Difference between revisions of "Immunological and protective function of the foreskin"

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Although circumcision promoter [[Abraham L. Wolbarst]] (1914} once claimed that the human [[foreskin]] was filthy and harbored disease and infection,<ref name="wolbarst1914">{{REFjournal
+
Although circumcision promoter [[Abraham L. Wolbarst]] (1914} once claimed that the human [[foreskin]] was filthy and harbored disease and [[infection]],<ref name="wolbarst1914">{{REFjournal
 
  |last=Wolbarst
 
  |last=Wolbarst
 
  |first=Abraham L.
 
  |first=Abraham L.
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  |url=https://jamanetwork.com/journals/jama/article-abstract/453164
 
  |url=https://jamanetwork.com/journals/jama/article-abstract/453164
 
  |accessdate=2022-08-11
 
  |accessdate=2022-08-11
−
}}</ref> in reality the opposite is true.  The [[foreskin]] is designed by nature to be self cleaning and to provide significant natural '''immunological and protective function''' against all types of infection, including [[HIV]].
+
}}</ref> in reality the opposite is true.  The [[foreskin]] is designed by nature to be self-cleaning and to provide significant natural '''immunological and protective function''' against all types of [[infection]], including [[HIV]].
 +
 
 +
[[Connor Judson Garrett| Connor Garrett]] (2024) demolishes the myths falsely claiming health benefits of circumcision that have been promoted by the [[circumcision industry]] and cites the health, psychological, and sexual benefits of [[intactness]].<ref name="garrett2024-03-09">{{REFweb
 +
|url=https://intactamerica.org/intact-penis-care/
 +
|title=Intact Penis Care: Embracing Natural Well-being
 +
|last=Garrett
 +
|first=Connor
 +
|init=
 +
|author-link=Connor Judson Garrett
 +
|publisher=Intact America
 +
|date=2024-03-09
 +
|accessdate=2024-05-15
 +
}}</ref>
  
 
== The protective and hygienic function of the foreskin ==
 
== The protective and hygienic function of the foreskin ==
  
−
The [[foreskin]], like the eyelid, also serves an important protective and hygienic function. The foreskin protects the delicate [[glans]] of the [[penis]] and puts the [[urethra]] at a distance from its environment, protecting it from foreign contaminants of all kinds while simultaneously shielding the [[penis]] from injury. It is a double fold of [[skin]] which offers two layers of protection to prevent [[keratinization]] and maintain sensitivity.
+
The [[foreskin]], like the eyelid, also serves an important protective and hygienic function. The [[foreskin]] protects the delicate [[glans]] of the [[penis]] and puts the [[urethra]] at a distance from its environment, protecting it from foreign pathogens and contaminants of all kinds while simultaneously shielding the [[penis]] from injury. It is a double fold of [[skin]] which offers two layers of protection to prevent [[keratinization]] and maintain sensitivity.
  
−
At birth, the [[foreskin]] is usually attached to the glans (head) of the penis by a [[synechia]], akin to how a fingernail is attached to a finger.<ref>{{REFjournal
+
At birth, the [[foreskin]] is usually attached to the [[glans]] (head) of the [[penis]] by a [[synechia]], akin to how a fingernail is attached to a finger.<ref>{{REFjournal
 
  |last=Deibert
 
  |last=Deibert
 
  |init=GA
 
  |init=GA
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  |pages=387-9
 
  |pages=387-9
 
  |accessdate=2019-10-20
 
  |accessdate=2019-10-20
−
}}</ref> The preputial cavity is sealed by the synechia so it cannot be infected.
+
}}</ref> The [[preputial sac]] is sealed by the synechia so it cannot be infected.
  
