
  |url=http://www.cirp.org/library/anatomy/mcgrath1/
 
  |work=
 
  |work=
−
  |editor=Denniston GC, Hodges FM, Milos MF
+
  |editors=Denniston GC, Hodges FM, Milos MF
 
  |edition=
 
  |edition=
 
  |volume=
 
  |volume=
Line 241: Line 338:
 
  |note=
 
  |note=
 
}}
 
}}
−
 
 
{{REF}}
 
{{REF}}
  
 
[[Category:Physiology]]
 
[[Category:Physiology]]
 
[[Category:Foreskin anatomy]]
 
[[Category:Foreskin anatomy]]
 +
[[Category:Penile anatomy]]
 +
 
[[Category:From Intactipedia]]
 
[[Category:From Intactipedia]]
 
[[Category:From IntactWiki]]
 
[[Category:From IntactWiki]]

Latest revision as of 14:24, 19 August 2024

IntactiWikiGraphicWarning.png

Pictured: Frenulum in the human penis.

A frenulum (or frenum, plural: frenula or frena, from the Latin frēnulum, meaning "little bridle") is a small fold of tissue that binds movable structures to non-movable structures in the body. In the human body, examples of frenula include the frenulum linguae, under the tongue, the frenulum labii superioris inside the upper lip, and the frenulum labii inferioris inside the lower lip. The word frenulum on its own is often used for the frenulum in the human penis, which is an elastic band of tissue under the glans penis that connects to the foreskin to the vernal mucosa, and helps contract the prepuce over the glans. This is sometimes colloquially known as the "banjo string".

The frenular artery passes though the frenulum.[1]

Sensation and stimulation

The frenulum and the associated tissue delta on the underside of the penis below the corona has been described in sexuality textbooks as "very reactive" and "particularly responsive to touch that is light and soft." The “underside of the shaft of the penis, meaning the body below the corona” is a “source of distinct pleasure.”[2] Crooks & Baur (1993) observe that two extremely sensitive specific locations that many men find particularly responsive to stimulation are the corona, and the frenulum.[3] Repeated stimulation of this structure will cause orgasm and ejaculation in some men. In men with spinal cord injury preventing sensations from reaching the brain, for example, the frenulum just below the glans can be stimulated to produce orgasm and peri-ejaculatory response.[4][5] [6]

Cepeda-Emiliani et al (2023) state:

One circumcision technique [91] has been proposed to protect as much tissue as possible ventrally due to the sexual functions attributed to this region. Concerningly and antithetically to the former technique, the frenular area has been intentionally targeted during adult circumcision by some urologists in the belief that its total and permanent denervation using monopolar current might be a definitive treatment for lifelong premature ejaculation. These urologists concluded that their circumcision technique resulted in “a consistent reduction in penile sensitivity” and “is a strong weapon in the hands of urological surgeons, which must be used very carefully, as its effects on male sexuality can be devastating and irreversible if performed in the wrong patient. Thus, the caveat must be right circumcision in the right patient using the correct surgical technique’”. To the extent that this type of circumcision may impair sexual function by denervating a neurologically permissive substrate through which sexual sensation enters the central nervous system, we agree with Jannini [93] that denervation of the frenular region is a potentially dangerous intervention.[7]

Pathology

Frenulum breve is a condition in which the frenulum is short and restricts the movement of the foreskin, which may or may not interfere with normal sexual activity. Frenulum breve may be treated by manually expanding the shaft skin by stretching. The condition may also be treated by frenuloplasty, or frenectomy. Frenulum breve may contribute to frenular chordee, where the glans is pulled toward the vernal body of the penis.

The frenulum may be entirely missing in cases of first degree hypospadias.

It is possible for the frenulum to tear during sexual activities. The frenular artery, a branch of the dorsal artery, may be severed, causing significant bleeding.

In the event of frenulum breve or frenular chordee, or to ensure that the glans can be freely and completely exposed, the frenulum may be partially or totally removed. It is also often removed in a circumcision.[8][9] It has been noted that the wound where the frenulum was amputated is usually slower to heal than the wound where the foreskin was amputated.

Song et al. (2015) report that the frenulum may need to be lengthened after a circumcision amputates skin tissue from the penis.[10]

Lack of a frenulum

The frenulum may be missing in some males for a few reasons.

Rarely, boys are born with a foreskin but without a frenulum. This condition causes no issues and permits unusually complete retraction of the foreskin.

It may be missing in men who were circumcised at birth, as it is often crushed and cut away, or broken during infant circumcision. Men who are circumcised as adults may specify whether or not they wish to preserve their frenulum. The frenulum was reported to be cut in 26.7%, 20%, and 33.33% of circumcised patients in various surveys.[8][9]

Some men choose to have the frenulum removed as a form of treatment for frenulum breve, a condition in which the frenulum of the penis is short and restricts the movement of the prepuce, which may or may not interfere with normal sexual activity. Yet, others may choose to have the frenulum removed purely out of cosmetic reasons.

Frenulum comparison.jpg

Comparison of an intact frenulum vs. the frenulum remnant on a circumcised penis. Image used with permission of artist.

See also

External links

References

  1. ↑ REFweb Frenulum, The damage from circumcision. Retrieved 17 December 2019.
  2. ↑ REFbook Hass K, Hass A (1993): Understanding Sexuality. St Louis: Mosby. Pp. 99–100.
  3. ↑ REFbook Crooks R, Baur K (1993): Our Sexuality. Edition: 5. Redwood City: Benjamin/Cummings. P. 129. ISBN 0534595677.
  4. ↑ REFweb Saulino, Michael F. (2006). Rehabilitation of Persons With Spinal Cord Injuries, WebMD.
  5. ↑ REFjournal Pryor JL, Leroy, Nagel, Hensleigh. Vibratory stimulation for treatment of anejaculation in quadriplegic men. Archives of physical medicine and rehabilitation. 1995; 76(1): 59-64. PMID. DOI. Retrieved 11 March 2021.
  6. ↑ REFjournal Taylor, John R.. Evidence sketchy on circumcision and cervical cancer link. Can Fam Physician. December 2003; 49: 1592. PMID. PMC. Retrieved 11 March 2021.
  7. ↑ REFjournal Cepeda-Emiliani A, Gándara-Cortés M, Otero-Alén M, García H, Suárez-Quintanilla J, García-Caballero T, Gallego R, García-Caballero R. Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis. Int J Impot Res. 2 May 2023; 35(3): 286-305. PMID. DOI. Retrieved 21 November 2023.
  8. ↑ a b REFjournal Griffin AS, Kroovand RL. Frenular chordee: implications and treatment. Urology. 1990; 35(2): 133-134. PMID. DOI. Retrieved 1 October 2019.
  9. ↑ a b REFjournal Preiser G, Herschel M, Bartman, T, Andersson C, Bailis SA, Shechet RJ, Tanenbaum B, Kunin SA, Hodges FM, et al. Circumcision - The Debates Goes On. Pediatrics. 2000; 105(3 Pt 1): 681-684. PMID. DOI.
  10. ↑ REFjournal Song B, Hou ZH, Liu QL, Qian WP. [Penile frenulum lengthening for premature ejaculation]. Zhonghua Nan Ke Xue. 1 January 2015; 21(2): 149-152. PMID. Retrieved 1 October 2019.
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