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While the outer foreskin layer is an extension of the penile shaft skin, the inner foreskin layer, which lies flat against the glans, is a mucous membrane. The inner layer is an extraordinarily complex tissue. It contains apocrine glands which produce Cathepsin B, lysozymes, chymotrypsin, neutrophil elastase, cytokines and pheromones such as androsterone. Indian scientists have shown that the subpreputial moisture contains lytic material which has an antibacterial and antiviral effect. The natural oils lubricate, moisten and protect the mucous membranes of both the glans and the inner foreskin layer. The tip of the foreskin is supplied with ample amounts of blood through important blood vessels.<ref>Dr.med Wolfram Hartmann, Stellungnahme zur Anhörung am 26. November 2012 im Rechtsausschuss des Bundestages</ref>===Sensory functions===
The two foreskin layers provide Lakshamanan & Prakash (1980) report the "prepuce covers the [[glans]] completely and snugly like a skin reservehosiered material and continues to do so through the entire span of life of the male", into which they explain as being caused by the growing shaft expands during an erectionsmooth muscle fibers within the prepuce. Depending The prepuce is free to the individual length of a man's foreskin[[gliding action| glide back and forth]]. When it does, it thereby retracts more or less far. In some men, the foreskin still fully covers must stretch to go over the glans during an erection, in others the glans is partly or completely exposedpenis.<ref name="lakshmanan-prakash1980" />
In addition, Taylor et al. (1996) carried out a histological study of the foreskin, in combination with . (Histology is the shaft skin, allows a natural gliding actionmicroscopic examination of cells and tissues.) Taylor et al. During intercourse as well as masturbation found an area of rete ridges just inside the outer skin is in contact with tip of the vagina or foreskin that he called the hand respectively[[ridged band]]. The penile shaft moves mostly within its skin and the skin only moves ridges were found to have nerve endings at the end top of its thrustthe ridges. Due They report that the ridged band area moves to this, the friction with shaft of the vagina or hand is reducedpenis when the penis becomes erect where the nerves are subject to stimulation. They stated:<blockquote>The sexual stimulation mostly occurs through the stretching prepuce provides a large and important platform for several nerves and movement nerve endings. The innervation of the foreskin, when it is pulled over the glans and back, as well as the direct stimulation outer skin of the inner foreskin when it prepuce is exposed impressive; its sensitivity to light touch and comes into direct contact with pain are similar to that of the vagina or skin of the handpenis as a whole.<ref name="taylor1996" /></blockquote>
== Medical indications Sorrells et al. (2007) conducted a fine-touch study of the penis of both circumcised and therapies ==intact men. Sorrells et al. concluded:<blockquote>In conclusion, circumcision removes the most sensitive parts of the penis and decreases the fine-touch pressure sensitivity of glans penis. The most sensitive regions in the [[uncircumcised]] penis are those parts ablated by circumcision. When compared to the most sensitive area of the circumcised penis, several locations on the [[uncircumcised]] penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.<ref>{{Sorrells etal 2007}}</ref> </blockquote>
There is Bronselaer et al. (2013) surveyed a large group of typical conditions of [[intact]] and [[circumcised]] men in Belgium. They reported:<blockquote>Of the men in Group A [intact males], 90.6% rated the sexual pleasure provided when the foreskin, that can occur in more was stimulated by themselves or less distinct waystheir partners from ‘mild’ to ‘very strong’ and 61.9% the respective orgasm from ‘mild’ to ‘very strong’.
If García-Mesa et al. (2021) reported the frenulum is too short, it can hinder or even prohibit retraction foreskin has an abundance of [[Meissner's corpuscles]] which provide pleasant sexual sensation when mechanically stimulated by motion of the foreskin. Since <ref name="garcía-mesa2021">{{REFjournal |last=García-Mesa |first=Yolanda |init= |author-link= |last2=García-Piqueras |first2=Jorge |init2= |author2-link= |last3=Cobo |first3=Ramón |init3= |author3-link= |last4=Martín-Cruces |first4=José |init4= |author4-link= |last5=Suazo |first5=Iván |init5= |author5-link= |last6=García-Suárez |first6=Olivia |init6= |author6-link= |last7=Feito |first7=Jorge |init7= |author7-link= |last8= |first8=Vega |init8=José A. |author8-link= |etal=no |title=Sensory innervation of the underside human male prepuce: Meissner's corpuscles predominate |trans-title= |language= |journal=Journal of the glans is attached to the inner foreskin by the frenulum, it can be bent downwards due to the resulting tension when the foreskin is retractedAnatomy |location= |date=2021-10 |volume=239 |issue=4 |article= |page= |pages=892-902 |url=https://onlinelibrary.wiley.com/doi/full/10. If the mechanical strain is too great, the frenulum can tear or rip apart1111/joa. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged bleeding13481 |pubmedID=34120333 |pubmedCID=8450466 |DOI=10. When only small tears appear, it may heal spontaneously1111/joa.13481 |accessdate=2021-11-15}}</ref>
To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.== Sexual behavior ==