−
In infancy, the foreskin's tubular neck (prepucial orifice) is often long and narrow while the sphincter muscle in the tip of the [[foreskin]] keeps its opening closed. This acts as an extension of the [[urethra]].<ref>{{REFjournal
+
In infancy, the foreskin's tubular neck (prepucial orifice) is often long and narrow while the [[Dartos]] sphincter muscle in the tip of the [[foreskin]] keeps its opening closed. This acts as an extension of the [[urethra]].<ref>{{REFjournal
 
  |last=Hunter
 
  |last=Hunter
 
  |init=RH
 
  |init=RH
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  |pages=243-249
 
  |pages=243-249
 
}}</ref>  
 
}}</ref>  
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Together, these properties prevent the entry of contaminants.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> The [[foreskin]] protects the infant [[glans penis]] from ammonia in diapers (nappies) and prevents meatal ulcer and [[meatal stenosis]].<ref>{{GairdnerDM 1949}}</ref> <ref name="vanhowe2006">{{REFjournal
+
Together, these properties prevent the entry of pathogens and contaminants.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> The [[foreskin]] protects the infant [[glans penis]] from ammonia in diapers (nappies) and prevents meatal ulcer and [[meatal stenosis]].<ref>{{GairdnerDM 1949}}</ref> <ref name="vanhowe2006">{{REFjournal
 
  |last=Van Howe
 
  |last=Van Howe
 
  |init=RS
 
  |init=RS
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  |pages=31-36
 
  |pages=31-36
 
  |accessdate=2019-10-20
 
  |accessdate=2019-10-20
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}}</ref> They are also present in the eye lid and perform the same function in both places. They secrete the oils necessary to keep the glans surface soft, moist, smooth, warm, sensitive, and with a healthy glistening red or purple color. This moisturizer also maintains PH balance, and optimal cleanliness. This is required to keep the surface of the glans healthy and clean via the cleaning effects of mucous secretions. Again, this function is analogous to the eye lid. The [[glans penis]] is meant to be an internal organ covered and protected from the outside world.
+
}}</ref> They are also present in the eyelid and perform the same function in both places. They secrete the oils necessary to keep the [[glans]] surface soft, moist, smooth, warm, sensitive, and with a healthy glistening red or purple color. This moisturizer also maintains PH balance, and optimal cleanliness. This is required to keep the surface of the glans healthy and clean via the cleaning effects of mucous secretions. Again, this function is analogous to the eye lid. The [[glans penis]] is meant to be an internal organ covered and protected from the outside world.
  
−
In the genitally [[intact]] [[penis]] the [[urine]] stream flushes out the [[urethra]] and [[foreskin]] of foreign microbes. In healthy individuals, [[urine]] is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of [[urine]] as it rushes through the foreskin flushes it out effortlessly and naturally.<ref name="parkash-jeykumar1973">{{REFjournal
+
In the genitally [[intact]] [[penis]] the [[urine]] stream flushes out the [[urethra]] and [[foreskin]] of foreign microbes. In healthy individuals, [[urine]] is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of [[urine]] as it rushes through the [[foreskin]] flushes it out effortlessly and naturally.<ref name="parkash-jeykumar1973">{{REFjournal
 
  |last=Parkash
 
  |last=Parkash
 
  |init=S
 
  |init=S
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}}</ref>
 
}}</ref>
  
−
Though [[urine]] passes through the [[foreskin]] every day, the inner foreskin is remarkably free of urea — a by-product of liver metabolism that is secreted in [[urine]]. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of seminal vesicles, prostate, and [[urethra]]l mucous glands, collectively or individually, keep the foreskin clear and clean as well.<ref>{{REFjournal
+
Though [[urine]] passes through the [[foreskin]] every day, the inner foreskin is remarkably free of urea — a by-product of liver metabolism that is secreted in [[urine]]. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of [[seminal vesicles]], prostate, and [[urethra]]l mucous glands, collectively or individually, keep the foreskin clear and clean as well.<ref>{{REFjournal
 
  |last=Parkash
 
  |last=Parkash
 
  |init=S
 
  |init=S
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The idea that the foreskin is "dirty" or "unclean" is a scientifically unfounded superstition. The [[intact]] [[penis]] is naturally clean and maintains a level of hygiene that is optimal when compared to a [[penis]] that has been altered by [[circumcision]].<ref name="fleiss-hodges-vanhowe1998" />  
 
