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Immunological and protective function of the foreskin: Difference between revisions

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The efficacy of these various protective functions of the [[foreskin]] have now been demonstrated. Fendereski et al. (2024) reported a massive study using data from a private insurance company database that found that [[circumcised]] boys have three times as many penile issues as compared with [[intact]] boys through age 5. This study matched 852,051 [[circumcised]] boys with 852,051 [[intact]] boys who served as controls,<ref name="fendereski2024">{{REFjournal
|last=Fendereski
|first=
|init=K
|author-link=
|last2=Horns
|first2=
|init2=JJ
|author2-link=
|last3=Driggs
|first3=
|init3=N
|author3-link=
|last4=Lau
|first4=
|init4=G
|author4-link=
|last5=Shaeffer
|first5=
|init5=AJ
|author5-link=
|etal=no
|title=Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision
|trans-title=
|language=
|journal=J Pediatr Surg
|date=2024-11
|volume=59
|issue=11
|article=161614
|url=https://www.sciencedirect.com/science/article/abs/pii/S002234682400407X
|archived=
|quote=
|pubmedID=39084960
|pubmedCID=11486584
|DOI=10.1016/j.jpedsurg.2024.06.022
|accessdate=2025-01-03
}}</ref> so it is very strong statistically.


== 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]] provides physical protection of 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 traumatic 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]] provides physical protection of 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 traumatic injury.<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
|init=RS
|author-link=
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
|journal=Clin Pediatr (Phila)
|volume=45
|issue=1
|pages=49-54
|url=https://journals.sagepub.com/doi/10.1177/000992280604500108?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
|quote=
|pubmedID=16429216
|pubmedCID=
|DOI=10.1177/000992280604500108
|date=2006-01
|accessdate=2020-01-09
|note=Jan-Feb 2006
}}</ref> 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 fused with 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=243-249
  |pages=243-249
}}</ref>  
}}</ref>  
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
Together, these properties prevent the entry of pathogens and contaminants.<ref name="fleiss-hodges-vanhowe1998" /> <ref>{{REFjournal
|last=Van Howe
|init=RS
|author-link=
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
|journal=Clin Pediatr (Phila)
|volume=45
|issue=1
|pages=49-54
|url=https://journals.sagepub.com/doi/10.1177/000992280604500108?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
|quote=
|pubmedID=16429216
|pubmedCID=
|DOI=10.1177/000992280604500108
|date=2006-01
|accessdate=2020-01-09
|note=Jan-Feb 2006
}}</ref> <ref>{{REFjournal
  |last=Upadhyay
  |last=Upadhyay
  |init=V
  |init=V
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}}</ref>  
}}</ref>  


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 an uncovered, exposed [[penis]] that has been altered by [[circumcision]].<ref name="fleiss-hodges-vanhowe1998"/>  


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
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
Line 169: Line 208:
  |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]], [[Skin bridge| 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"/> Fendereski et al. (2024) reported a massive study using data from a private insurance company database that found that [[circumcised]] boys have three times as many penile issues as compared with [[intact]] boys through age 5.<ref name=fendereski2024">{{REFjournal
|last=Fendereski
|first=
|init=K
|author-link=
|last2=Horns
|first2=
|init2=JJ
|author2-link=
|last3=Driggs
|first3=
|init3=N
|author3-link=
|last4=Lau
|first4=
|init4=G
|author4-link=
|last5=Shaeffer
|first5=
|init5=AJ
|author5-link=
|etal=no
|title=Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision
|trans-title=
|language=
|journal=J Pediatr Surg
|date=2024-11
|volume=59
|issue=11
|article=161614
|url=https://www.sciencedirect.com/science/article/abs/pii/S002234682400407X
|archived=
|quote=
|pubmedID=39084960
|pubmedCID=11486584
|DOI=10.1016/j.jpedsurg.2024.06.022
|accessdate=2025-01-03
}}</ref>


After retraction commences, 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
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}}</ref>  
}}</ref>  


