Difference between revisions of "Attachment of the foreskin"

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The '''attachment of the foreskin''' to the [[penis]] may occur in three different ways that tend to be confusing even to medical doctors. They are ''fusion'', ''adhesion'', and the ''frenulum''.
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The '''attachment of the foreskin''' to the [[penis]] may occur in three different ways that tend to be confusing. They are ''fusion'', ''adhesion'', and the ''frenulum''.
 
 
== Fusion ==
 
== Fusion ==
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Baby boys are born with the inner surface of their [[foreskin]] fused with the underlying [[glans penis]] by the balano-preputial lamina,<ref name="deibart1933">{{REFjournal
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Boys are born with the inner surface of their [[foreskin]] fused with the underlying [[glans penis]] by a [[synechia]] named the balano-preputial lamina,<ref name="deibart1933">{{REFjournal
 
  |last=Deibart
 
  |last=Deibart
 
  |init=GA
 
  |init=GA
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  |DOI=https://doi.org/10.1002/ar.1090570409
 
  |DOI=https://doi.org/10.1002/ar.1090570409
 
  |accessdate=2023-05-09
 
  |accessdate=2023-05-09
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}}</ref> which is a thin sheet of connective tissue. The balano-preputial lamina seals the [[preputial sac]] and prevents [[infection]]. It spontaneously breaks down over a widely-variable span of years and releases the foreskin from the glans penis.
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}}</ref> which is a thin sheet of connective tissue. The balano-preputial lamina seals the [[preputial sac]] and prevents [[infection]].<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref> It spontaneously breaks down over a widely-variable span of years (from about 6 to 17) and releases the [[foreskin]] from the [[glans penis]]. The average age of first foreskin retraction in Danish boys was found to be 10.4 years of age. One half were earlier and one half were later. <ref name="Thorvaldsen">{{REFjournal
 +
|last=Thorvaldsen
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|init=MA
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|last2=Meyhoff
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|init2=H
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|title=Patologisk eller fysiologisk fimose?
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|trans-title=Pathological or physiological phimosis?
 +
|language=Danish
 +
|journal=Ugeskr Læger
 +
|volume=167
 +
|issue=17
 +
|pages=1858-1862
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|url=http://www.cirp.org/library/normal/thorvaldsen1/
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|quote=
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|pubmedID=
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|pubmedCID=
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|DOI=
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|date=2005
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|accessdate=2023-05-09
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}}</ref>
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Fusion of the [[foreskin]] in boys is normal, natural, healthy, and does ''not'' indicate need for treatment. It is erroneous to mischaracterize fusion as an adhesion.
 +
 
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==Adhesion==
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An adhesion of the [[foreskin]] to the [[glans penis]] is abnormal, pathological, and usually iatrogenic. They frequently occur as a [[complication]] of [[circumcision]] of the newborn.<ref name="gracelykilgore1984">{{REFjournal
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|last=Gracely-Kilgore
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|first=Katherine
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|init=K
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|author-link=
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|etal=no
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|title=Penile adhesion: the hidden complication of circumcision
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|trans-title=
 +
|language=English
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|journal=Nurse Pract
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|location=
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|date=1984
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|volume=9
 +
|issue=5
 +
|pages=22-4
 +
|url=http://www.cirp.org/library/complications/gracely1/
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|archived=
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|quote=
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|pubmedID=6728346
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|pubmedCID=
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|DOI=
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|accessdate=2023-05-09
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}}</ref>
 +
 