The idea that the foreskin is "dirty" or "unclean" is a scientifically unfounded superstition. The [[intact]] [[penis]] is naturally clean and maintains a level of hygiene that is optimal when compared to a [[penis]] that has been altered by [[circumcision]].<ref name="fleiss-hodges-vanhowe1998" />  
  
−
In comparison, due to the open wounds and raw [[bleeding]] flesh, the [[circumcised]] [[penis]] needs much more care after circumcision. The surgically externalized glans is dirty rather then clean because of constant exposure to dirt, abrasion and contaminants.<ref name="vanhowe1997">{{REFjournal
+
In comparison, due to the open wounds and raw [[bleeding]] flesh in a diaper, the [[circumcised]] [[penis]] needs much more care after [[circumcision]]. The surgically externalized [[glans]] is dirty rather then clean because of constant exposure to dirt, abrasion, pathogens, and contaminants.<ref name="vanhowe1997">{{REFjournal
 
  |last=Van Howe
 
  |last=Van Howe
 
  |init=RS
 
  |init=RS
Line 157: Line 169:
 
  |DOI=10.1046/j.1464-410X.1997.00467.x
 
  |DOI=10.1046/j.1464-410X.1997.00467.x
 
  |accessdate=2019-10-20
 
  |accessdate=2019-10-20
−
}}</ref> [[Circumcised]] boys are also found to be more likely to develop [[balanitis]], [[meatitis]], coronal adhesions, and [[meatal stenosis]].<ref name="vanhowe1997"/>
+
}}</ref> [[Circumcised]] boys are also found to be more likely to develop [[balanitis]], [[meatitis]], [[Skin bridge| coronal adhesions]], and [[meatal stenosis]].<ref name="vanhowe1997"/>
  
−
Excessive washing and the use of soap inside the [[foreskin]] should be avoided.<ref name="birley1993">{{REFjournal
+
After retraction commences, excessive washing and the use of soap inside the [[foreskin]] should be avoided.<ref name="birley1993">{{REFjournal
 
  |last=Birley
 
  |last=Birley
 
  |init=HDL
 
  |init=HDL
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== The immunological function of the foreskin ==
 
== The immunological function of the foreskin ==
  
−
The foreskin's inner fold and the glans of the penis are comprised of [[Preputial mucosa|mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.  
+
The foreskin's inner fold and the [[glans]] of the [[penis]] are comprised of [[Preputial mucosa|mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.  
  
 
Certain components such as [[Langerhans cells]],<ref>{{REFjournal
 
Certain components such as [[Langerhans cells]],<ref>{{REFjournal
Line 330: Line 342:
 
  |accessdate=2019-10-20
 
  |accessdate=2019-10-20
 
}}</ref> which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.<ref name="flower1983"/>
 
}}</ref> which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.<ref name="flower1983"/>
−
It is also very important to note that [[Langerhans cells]] that are present in the foreskin produce ''Langerin'', a substance that has been proven to kill human immunodeficency virus ([[HIV]]) on contact.<ref>{{DeWitte etal 2007}}</ref>
+
It is also very important to note that [[Langerhans cells]] that are present in the [[foreskin]] produce ''Langerin'', a substance that has been proven to kill human immunodeficiency virus ([[HIV]]) on contact.<ref>{{DeWitte etal 2007}}</ref>
  