There is also some research to suggest that lysozyme may protect against [[HIV]] infection.<ref>{{REFweb
There is also some research to suggest that lysozyme protects against [[HIV]] infection.<ref>{{REFweb
  |first=George
  |first=George
  |last=Hill
  |last=Hill
  |author-link=George Hill
  |author-link=George Hill
  |url=http://www.cirp.org/library/disease/HIV/hill1/
  |url=https://www.cirp.org/library/disease/HIV/hill1/
  |title=Summary of evidence that the foreskin and lysozyme may protect against HIV infection
  |title=Summary of evidence that the foreskin and lysozyme may protect against HIV infection
  |date=2003-09-07
  |date=2003-09-07
  |accessdate=2019-10-20
  |accessdate=2019-10-20
}}</ref> <ref name="fleiss-hodges-vanhowe1998" />
}}</ref><ref name="fleiss-hodges-vanhowe1998"/>


Apocrine glands also produce cytokine,<ref>{{REFjournal
Apocrine glands also produce cytokine,<ref>{{REFjournal
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{{SEEALSO}}
{{SEEALSO}}
* [[Balanitis]]
* [[Breastfeeding]]
* [[Breastfeeding]]
* [[Care of intact, foreskinned boys]]
* [[Care of intact, foreskinned boys]]
* [[Circumcision and HIV]]
* [[Circumcision and STDs]]
* [[Circumcision and STDs]]
* [[Circumcision and HIV]]
* [[Development of retractable foreskin]]
* [[Development of retractable foreskin]]
* [[Foreskin]]
* [[Foreskin]]
* [[Foreskin sensitivity]]
* [[Foreskin sensitivity]]
* [[Immunological protection of breastfeeding]]
* [[Immunological protection of breastfeeding]]
* [[Jojoba]]
* [[Keratinization]]
* [[Keratinization]]
* [[Penis]]
* [[Penis]]
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  |accessdate=2020-06-05
  |accessdate=2020-06-05
}}
}}
* {{REFweb
|url=https://www.cirp.org/library/hygiene/
|title=Penile hygiene in the intact non-circumcised male
|last=Anonymous
|first=
|init=
|author-link=
|publisher=Circumcision Information Reference Library
|date=2013
|accessdate=2025-03-01
}}
* {{REFweb
|url=https://intactamerica.org/science-of-skin-and-foreskin/
|title=The Science Behind Skin and Its Role in Protecting Our Bodies
|last=Cartwright-Smith
|first=Jeffrey
|init=
|author-link=Jeffrey Cartwright-Smith
|publisher=[[Intact America]]
|date=2025-09-18
|accessdate=2025-10-02
}}
==Conclusion==
Male mammals have a foreskin. The [[foreskin]] evolved over millions of years to provide protection in difficult environments against [[trauma]] and [[infection]]. The various protections described in this article work best when the foreskin is of sufficient length to securely cover and protect the [[penis]] with the tip of the foreskin puckered closed by the [[dartos]] fascia at all times to protect against entry of irritants and pathogens. Urine has a healthy microbiome<ref name="cold-taylor1999">{{ColdCJ TaylorJR 1999}}</ref> when it leaves the urethra and is helpful for flushing out the [[foreskin]] and keeping it clean.
Many ill-informed sources will advise [[foreskinned]] men to retract their [[foreskin]] and wash their [[penis]] at least daily. This advice ignores the findings of medical science.<ref name="birley1993"/> Retraction of the foreskin provides an opportunity for pathogens to enter. Washing removes the protective substances found in the [[preputial sac]].
Washing with warm water is recommended before and after a sexual encounter and as necessary to remove accumulated [[smegma]]. The use of soap, body wash, and shampoo in the [[preputial sac]] should be avoided.


{{REF}}
{{REF}}
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[[Category:Education]]
[[Category:Education]]
[[Category:Foreskin anatomy]]
[[Category:Foreskin anatomy]]
[[Category:Foreskinned life]]
[[Category:Immunology]]
[[Category:Immunology]]
[[Category:Parental information]]
[[Category:Parental information]]
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