There Laumann et al. (1997) reported that men who lack a foreskin "engage in a somewhat more elaborated set of sexual practices than do men who are 3 surgical variantsnot [[circumcised]]. For each of the practices examined, lifetime experience of various forms of oral and anal sex and [[masturbation]] frequency in the past year, [[circumcised]] men engaged in these behaviors at greater rates. The difference between [[circumcised]] men was greatest for [[masturbation]] — ironically, a practice that [[circumcision]] was once thought to limit. A total of 47% of circumcised men reported masturbating at least once a month vs 34% for their [[uncircumcised]] peers."<ref name="laumann1997>{{REFjournal |last=Laumann |init=EO |author-link= |last2=Masi |init2=CM |author2-link= |last3=Zuckerman |init3=CW |author3-link= |etal=no |title=Circumcision in the United States |journal=JAMA |location= |date=1997-04-02 |volume=277 |issue=13 |pages=1052-7 |url=http://www.cirp.org/library/general/laumann/ |quote= |pubmedID=9091693 |pubmedCID= |DOI= |accessdate=2019-10-23}}</ref>Dave et al. (2003) reported that men without foreskins "were more likely to report having had homosexual partner(s) (7.5% v 5.3%, p =0.012) and partners from abroad (19.7% v 13.1%, p...0.001)."<ref name="dave2003">{{REFjournal |last=Dave |init=SS |author-link= |last2=Johnson |init2=AM |author2-link= |last3=Fenton |init3=KA |author3-link= |last4=Mercer |init4=CH |author4-link= |last5=Erens |init5=B |author5-link= |last6=Wellings |init6=K |author6-link= |etal=no |title=Male circumcision in Britain: findings from a national probability sample survey |journal=Sex Trans Infect |location= |date=2003-12 |volume=79 |issue= |pages=499-500 |url=http://dewww.wikipediacirp.org/wikilibrary/general/dave1/ |quote= |pubmedID=14663134 |pubmedCID=1744763 |DOI=10.1136/Frenulum_brevesti.79.6.499 |accessdate=2019-10-29}}</ref>
* FrenectomyCold & Taylor (1999) commented, "The increased frequency of [[masturbation]], anal intercourse and fellatio reported by [[circumcised]] men in the complete removal [[United States of America| USA]] may possibly be due to the frenulum* Frenuloplastysensory imbalance caused by [[circumcision]]. Clearly, where [[amputation]] of the frenulum is cut horizontally, prepuce causes changes in sexual behaviour in human males and sewed together vertically* Elongation of the frenulum with a skin graftfemales."<ref name="cold-taylor1999" />
Physiological phimosis can be divided into three main categories - symptom-free, in need ==The role of therapy, and the foreskin in need of surgery.heterosexual relations==
From a medical standpoint, an otherwise symptom-free The knowledge of the important of the [[phimosisintact]], even after dissolution [[penis]] in heterosexual relations long has been known to the Jews who give us our earliest evidence of preputial adhesions, does not require any treatment before the child enters puberty. The widespread notion that full retractability has value of the [[foreskin]] to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that pointthe female partner.
Even though Moses Maimonides, a Jewish rabbi and physician, stated in the data from Jakob Øster's studies (see above) have been known 12th century:{{Citation |Text=It is hard for 45 years, some check lists for school doctors‘ examinations still erroneously refer a woman with whom an [[uncircumcised]] man has had sexual intercourse to physiological phimosis as an abnormalityseparate from him. |Author=[[Moses Maimonides]] |ref=<ref>{{REFbook |last=Maimonides |first=Moses |init=M |author-link=Moses Maimonides |year=1963 |title=The Guide of the Perplexed |url=http://www.cirp.org/library/cultural/maimonides/ |page=609 |isbn= |accessdate=2019-10-11}}</ref>}}
If, Solinis & Yiannaki (2007) concluded; "[t]here was a decrease in couple’s sexual life after circumcision indicating that, the foreskin still remains too tight, resulting [[Adolescent_and_adult_circumcision|adult circumcision]] adversely affects sexual function in pain during sexual activities, many men or/andmaking genital hygiene difficulttheir partners, treatment is indicated. The boy himself should engage instretching exercises, if needed with the aid possibly because of complications of corticosteroid cream. Depending on the activesubstances, success rates surgery and loss of 80-90% have been documentednerve endings."<refname="solinis-yiannaki2005">Orsola A, Caffaratti J, Garat JM. Conservative treatment of [[phimosis]] in children using a topical steroid. ''Urology'' 2000;56(2):307{{REFjournal |last=Solinis |first= |author-link= |last2=Yiannaki |first2= |author2-10.</ref>link= |etal=no<ref>Ashfield JE, Nickel KR, Siemens DR, |title=Does circumcision improve couple''et al''. Treatment s sex life? |journal=Journal of [[phimosis]] with topical steroids in 194 children. Men''J Urol.'' 2003;169(s Health and Gender |location= |date=2007-09 |volume=4 |issue=3) |pages=361 |url=http:1106-8.</ref><ref>Pileggi Fde O, Vicente YA/www. Phimotic ring topical corticoid cream (0cirp.1% mometasone furoate) treatment in children. ''J Pediatr Surg''. 2007 Oct;42(10):1749-52.<org/library/sex_function/solinis2007/ref><ref>Ghysel C, Vander Eeckt K, Bogaert GA.Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and [[phimosis]] in prepubertal boys. ''Urol Int''. 2009;82(1):81-8.</ref> |quote= |pubmedID= |pubmedCID=<ref>Reddy S, Jain V, Dubey M, Deshpande P, Singal AK. Local steroid therapy as the first line treatment for boys |DOI=with symptomatic [[Phimosis |phimosis]] accessdate=2019-10- A long term prospective study. ''Acta Paediatr''. 2011 Nov 21. [Epub ahead of print]23}}</ref>
Should those therapies not yield the desired outcomesFrisch et al. (2011) surveyed a very large group of men and women in [[Denmark]]. They concluded:<blockquote>"Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, there is a surgical optionnotably orgasm difficulties, namely dyspareunia and a preputioplastysense of incomplete sexual needs fulfilment."<ref name="frisch lindholm groenbaek 2011"/></blockquote><!--''The following content is part of the [[Circumpendium]].'' == Anatomy and function of the foreskin in detail ==
====Preputioplasty====The foreskin covers the glans, thus protecting it from pollutants, friction, injury and drying out. It consists of two superimposed layers, which are only joined together at the very end. The [[ridged band]] is located just inside the tip of the foreskin.