 +
To effect a [[circumcision]] of a newborn boy, the natural healthy fusion described above must first be destroyed, which is done by the passage of a blunt probe between the infant [[foreskin]] and the [[glans penis]], which leaves both surfaces in a  raw state. The [[foreskin]] is then [[Excision| excised]], leaving the residual shaft skin in a raw condition. Sutures are not used in circumcision of infants so the raw cut end of the shaft skin is free to fall where it may. In some cases it falls on the raw [[glans penis]] and the two heal together, thus forming an adhesion. Adhesions take many forms.<ref name="gracelykilgore1984" /> One common form is the [[skin bridge]].
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An adhesion may form in adults when a foreskin is not retracted for a very long time.
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Adhesions are not fusions and do not have a balanopreputial lamina, so they are unlikely to spontaneously disintegrate.<ref>{{REFjournal
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|last=Pitts
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|first=
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|init=D
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|author-link=
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|last2=Aponte-Colon
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|first2=
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|init2=D
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|author2-link=
 +
|last3=Chalmers
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|first3=
 +
|init3=D
 +
|author3-link=
 +
|etal=no
 +
|title=Resolution of post-circumcision penile adhesions in newborns
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|trans-title=
 +
|language=
 +
|journal= J Pediatr Urol
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|location=
 +
|date=2022-04
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|volume=18
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|issue=2
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|article=
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|page=
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|pages=183e1-183-e5
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|url=https://www.jpurol.com/article/S1477-5131(21)00593-3/fulltext
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|archived=
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|quote=
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|pubmedID=34980556
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|pubmedCID=
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|DOI=10.1016/j.jpurol.2021.12.010
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|accessdate=2023-05-11
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}}</ref>
  
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Adhesions are pathological and require treatment by a urological surgeon.<ref>{{REFdocument
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|title=Freeing of Preputial (Foreskin) Adhesions
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|url=https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Preputial%20adhesions.pdf
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|contribution=
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|last=Anonymous
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|first=
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|publisher=British Association of Urological Surgeons (BAUS)
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|format=PDF
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|date=2017-06
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|accessdate=2023-05-09
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}}</ref>
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== Frenulum ==
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A frenulum is a small frenum or bridle.<ref>{{REFweb
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|url=https://medical-dictionary.thefreedictionary.com/Frenulum
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|title=Frenulum
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|last=
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|first=
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|init=
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|publisher=The Free Dictionary by Farlex
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|date=2012
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|accessdate=2023-05-10
 +
}}</ref> The [[frenulum]] of the [[penis]], often known simply as the frenulum (from Latin: frēnulum, lit. 'little bridle'), is a thin elastic strip of tissue on the underside (ventral side) of the [[glans]] and the neck of the human [[penis]]. In men who are not [[circumcised]], it also connects the [[foreskin]] to the [[glans]] and the ventral [[mucosa]].
 +
 +
The frenulum has several important functions. The [[frenular artery]], which supplies blood to the [[glans penis]], passes through the frenulum.  The [[frenulum]] serves to limit retraction of the [[foreskin]]. The frenulum is erogenous tissue important for penile erection, so stretching of the [[frenulum]] also may induce orgasm.<ref>{{REFjournal
 +
|last=Song
 +
|first=
 +
|init=B
 +
|author-link=
 +
|last2=Cai
 +
|first2=
 +
|init2=C-M
 +
|author2-link=
 +
|etal=no
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|title=Possible function of the frenulum of prepuce in penile erection
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|trans-title=
 +
|language=
 +
|journal=Andrologia
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|location=
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|date=2012-12
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|volume=44
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|issue=1
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|pages=23-5
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|url=https://onlinelibrary.wiley.com/doi/10.1111/j.1439-0272.2010.01099.x
 +
|archived=
 +
|quote=
 +
|pubmedID=22126255
 +
|pubmedCID=
 +
|DOI=10.1111/j.1439-0272.2010.01099.x
 +
|accessdate=2023-05-10
 +
}}</ref>
  
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The frenulum may look somewhat like an adhesion, however it is a functional, natural part of the [[penis]], which is normal and supposed to be there.
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{{SEEALSO}}
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* [[Development of retractable foreskin]]
 
{{REF}}
 
{{REF}}
  
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[[Category:Circumcision complication]]
 
[[Category:Circumcision complication]]
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[[Category:Circumcision risk]]
 
[[Category:Foreskin anatomy]]
 
[[Category:Foreskin anatomy]]
 
[[Category:Penile anatomy]]
 
[[Category:Penile anatomy]]

Latest revision as of 19:04, 12 February 2024

The attachment of the foreskin to the penis may occur in three different ways that tend to be confusing even to medical doctors. They are fusion, adhesion, and the frenulum.

