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. 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 frequently iatrogenic. They frequently occur as a complication of circumcision of the newborn.[4]

To effect a circumcision of a newborn boy, the natural 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 when a foreskin is not retracted for a very long time.

Adhesions are not fusions and do not have a balanopreputial lamina, so they will not spontaneously disintegrate.

Adhesions are pathological and require treatment by a urological surgeon.[5]

Frenulum

A frenulum is a small frenum or bridle.[6] 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.

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. ↑ REFdocument Anonymous: Freeing of Preputial (Foreskin) Adhesions PDF, British Association of Urological Surgeons(BAUS). (June 2017). Retrieved 9 May 2023.
  6. ↑ REFweb (2012). Frenulum, The Free Dictionary by Farlex. Retrieved 10 May 2023.
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