This surgical method preserves While the outer foreskinlayer is an extension of the penile [[shaft skin]], the inner foreskin layer, which lies flat against the glans,<ref name="prakash1">{{REFjournal |last=Prakash |init=S |last2=Raghuram |init2=R |last3=Venkatesan |etal=yes |title=Sub-preputial wetness - Its nature |journal=Ann Nat Med Sci (India) |date=1982 |volume=18 |issue=3 |pages=109-12 |url=http://www.cirp.org/library/anatomy/prakash/ |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2019-10-14}}</ref> is a mucous membrane. The inner layer is an extraordinarily complex tissue. It contains apocrine glands which produce Cathepsin B, lysozymes, chymotrypsin, neutrophil elastase, cytokines and pheromones such as androsterone. A good cosmetic result <ref name="fleiss-hodges-vanhowe1998"/> Indian scientists have shown that the subpreputial moisture contains lytic material which has an antibacterial and total preservation antiviral effect.<ref name="lakshmanan-prakash1980"/> The natural oils lubricate, moisten and protect the mucous membranes of both the glans and the inner foreskin are achievedlayer. <ref name="prakash1"/> The basic principle tip of most the foreskin is supplied with ample amounts of those methods consists of making one or more small longitudinal incisionsblood through important blood vessels.<ref>Dr. med. Wolfram Hartmann, and then suturing the wound or wounds transverselyStellungnahme zur Anhörung am 26.November 2012 im Rechtsausschuss des Bundestages</ref>
There are several different methods:<ref>The [http://de[foreskin]] serves as a pathway for many significant veins.wikipediaIn addition the foreskin is saturated with very many nerve endings and tactile corpuscles, the same receptors that exist in the fingertips.org/wiki/Phimose#PrThe enormous density of nerves and mechanoreceptors make the foreskin the most sensitive part of the body, approximately 10 times more sensitive than the fingertips.C3This also distinguishes the human penis from those of other mammals, which in contrast have the main concentration of nerves in the [[glans]], and not in the foreskin.A4putiumsplastik| Phimose]</ref>
* Dorsal slit with transverse suturing: this technique places The two foreskin layers provide a single lengthwise cut skin reserve, into which the stenotic ring which is then closed transverselygrowing shaft expands during an [[erection]].* Lateral preputioplasty: this is a refinement of Depending to the dorsal slit with transverse suturing. It consists individual length of two lateral, longitudinal incisions sutured transversely.* Triple incision: this is a method of man's foreskin widening. It typically consists of three incisions across the tight ring, it thereby retracts more or less far. They are closed from side to sideIn some men, thereby increasing the circumference of the tight ring relative to the length of [[foreskin]] still fully covers the cuts. From glans during an aesthetic view[[erection]], it has results far superior to those of a dorsal slit, and usually yields a good cosmetic resultin others the [[glans]] is partly or completely exposed.
If after In addition, the foreskin, in combination with the [[shaft skin]], allows a failed attempt natural [[gliding action]]. During intercourse as well as [[masturbation]] the outer skin is in contact with the [[vagina]] or the hand respectively. The penile shaft moves mostly within its skin and the skin only moves at the end of its thrust. Due to stretch this, the foreskin friction with corticosteroid cream a surgical intervention the [[vagina]] or hand is necessaryreduced. The sexual stimulation mostly occurs through the [[stretching]] and movement of the [[foreskin], a preputioplasty when it is always to be preferred pulled over classic circumcisionthe glans and back, due to its lower morbidity, lower rate as well as the direct stimulation of complications the inner foreskin when it is exposed and lower costscomes into direct contact with the vagina or the hand. The [[frenulum]] may limit retraction.
=== Pathological Phimosis ===The foreskin in childhood is fused with the glans penis by a [[synechia]].-->
In pathological phimosis==Videos==<b>Why you need to pull back your foreskin.</b><youtube>v=PcxwW4KH3Wg</youtube><br>Pathologist [[Ken McGrath]], Senior Lecturer in Pathology at the foreskin cannot be retracted over Faculty of Health, [https://www.aut.ac.nz/ Auckland University of Technology] and Member of the glans without injuryNew Zealand Institute of Medical Laboratory Scientists, due to a lack of elasticity caused by scarring or hardening.discusses the neurological structures in the foreskin:
Repeated infections of the tight foreskin cause this scarring. Also, forceful attempts to retract the foreskin cause tearing with subsequential scarred [[phimosis]]. [[Lichen sclerosus]], that first leads to adhesion and then to shrinking, can also be the cause of [[phimosis]]. This rare, non-contagious chronic skin disease is partly genetically caused and considered incurable.<refyoutube>http://de.wikipedia.org/wiki/Lichen_sclerosus_et_atrophicusv=lmToXLVrZ7c</refyoutube>
Pathological phimosis usually requires treatmentDr. Willam Collins explains the nature of the prepuce.