 
All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998" />
 
All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998" />
  
−
<!--In infancy, simple sugars in breast milk, like antibacterial oligosaccharides, are acquired from the mother's milk and excreted in [[urine]]. University studies have shown that these substances cling to the [[mucosa]]l lining of the inner foreskin and protect against urinary tract infections,<ref>Hanson LA, Karlsson B, Jalil F, et al. Antiviral and antibacterial factors in human milk. In: Hanson LA, ed. ''Biology of Human Milk''. New York Raven Press; 1988. pp. 141-57</ref> as well as infections in other parts of the body.<ref>Coppa GV, Gabrielli O, Giorgi P, Catassi C, Montanari MP, Veraldo PE, Nichols BL. Preliminary study of breast feeding and bacterial adhesion to uroepithelial cells. ''Lancet'' 1990 Mar 10;335(8689):569-71.</ref> Babies excrete in their [[urine]] about 300-500 milligrams of oligosaccharides each day. These compounds prevent virulent strains of ''Escherichia coli'' from adhering to the [[mucosa]]l lining of the entire urinary tract, including the foreskin and glans. For these reasons breast-milk is highly efficacious at preventing UTI.<ref>Gothefors L, Olling S, Winberg J. Breastfeeding and biological properties of faecal ''E. coli'' strains. ''Acta Paediatr Scand'' 1975 Nov;54(6):807-12.</ref> Rigorous studies have repeatedly demonstrated that breast feeding protects against urinary tract infections.<ref>Mårild S. Breastfeeding and Urinary Tract Infections. ''Lancet'' 1990;336:942.</ref> <ref>Pisacane A, et al. Breastfeeding and urinary tract infection. ''The Lancet'', July 7, 1990, p50 </ref> <ref>Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. ''J Pediatr'' 1992;120:87-89.</ref>
+
[[Breastfeeding]] provides additional protection against [[urinary tract infection]].
−
 
 
−
Researchers have shown that premature foreskin retraction can expose the penis to hospital strains of ''Escherichia coli'' and can result in UTI.<ref>Winberg J, et al. The prepuce: A mistake of nature? ''Lancet'' 1989, pp.598-99.</ref> Hence the protective function of the foreskin is in the child's best interest, especially during chemically treated diaper wearing years where feces mixed with [[urine]] can not only contaminate the permanently exposed [[urinary meatus]] but also the [[amputation]] wound from the circumcision surgery itself.
 
−
 
 
−
It is important to note that women have a higher risk of UTI. This is because the shorter [[urethra]] offers less protection via the immunological function of the [[urethra]]'s [[mucosa]]l lining. By the same observation we see that the tubular tip of the foreskin and its [[mucosa]]l lining act as an extension of the [[urethra]], hence providing more of that same protection via [[mucosa]] immunology and the adherence of antibacterial substances in breast milk. Understandably, removal of the foreskin destroys all this functionality.-->
 
  
 
{{SEEALSO}}
 
{{SEEALSO}}
 +
* [[Breastfeeding]]
 +
* [[Care of intact, foreskinned boys]]
 
* [[Circumcision and STDs]]
 
* [[Circumcision and STDs]]
 
* [[Circumcision and HIV]]
 
* [[Circumcision and HIV]]
 +
* [[Development of retractable foreskin]]
 
* [[Foreskin]]
 
* [[Foreskin]]
 +
* [[Foreskin sensitivity]]
 +
* [[Immunological protection of breastfeeding]]
 +
* [[Keratinization]]
 +
* [[Penis]]
 
* [[Pheromone]]
 
* [[Pheromone]]
 +
* [[Preputial sac]]
 
* [[Smegma]]
 
* [[Smegma]]
 
* [[Transudation]]
 
* [[Transudation]]
Line 363: Line 379:
 
{{REF}}
 
{{REF}}
  
 +
[[Category:Education]]
 
[[Category:Foreskin anatomy]]
 
[[Category:Foreskin anatomy]]
 
[[Category:Immunology]]
 
[[Category:Immunology]]

Latest revision as of 15:56, 11 June 2024

Although circumcision promoter Abraham L. Wolbarst (1914} once claimed that the human foreskin was filthy and harbored disease and infection,[1] in reality the opposite is true. The foreskin is designed by nature to be self-cleaning and to provide significant natural immunological and protective function against all types of infection, including HIV.