Fusion

Boys are born with the inner surface of their foreskin fused with the underlying glans penis by a synechia named the balano-preputial lamina,[1] which is a thin sheet of connective tissue. The balano-preputial lamina seals the preputial sac and prevents infection.[2] It spontaneously breaks down over a widely-variable span of years (from about 6 to 17) and releases the foreskin from the glans penis. The average age of first foreskin retraction in Danish boys was found to be 10.4 years of age. One half were earlier and one half were later. [3]

Fusion of the foreskin in boys is normal, natural, healthy, and does not indicate need for treatment. It is erroneous to mischaracterize fusion as an adhesion.

Adhesion

An adhesion of the foreskin to the glans penis is abnormal, pathological, and usually iatrogenic. They frequently occur as a complication of circumcision of the newborn.[4]

To effect a circumcision of a newborn boy, the natural healthy fusion described above must first be destroyed, which is done by the passage of a blunt probe between the infant foreskin and the glans penis, which leaves both surfaces in a raw state. The foreskin is then excised, leaving the residual shaft skin in a raw condition. Sutures are not used in circumcision of infants so the raw cut end of the shaft skin is free to fall where it may. In some cases it falls on the raw glans penis and the two heal together, thus forming an adhesion. Adhesions take many forms.[4] One common form is the skin bridge.

An adhesion may form in adults when a foreskin is not retracted for a very long time.

Adhesions are not fusions and do not have a balanopreputial lamina, so they are unlikely to spontaneously disintegrate.[5]

Adhesions are pathological and require treatment by a urological surgeon.[6]

Frenulum

A frenulum is a small frenum or bridle.[7] The frenulum of the penis, often known simply as the frenulum (from Latin: frēnulum, lit. 'little bridle'), is a thin elastic strip of tissue on the underside (ventral side) of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa.

The frenulum has several important functions. The frenular artery, which supplies blood to the glans penis, passes through the frenulum. The frenulum serves to limit retraction of the foreskin. The frenulum is erogenous tissue important for penile erection, so stretching of the frenulum also may induce orgasm.[8]

The frenulum may look somewhat like an adhesion, however it is a functional, natural part of the penis, which is normal and supposed to be there.

See also

References

  1. ↑ REFjournal Deibart GA. The separation of the prepuce in the human penis. Anat Rec. 1933; 57: 387-99. DOI. Retrieved 9 May 2023.
  2. ↑ 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.
  3. ↑ REFjournal Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? [Pathological or physiological phimosis?] (Danish). Ugeskr Læger. 2005; 167(17): 1858-1862. Retrieved 9 May 2023.
  4. ↑ a b REFjournal Gracely-Kilgore K. Penile adhesion: the hidden complication of circumcision. Nurse Pract. 1984; 9(5): 22-4. PMID. Retrieved 9 May 2023.
  5. ↑ REFjournal Pitts D, Aponte-Colon D, Chalmers D. Resolution of post-circumcision penile adhesions in newborns. J Pediatr Urol. April 2022; 18(2): 183e1-183-e5. PMID. DOI. Retrieved 11 May 2023.
  6. ↑ REFdocument Anonymous: Freeing of Preputial (Foreskin) Adhesions PDF, British Association of Urological Surgeons (BAUS). (June 2017). Retrieved 9 May 2023.
  7. ↑ REFweb (2012). Frenulum, The Free Dictionary by Farlex. Retrieved 10 May 2023.
  8. ↑ REFjournal Song B, Cai C-M. Possible function of the frenulum of prepuce in penile erection. Andrologia. December 2012; 44(1): 23-5. PMID. DOI. Retrieved 10 May 2023.
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