A circumcision is indicated <youtube>v=tggap0Hy1l0</youtube><br><youtube>v=OfeK75HWW7k</youtube>{{SEEALSO}}* [[Acroposthion]]* [[Care of intact, foreskinned boys]]* [[Foreskin in severe cases Motion]]* [[Foreskin sensitivity]]* [[Frenulum]]* [[Gliding action]]* [[Immunological and protective function of pathological phimosis, where neither nonthe foreskin]]* [[Pre-surgical methods with corticosteroid cream nor ejaculate]]* [[Preputial sac]]* [[Retraction of the foreskin-preserving preputioplasty are promising ]]* [[Ridged band]]* [[The Foreskin and Why You Should Keep It (for example with chronic balanitis xerotica obliteransbook) or have failed in previous attempts.]]
[[Category:Genitals]]
[[Category:Penile anatomy]]
→Foreskin length: Revise text.
<div class='res-img'>[[File:Infographic Foreskin.jpg|Foreskin - Anatomy and function]]</div> The '''foreskin''' or '''prepuce''' is the double-layered fold of smooth muscle tissue, blood vessels, neurons, [[skin]], and [[mucosa| mucous membrane]] part of the [[penis]] that creates the [[preputial sac]], while covering and protecting the [[glans penis]] and the [[urinary meatus]]. The nature of the prepuce or foreskin, which is amputated and destroyed by circumcision, must be considered and fully understood in any discussion of male [[circumcision]].<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref> Purpura et al. (2018) described the foreskin as follows:<blockquote>Few parts of the human anatomy can compare to the incredibly multifaceted nature of the human foreskin. At times dismissed as “just [[skin]],” the adult foreskin is, in fact, a highly vascularized and densely innervated bilayer tissue, with a surface area of up to 90 cm, and potentially larger. On average, the foreskin accounts for 51% of the total length of the penile [[shaft skin]] and serves a multitude of functions. The tissue is highly dynamic and biomechanically functions like a roller bearing; during intercourse, the foreskin “unfolds” and glides as abrasive friction is reduced and lubricating fluids are retained. The sensitive foreskin is considered to be the primary erogenous zone of the male [[penis]] and is divided into four subsections: [[Preputial mucosa|inner mucosa]], [[ridged band]], [[frenulum]], and outer foreskin; each section contributes to a vast spectrum of sensory pleasure through the [[gliding action]] of the foreskin, which mechanically stretches and stimulates the densely packed corpuscular receptors. Specialized immunological properties should be noted by the presence of [[Langerhans cells]] and other lytic materials, which defend against common microbes, and there is robust evidence supporting [[HIV]] protection. The [[glans penis| glans]] and inner [[mucosa]] are physically protected against external irritation and contaminants while maintaining a healthy, moist surface. The foreskin is also immensely vascularized and acts as a conduit for essential blood vessels within the penis, such as supplying the [[glans]] via the frenular artery.<ref>{{REFjournal |last=Purpura |first=Valeria |init=V |author-link= |last2=Bondioli |first2=Elena |init2=E |author2-link= |last3=Cunningham |first3=Eric J. |init3=EC |author3-link= |etal=yes |title=The development of a decellularized extracellular matrix–based biomaterial scaffold derived from human foreskin for the purpose of foreskin reconstruction in circumcised males |journal=J Tissue Eng |location= |date=2018-12-22 |volume= |issue= |pages= |url=https://journals.sagepub.com/doi/full/10.1177/2041731418812613 |quote= |pubmedID=30622692 |pubmedCID=6304708 |DOI=10.1177/2041731418812613 |accessdate=2020-02-09}}</ref></blockquote> The medical community usually omits information on the nature and functions of the foreskin from information provided to the public and to parents. == Structure == ===Foreskin in infancy and childhood===Baby boys are born with the foreskin fused with the [[glans penis]] by the balanopreputial lamina, a [[synechia| synechial membrane]], which prevents retraction. In addition, the tip of the foreskin ([[acroposthion]]) is usually too narrow to allow [[retraction of the foreskin]]. The [[preputial sac]] is closed by the synechia and cannot be infected.<ref name="fleiss-hodges-vanhowe1998"/> Forcible attempts to retract the foreskin result in injury to the boy, so should be avoided. The first person to retract the foreskin should be the boy himself.<ref name="Wright1994">{{REFjournal |last=Wright |init=JE |title=Further to the "Further Fate of the Foreskin" |journal=Med J Aust |volume=160 |issue= |pages=134-135 |url=http://www.cirp.org/library/normal/wright2/ |quote= |pubmedID=8295581 |pubmedCID= |DOI= |date=1994-02-07 |accessdate=2020-05-16}}</ref> Thorvaldsen & Meyhoff (2005) conducted a survey of 4,000 boys in [[Denmark]]. They reported that the mean age of first foreskin retraction is 10.4 years in [[Denmark]].<ref name="Thorvaldsen-meyhoff2005">{{REFjournal |last=Thorvaldsen |init=MA |last2=Meyhoff |init2=H |title=Patologisk eller fysiologisk fimose? |trans-title=Pathological or physiological phimosis? |language=Danish |journal=Ugeskr Læger |volume=167 |issue=17 |pages=1858-1862 |url=http://www.cirp.org/library/normal/thorvaldsen1/ |quote= |pubmedID= |pubmedCID= |DOI= |date=2005 |accessdate=2019-11-14}}</ref> ===Foreskin in adolescence===The foreskin is in a transitional state during puberty and adolesence in which it is changing from the non-retractile foreskin of childhood to thh fully retractable foreskin of adulthood. Many adolescents complain of a non-retractable foreskin. Many need to do manual [[stretching]]. They usually achieve full retraction by age 16. ===Foreskin in adulthood=== The foreskin (also known as the ''prepuce'') is the layered fold of smooth muscle tissue, blood vessels, neurons, [[skin]], and [[Preputial mucosa|mucous membrane]] part of the [[penis]] that covers and protects the [[glans penis]] and the urinary meatus.