Connor Garrett (2024) demolishes the myths falsely claiming health benefits of circumcision that have been promoted by the circumcision industry and cites the health, psychological, and sexual benefits of intactness.[2]

The protective and hygienic function of the foreskin

The foreskin, like the eyelid, also serves an important protective and hygienic function. The foreskin protects the delicate glans of the penis and puts the urethra at a distance from its environment, protecting it from foreign pathogens and contaminants of all kinds while simultaneously shielding the penis from injury. It is a double fold of skin which offers two layers of protection to prevent keratinization and maintain sensitivity.

At birth, the foreskin is usually attached to the glans (head) of the penis by a synechia, akin to how a fingernail is attached to a finger.[3] The preputial sac is sealed by the synechia so it cannot be infected.

In infancy, the foreskin's tubular neck (prepucial orifice) is often long and narrow while the Dartos sphincter muscle in the tip of the foreskin keeps its opening closed. This acts as an extension of the urethra.[4][5] Together, these properties prevent the entry of pathogens and contaminants.[6] The foreskin protects the infant glans penis from ammonia in diapers (nappies) and prevents meatal ulcer and meatal stenosis.[7] [8] [9]

Natural secretions of oil are achieved by sebaceous glands which are abound in the foreskin's inner lining, these are not present in the glans penis.[10] They are also present in the eyelid and perform the same function in both places. They secrete the oils necessary to keep the glans surface soft, moist, smooth, warm, sensitive, and with a healthy glistening red or purple color. This moisturizer also maintains PH balance, and optimal cleanliness. This is required to keep the surface of the glans healthy and clean via the cleaning effects of mucous secretions. Again, this function is analogous to the eye lid. The glans penis is meant to be an internal organ covered and protected from the outside world.

In the genitally intact penis the urine stream flushes out the urethra and foreskin of foreign microbes. In healthy individuals, urine is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of urine as it rushes through the foreskin flushes it out effortlessly and naturally.[11]

Though urine passes through the foreskin every day, the inner foreskin is remarkably free of urea — a by-product of liver metabolism that is secreted in urine. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of seminal vesicles, prostate, and urethral mucous glands, collectively or individually, keep the foreskin clear and clean as well.[12]

The idea that the foreskin is "dirty" or "unclean" is a scientifically unfounded superstition. The intact penis is naturally clean and maintains a level of hygiene that is optimal when compared to a penis that has been altered by circumcision.[6]

In comparison, due to the open wounds and raw bleeding flesh in a diaper, the circumcised penis needs much more care after circumcision. The surgically externalized glans is dirty rather then clean because of constant exposure to dirt, abrasion, pathogens, and contaminants.[13] Circumcised boys are also found to be more likely to develop balanitis, meatitis, coronal adhesions, and meatal stenosis.[13]

After retraction commences, excessive washing and the use of soap inside the foreskin should be avoided.[14]

The immunological function of the foreskin

The foreskin's inner fold and the glans of the penis are comprised of mucous membrane tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.

Certain components such as Langerhans cells,[15] plasma cells,[16] apocrine glands,[17] and sebaceous glands,[18][19][20][21], collectively secrete emollient lubricants.[11] Apocrine glands perform a crucial function by secreting enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, and neutrophil elastase.[22]

There is also some research to suggest that lysozyme may protect against HIV infection.[23] [6]

Apocrine glands also produce cytokine,[24] which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.[16] It is also very important to note that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill human immunodeficiency virus (HIV) on contact.[25]

All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.[6]

Breastfeeding provides additional protection against urinary tract infection.

