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Foreskin

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normalize et al. (AMA)
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Purpura ''et al.'' (2018) describe 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
|DOI=
|accessdate=2019-10-14
}}</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 mucosae. 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" />
=== 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 desttroy 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 [[Langerhans 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>{{REFjournal
|last=de Witte
|first=Lot
Lakshamanan & Prakash (1980) report the "prepuce covers the glans completely and snugly like a hosiered material and continues to do so through the entire span of life of the male", which they explain as being caused by the smooth muscle fibers within the prepuce. The prepuce is free to glide back and forth. When it does, it must stretch to go over the glans penis.<ref name="lakshmanan-prakash1980" />
Taylor ''et al.'' (1996) carried out a histological study of the foreskin. (Histology is the microscopic examination of cells and tissues.) Taylor ''et al''. found an area of rete ridges just inside the tip of the foreskin that he called the [[ridged band]]. The ridges were found to have nerve endings at the top of the ridges. They report that the ridged band area moves to the shaft of the penis when the penis becomes erect where the nerves are subject to stimulation. They stated:
<blockquote>
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>
Sorrells ''et al.'' (2007) conducted a fine-touch study of the penis of both circumcised and 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>
Bronselaer ''et al''. (2013) surveyed a large group 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 was stimulated by themselves or their partners from ‘mild’ to ‘very strong’ and 61.9% the respective orgasm from ‘mild’ to ‘very strong’.
===Sexual behavior===
Laumann ''et al''. (1997) report that men who lack a foreskin "engage in a somewhat more elaborated set of sexual practices than do men who are not 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
|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
Cold & Taylor (1999) commented, "The increased frequency of [[masturbation]], anal intercourse and fellatio reported by circumcised men in the USA may possibly be due to the sensory imbalance caused by circumcision. Clearly, amputation of the prepuce causes changes in sexual behaviour in human males and females."<ref name="cold-taylor1999" />
Frisch ''et al''. (2013) 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="morten-lindholm2013">{{REFjournal
|last=Frisch
|first=Morten
}}</ref>
Morten ''et al''. (2013) 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, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment."<ref name="morten-lindholm2013"/>
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