<ref name="cold-taylor1999"/> There are four layers in the foreskin. The top layer is either epidermis in the outer foreskin or [[mucosa]], in the inner foreskin. The second layer is the lamina propria. The third layer is the [[dartos]]. The fourth layer is the dermis. It is normal for the foreskin to be darker in color than the rest of one's body after puberty. This condition is called hyperpigmentation. The adult foreskin measures about 3 inches by 5 inches or [[The Foreskin: 15 Square Inches of Erogenous Tissue| 15 square inches]].<ref name="taylor1996">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> The foreskin creates the [[preputial sac]]. The two foreskin layers provide a [[skin]] reserve. When the penis becomes erect, the foreskin may wholly or partially unfold to provide the necessary [[skin]] to allow for expansion of the penis during [[erection]]. The foreskin is the movable part of the [[penis]]. The foreskin is not attached to the underlying structure and is free to [[gliding action| glide back and forth]].<ref name="lakshmanan-prakash1980">{{REFjournal |last=Lakshmanan |init=S |author-link= |last2=Prakash |init2=S |title=Human prepuce: some aspects of structure and function |journal=Indian J Surg |date=1980 |volume=44 |issue= |pages=134-7 |url=http://www.cirp.org/library/anatomy/lakshmanan/ |quote= |accessdate=}}</ref> The [[gliding action]] reduces the friction of intercourse and helps to prevent abrasions, while conserving vaginal lubrication and moisture.<ref name="warren-bigelow1994">{{REFjournal |last=Warren |first=John |init=J |author-link=John Warren |last2=Bigelow |first2=Jim |init2=J |author2-link=Jim Bigelow |title=The case against circumcision |journal=Brit J Sex Med |date=1994-09 |url=http://www.cirp.org/library/general/warren2/ |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2019-10-28}}</ref> The foreskin is attached to the [[glans penis]] on the ventral side by the [[frenulum]], which usually limits [[Retraction of the foreskin| retraction]] to a widely variable degree. The [[ridged band]] emanates from the frenulum.<ref name="cold-taylor1999" /> The epithelium of the outer layer of the foreskin is true [[skin]] while the epithelium of the inner layer is [[Preputial mucosa|mucosal membrane]]. There is a mucocutaneous boundary at the tip of the foreskin. The mucocutaneous junction is a specific erogenous zone,<ref name="winklemann1959">{{WinkelmannRK 1959}}</ref> Taylor et al. reported:<blockquote>The vascular ridges of the `ridged band' and its [[Meissner's corpuscles]] firmly separate preputial epithelium from true [[skin]] and place preputial [[mucosa]] amongst other mucocutaneous [[mucosa]]e. Winkelmann emphasized the structural and functional importance of junctional regions of the body and focused on mucocutaneous end-organs, or `genital corpuscles', of the [[glans penis]] and prepuce. Some of these end-organs resemble Krause end-bulbs; others resemble [[Meissner's corpuscles]]. … [[Meissner's corpuscles]] of the prepuce may be compared with similar nerve-endings in the finger-tips and lips, which respond in a fraction of a second to contact with light objects that bring about deformation of their capsules. … The prepuce provides a large and important platform for several nerves and nerve endings. The innervation of the outer [[skin]] of the prepuce is impressive; its sensitivity to light touch and pain are similar to that of the [[skin]] of the penis as a whole.<ref name="taylor1996" /> </blockquote> The highly innervated [[ridged band]] area is found at the mucocutaneous junction. The ridged band area is characterized by rete ridges with [[Meissner's corpuscles]] in the ridges.<ref name="taylor1996"/> As with other neurologic structures such as the brain, the tip of the prepuce is richly supplied with blood by important vascular structures.<ref name="taylor1996"/> The prepuce serves as a conduit for several important veins.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> The glans penis receives blood through the frenular artery.<ref>{{REFjournal |last=Persad |init=R |author-link= |last2=Sharma |init2=S |author2-link= |last3=McTavish |init3=J |author3-link= |etal=yes |title=Clinical presentation and pathophysiology of meatal stenosis following content circumcision |journal=Brit J Urol |date=1995 |volume=75 |issue=1 |pages=91-3 |url=https://www.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1995.tb07242.x |quote= |pubmedID=7850308 |pubmedCID= |DOI=10.1111/j.1464-410x.1995.tb07242.x |accessdate=2019-10-15}}</ref> The adult foreskin frequently has prominent visible veins. The layer of [[dartos]] muscle is part contained within the foreskin.<ref name="cold-taylor1999 /> It makes the foreskin rather stretchy. The dartos muscle keeps the foreskin snugly against the [[glans]]. The fibers of the [[dartos]] muscle form a whorl at the tip that functions as a sphincter. The sphincter opens to allow [[urine]] to flow out, but closes to protect the [[penis]] from foreign matter, contaminants, and pathogens.<ref name="lakshmanan-prakash1980"/><ref>{{REFjournal |last=Jefferson |first= |author-link= |title=The peripenic muscle; some observations on the anatomy of phimosis |journal=Surgery, Gynecology, and Obstetrics (Chicago) |date=1916 |volume=23 |issue=2 |pages=177-81 |url=http://www.cirp.org/library/anatomy/jefferson/ |quote= |pubmedID= |pubmedCID= |DOI= |accessdate=2019-10-14}}</ref> ===Foreskin length===Natural foreskins are found in all lengths from very short to very long. Most fall near the center of the range. Longer foreskins appear to perform their [[Immunological and protective function of the foreskin| protective and immunological function]] more satisfactorily. Shorter foreskins may be lengthened by [[tissue expansion]] to improve function and aesthetics. The tapered tip of a longer foreskin that extends beyond the [[glans penis]] is known as the ''[[acroposthion]]''. A very few of the longest foreskins will not remain retracted when released, but will spontaneously [[Gliding action| glide]] forward to recover the glans penis. Longer foreskins improve protection and [[gliding action]] and do not usually create an issue. There is no recognized definition of an excessively long foreskin.