See also

External links

References

  1. ↑ REFjournal Wolbarst AL. Universal Circumcision as a Sanitary Measure. JAMA. 10 January 1914; 62(2): 92-97. Retrieved 11 August 2022.
  2. ↑ REFweb Garrett, Connor (9 March 2024). Intact Penis Care: Embracing Natural Well-being, Intact America. Retrieved 15 May 2024.
  3. ↑ REFjournal Deibert GA. The separation of the prepuce in the human penis. Anatomical Record. November 1933; 57(4): 387-9. Retrieved 20 October 2019.
  4. ↑ REFjournal Hunter RH. Notes on the development of the prepuce PDF. Journal of Anatomy. October 1935; 70(1): 6875. Retrieved 20 October 2019.
  5. ↑ REFjournal Glenister TW. A consideration of their process involved in the development of the prepuce in man. Br J Urol. September 1956; 28(3): 243-249.
  6. ↑ a b c d REFjournal Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. PMC. DOI. Retrieved 14 January 2022.
  7. ↑ REFjournal Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  8. ↑ REFjournal Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). January 2006; 45(1): 49-54. PMID. DOI. Retrieved 9 January 2020.
  9. ↑ REFjournal Upadhyay V, Hammodat HM, Pease PW. Post circumcision meatal stenosis. N Z Med J. 27 February 1998; 111(1060): 57-8. PMID. Retrieved 10 January 2020.
  10. ↑ REFjournal Hyman AB, Brownstein MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol. January 1969; 99(1): 31-36. Retrieved 20 October 2019.
  11. ↑ a b REFjournal Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human subpreputial collection: its nature and formation. J Urol. August 1973; 110(2): 211-212. Retrieved 20 October 2019.
  12. ↑ REFjournal Parkash S. Penis: some facts and fancies. Journal of Physician's Association of Madras. June 1982; : 1-13.
  13. ↑ a b REFjournal Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol. 1997; 80: 776-782. DOI. Retrieved 20 October 2019.
  14. ↑ REFjournal Birley HDL, Walker MM, Luzzi GA, Bell R, et al. Clinical Features and management of recurrent balanitis; association with atopy and genital washing]. Genitourin Med. October 1993; 69(5): 400-3. PMID. PMC. DOI. Retrieved 20 March 2021.
  15. ↑ REFjournal Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response?. Isr J Med Sci. January 1993; 29(1): 42-43. Retrieved 20 October 2019.
  16. ↑ a b REFjournal Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol. March 1983; 20(2): 189-201. Retrieved 20 October 2019.
  17. ↑ REFjournal Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol. December 1969; 81(12): 899-901. Retrieved 20 October 2019.
  18. ↑ REFjournal Hyman AB, Brownstein MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol. January 1969; 99(1): 31-36. Retrieved 20 October 2019.
  19. ↑ REFjournal Delbanco E. Über das gehäufte Auftreten von freien Talgdrüsen an der Innenfläche des Präputiums [About the increased occurrence of free sebaceous glands on the inner surface of the prepuce] (German). Monatshefte für praktische Dermatologie. 1904; 38: 536-538. Retrieved 20 October 2019.
  20. ↑ REFjournal Piccinno R, Carrel CF, Menni S, et al. sebacous glands mimicking molluscum contagiosum. Acta Derm Venerol. 1990; 70: 344-345.
  21. ↑ REFjournal Krompecher S. Die Histologie der Absonderung des Smegma praeputii [Histology of allocation of a smegma praeputii] (German). Anatomischer Anzeiger. 1932; 75: 170-176.
  22. ↑ REFjournal Frohlich E, Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol. February 1993; 20(1): 54-60.
  23. ↑ REFweb Hill, George (7 September 2003). Summary of evidence that the foreskin and lysozyme may protect against HIV infection. Retrieved 20 October 2019.
  24. ↑ REFjournal Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohistochemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands. Arch Dermatol Res. 1995; 287(8): 764-766. Retrieved 20 October 2019.
  25. ↑ REFjournal de Witte L, Nabatov A, Pion M, Fluitsma D, de Jong MAWP, de Gruijl T, Piguet V, van Kooyk Y, Geijtenbeek TBH. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells PDF. Nature Medicine. 4 March 2007; 13(3): 367-71. PMID. PMC. DOI. Retrieved 6 October 2022.
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