<ref name="tip2022">{{REFweb |url=http://acroposthion.com/the-tip-at-the-end/ |title=The ‘Tip’ At The End |last= |first= |publisher=Acroposthion |date=2022 |accessdate=2022-06-21}}</ref> <i>See [[Development_of_retractable_foreskin#Adult_foreskin| Adult foreskin]].</i> ==Physiological functions== Antique research by Alfred Kinsey (1948)<ref>{{REFbook |last=Kinsey |first=Alfred C. |init= |year=1948 |title=Sexual behavior in the human male |url= |scope= |ISBN= |accessdate=2022-06-16 }}</ref> and Masters & Johnson (1966)<ref>{{REFbook |last=Masters |first=William |init= |year=1966 |title=Human sexual response |url= |scope= |ISBN=978-0-553-20429-2 |accessdate=2022-06-16 }}</ref> misled medical science into believing that the foreskin had no function. This meant the foreskin could be excised without doing harm. In actuality, the foreskin has many functions, so its [[amputation]] does [[Bodily harm| great harm]].<ref name="hill2017">{{REFjournal |last=Hill |first=George |init=G |author-link=George Hill |title=The case against circumcision |journal=Journal of Men's Health and Gender |date=2007 |volume=4 |issue=3 |pages=318-323 |url=https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=04ace5046cc27f01b8fbe4aa359c059778983912 |quote= |format=PDF |accessdate=2023-10-01}}</ref> === Protective functions === The foreskin provides physical protection to the [[glans penis]] and inner [[mucosa]], supplying moisture and natural oils by [[transudation]], while protecting the [[mucosa]]l tissue from pathogens, pollutants, friction, injury, [[keratinization]], de-sensitization, and drying out. The foreskin protects the glans penis and meatus of infant boys from abrasion and irritation from ammoniacal diapers.<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> <ref name="dobanavacki2012">{{REFjournal |last=Dobanavacki |init=D |author-link= |last2=Lucić Prostran |init2=B |author2-link= |last3=Sarac |init3=D |author3-link= |etal=yes |title=Prepuce in boys and adolescents: what when, and how? |journal=Med Pregl |date=2012 |volume=65 |issue=7-8 |pages=295-300 |url=https://www.researchgate.net/publication/230746332_Prepuce_in_boys_and_adolescents_What_when_and_how |quote= |pubmedID=22924249 |pubmedCID= |DOI=10.2298/MPNS1208295D |accessdate=2019-10-14}}</ref> In the absence of the foreskin about ten to twenty percent of [[circumcised]] boys suffer urethral stricture ([[meatal stenosis]]) requiring further treatment.<ref name="frisch2016">{{REFjournal |last=Frisch |first=Morten |init=M |author-link=Morten Frisch |last2=Simonsen |init2=J |author2-link= |title=Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013 |journal=The Surgeon |date=2016-04-01 |volume=16 |issue=2 |pages=107-18 |url=http://www.thesurgeon.net/article/S1479-666X(16)30179-2/pdf |quote= |pubmedID=28017691 |pubmedCID= |DOI=10.1016/j.surge.2016.11.002 |accessdate=2019-10-23}}</ref> Frisch & Simonsen (2016) reported the incidence of meatal stenosis to be 3.7 times higher in [[circumcised]] boys.<ref name="frisch2016"/> The foreskin continues to protect the [[glans penis]] throughout life, keeping it smooth, glossy, moist, [[Foreskin sensitivity| sensitive]], and free from [[keratinization]] and loss of sensation. === Immunological functions === Fleiss et al. (1998) have listed numerous immunological functions of the foreskin that help to protect the human body against [[infection]]. The foreskin maintains the moistness of the [[preputial mucosa]] and the [[glans penis]] by [[transudation]]. The sub-preputial moisture contains cathepsin B, chymotrypsin, neutrophil elastase, cytokines, and lysozyme, which has the capacity to destroy the cell walls of bacteria. The preputial muscles keep the tip of the foreskin closed to keep out pathogens.<ref name="fleiss-hodges-vanhowe1998"/> The foreskin is highly vascularized. The high rate of blood flow helps to prevent infection.<ref name="fleiss-hodges-vanhowe1998"/> Although claims have been made that the presence of the foreskin increases the risk of infection with [[Circumcision and HIV|human immune deficiency virus]] ([[HIV]]), that is not correct. The claims are based on the reported findings of three randomized clinical trials (RCTs) that were carried out more than a decade ago in Africa. Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref> Fleiss et al. noted the presence of [[CircumpendiumLangerhans cells]]in the prepuce.<ref name="fleiss-hodges-vanhowe1998"/> De Witte et al.(2007) have discovered that Langerhans cells produce ''Langerin'', which is a "natural barrier to [[HIV]] infection".<ref>{{DeWitte etal 2007}}</ref> For more information, see [[Immunological and protective function of the foreskin]]. === Sexual functions ===
The foreskin is a sexual organ.<ref name="hill2017" /> It provides both mechanical and erogenous functions in sexual intercourse, as well as [[pheromone| pheromones]].<ref name= Anatomy and function of "fleiss-hodges-vanhowe1998"/> Winkelmann (1959) classified the foreskin in detail =as ''specific erogenous tissue''.<ref name="winklemann1959" /> When the [[penis]] becomes erect, the foreskin unfolds to provide the skin necessary to allow the [[penis]] to expand to full size and length.
The [[gliding action]] provides stimulation and facilitates intromission.<ref name="warren-bigelow1994"/><ref name="morgan1965">{{REFjournal |last=Morgan |init=WKC |author-link= |title=The rape of the phallus |journal=JAMA |date=1965 |volume=193 |issue= |pages=123-4 |url=https://jamanetwork.com/journals/jama/article-abstract/656072 |quote= |pubmedID=14310332 |pubmedCID= |DOI=10.1001/jama.1965.03090030045013 |accessdate=2019-10-15}}</ref> <ref name="taves2002">{{REFjournal |last=Taves |init=D |author-link= |title=The intromission function of the foreskin |journal=Med Hypotheses |date=2002 |volume=59 |issue=2 |pages=180 |url=http://www.sciencedirect.com/science/article/pii/S0306987702002505 |quote= |pubmedID=12208206 |pubmedCID= |DOI=10.1016/s0306-9877(02)00250-5 |accessdate=2019-10-15}}</ref> At times of sexual arousal, the foreskin covers may be lubricated by [[pre-ejaculate]]. During the glansthrusting of sexual congress, thus protecting it from pollutants, friction, injury the [[gliding action]] reduces abrasions and irritation in the [[Vagina| female partner]] and drying outavoids problems with vaginal dryness. It consists of two superimposed layers, which are only joined together at <ref name="warren-bigelow1994"/><ref name="morgan1965"/> The foreskin may protect the very endcorona glandis from hyper-stimulation and prevent [[premature ejaculation]].
Nature designed the foreskin to be an [[Foreskin sensitivity| erogenous sensory organ]].<ref name="hill2017" /> The foreskin serves as has a pathway for many significant veins. In addition layer of muscle called the [[dartos]] muscle sheath that provides the foreskin is saturated with very many nerve endings elasticity, flexibility, and tactile corpusclesstretchiness, which allows full stimulation of the same receptors that exist nerves in the fingertips. The enormous density of nerves [[ridged band]] that sense movement and mechanoreceptors make the [[stretching]] to provide [[foreskin sensitivity]]. There is a mucocutaneous region at the most sensitive part tip of the body, approximately 10 times more sensitive than the fingertipsforeskin where outer skin changes to inner [[mucosa]]. This also distinguishes Winkelmann (1959) identified the human penis from those foreskin as a ''specific erogenous zone'' (meaning an area of other mammals, which acute erogenous sensation). Winklemann reported rete ridges in contrast have the main concentration of foreskin with nerves in set close to the glans, and not in the foreskinsurface with closely set networks.<ref name="winklemann1959"/>
For the [[glans penis]], men in Group B [circumcised males] reported significantly less sexual pleasure than men in Group A at the dorsal side (P ≤ 0.001), and the lateral (P ≤ 0.001) and ventral sides (P = 0.02). Orgasm was less intense in Group B at the dorsal side (P = 0.006) and at the lateral sides (P = 0.02). Group B required more effort in achieving orgasm at the lateral sides (P = 0.04). Furthermore, a larger percentage of men in this group reported numbness at the dorsal, lateral, and ventral sides (all P ≤ 0.001), as well as unusual sensations (burning, prickling, itching, or tingling) at the lateral sides (P = Short Frenulum 0.02) and at the ventral side (frenulum breveP = 0.003) of the glans.<ref>{{REFjournal |last=Bronselaer |first=Guy |init=G |author-link= |last2=Schoeber |first2=Justine M. |init2=JM |author2-link= |last3=Meyer-Bahlburg |init3=HM |author3-link= |last4=T'Sjoen |first4=Guy |init4=G |author4-link= |last5=Vlietinck |first5=Robert |init5=R |author5-link= |last6=Hoebeke |first6=Piet B. |init6=PB |author6-link= |etal=no |title=Male circumcision decreases penile sensitivity as measured in a large cohort |journal=BJU Int |location= |date=2013-05 |volume=111 |issue=5 |pages=820-7 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2012.11761.x |quote= |pubmedID= |pubmedCID= |DOI=10.1111/j.1464-410X.2012.11761.x |accessdate=2019-10-23}}</ref> </blockquote>
Frisch et al. (2011) surveyed the sexual function and behavior of a large group of [[intact]] and [[circumcised]] men in [[Denmark]]. They reported that "[[circumcised]] men were more likely (38%) than [[uncircumcised]] men (28%) to report ≥10 sex partners."<ref name=== Physiological Phimosis ==="frisch lindholm groenbaek 2011">{{FrischM LindholmM GroenbaekM 2011}}</ref>
According to the Rabbi Isaac ben Yedaiah, who lived in Southern France in the late 13th century:<blockquote>''She too will court the man who is [[uncircumcised]] in the flesh and lie against his breast with great passion, for he thrusts inside her a long time because of his foreskin, which is a barrier against ejaculation in intercourse. Thus she feels pleasure and reaches an orgasm first. When an [[uncircumcised]] man sleeps with her, and then resolves to return to his home, she brazenly grabs him, holding on to his genitals and says to him, "Come back, make love to me." This is because of the pleasure that she finds in intercourse with him, from the sinews of his testicles—sinew of iron—and from his ejaculation—that of a horse which he shoots like an arrow into her womb. They are united without separating, and he makes love twice and three times in one night, yet the appetite is not filled.''<ref name="saperstein1980">{{REFbook |last=Saperstein |first=Marc |init=Manual stretchingM |year=1980 |title=Decoding the Rabbis: A Thirteenth-Century Commentary on the Aggadah |url=http://www.cirp.org/library/cultural/yedaiah1/ |pages= |isbn= |accessdate=2019-10-22}}</ref></blockquote>As previously reported, the foreskin reduces the force required for penetration of the female partner's [[vagina]] by as much as ninety percent.<ref name="taves2002"/> The [[gliding action]] of the foreskin reduces friction and abrasion, while conserving vaginal lubrication.<ref name="warren-bigelow1994"/>
In a first of its kind, O'Hara & O'Hara (1999) carried out a retrospective survey of 138 women with experience of both [[intact]] and [[circumcised]] partners. The growth women overwhelmingly concurred that the mechanics of [[sexual intercouse| coitus]] was different for the two groups of men. Of the women, 73% reported that [[circumcised]] men tend to thrust harder and deeper, using elongated strokes, while unaltered men by comparison tended to thrust more gently, to have shorter thrusts, and tended to be in contact with the mons pubis and hormonal surge [[clitoris]] more, according to 71% of the respondents. Women with [[intact]] partners had a higher rate of orgasms than women with [[circumcised]] partners. O'Hara & O'Hara concluded:<blockquote>Clearly, the anatomically complete penis offers a more rewarding experience for the female partner during puberty alter coitus. While this study has some obvious methodological flaws, all the differences cannot be attributed to them. It is important that these findings be confirmed by a prospective study of a randomly selected population of women with experience with both types of men. It would be useful to examine the size and size ratio role of the penis and penile skin significantlyforeskin in other sexual activities. AlsoBecause these findings are of interest, the first masturbations aid negative effect of circumcision on the process sexual enjoyment of stretching the female partner needs to be part of any discussions providing '[[informed consent]]' before circumcision.<ref name="ohara1998">{{REFjournal |last=O'Hara |init=K |author-link= |last2=O'Hara |init2=J |author2-link= |etal=yes |title=The effect of male circumcision on the skin and detachment sexual enjoyment of remaining adhesionsthe female partner |journal=BJU Int |location= |date=1999 |volume=83 Suppl 1 |issue= |pages=79-84 |url=https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1464-410x.1999.0830s1079.x |quote= |pubmedID=10349418 |pubmedCID= |DOI=10.1046/j.1464-410x.1999.0830s1079.x |accessdate=2019-10-22}}</ref></blockquote>
{{LINKS}}
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|website=NOHARMM
|date=2013-11-22
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* {{REFweb
|url=http://www.intactaus.org/information/functionsoftheforeskin/
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* {{REFweb
|url=https://circumcision.org/functions-of-the-foreskin/
|title=Functions of the Foreskin
|last=Goldman
|first=Ronald
|author-link=Ronald Goldman
|publisher=Circumcision Resource Center
|website=circumcision.org
|date=
|accessdate=2020-07-01
|format=
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}}
* {{REFweb
|url=https://www.doctorsopposingcircumcision.org/for-professionals/the-prepuce/
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|last=
|first=
|author-link=
|publisher=Doctors Opposing Circumccision
|website=
|date=2016-07
|accessdate=2019-10-16
|format=
|quote=To provide informed, respectful care to males with intact genitals, and to fully understand the harms of circumcision, health professionals must have a thorough grasp of the anatomy, development, and functions of the foreskin (also known as the prepuce).
}}
* {{REFweb
|url=http://www.noharmm.org/advantage.htm
|title=The Foreskin Advantage
|first=Gary L
|last=Harryman
|publisher=NORM/Southern California
|website=[[NOHARMM]]
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}}
* {{REFweb
|url=https://intactamerica.org/promoting-the-prepuce/
|title=Promoting the Prepuce
|last=Chapin
|first=Georganne
|author-link=
|publisher=Intact America
|website=
|date=2016-05-13
|accessdate=2021-04-02
|format=
|quote=
}}
* {{REFweb
|url=https://15square.org.uk/male-foreskin-is-functional-5-amazing-facts/
|archived=
|title=Male Foreskin is Functional – 5 Amazing Facts
|trans-title=
|language=
|last=Troy
|first=Louise
|author-link=
|publisher=15 Square
|website=
|date=2022-05-24
|accessdate=2022-05-24
|format=
|quote=The foreskin is the primary fine-touch sensory tissue of the penis.
}}
* {{REFweb
|url=https://www.linkedin.com/pulse/circumcision-sexological-damage-erogenous-lip-tool-michel-herv%C3%A9
|title=Circumcision, the sexological damage (an erogenous lip, protective of erogeneity and the tool of autosexuality, the foreskin is a sexual organ)
|last=Bertaux-Navoiseau
|first=Michel Hervé
|init=
|author-link=Michel Hervé Bertaux-Navoiseau
|publisher=Linkedin
|date=2022-11-06
|accessdate=2022-11-16
}}
* {{REFweb
|url=https://www.youtube.com/watch?v=09gW4TclGqY
|title=The Amazing Foreskin: Learn Integral Anatomy with Gil Hedley
|last=Headley
|first=Gil
|init=
|publisher=
|date=2022
|accessdate=2022-12-03
}}
{{REF}}
[[Category:Foreskin anatomy]]
[[Category:Genital]]
[[Category:Parental information]]
[[Category:Penile anatomy]]
[[Category:Male sexuality]]
[[Category:Education]]
[[Category:From Intactipedia]]
[[de:Vorhaut]]