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{{Construction Site}}The '''attachment of the foreskin''' to the [[penis]] may occur in three different ways that tend to be confusingeven to medical doctors. They are ''fusion'', ''adhesion'', and the ''frenulum''.
Baby boys 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
→Frenulum: Wikify; add text.
== Fusion ==
|last=Deibart
|init=GA
|DOI=https://doi.org/10.1002/ar.1090570409
|accessdate=2023-05-09
}}</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
|init=MA
}}</ref>
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.<ref name="gracelykilgore1984">{{REFjournal
|last=Gracely-Kilgore
|first=Katherine
|init=K
|author-link=
|etal=no
|title=Penile adhesion: the hidden complication of circumcision
|trans-title=
|language=English
|journal=Nurse Pract
|location=
|date=1984
|volume=9
|issue=5
|pages=22-4
|url=http://www.cirp.org/library/complications/gracely1/
|archived=
|quote=
|pubmedID=6728346
|pubmedCID=
|DOI=
|accessdate=2023-05-09
}}</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]].
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.<ref>{{REFjournal
|last=Pitts
|first=
|init=D
|author-link=
|last2=Aponte-Colon
|first2=
|init2=D
|author2-link=
|last3=Chalmers
|first3=
|init3=D
|author3-link=
|etal=no
|title=Resolution of post-circumcision penile adhesions in newborns
|trans-title=
|language=
|journal= J Pediatr Urol
|location=
|date=2022-04
|volume=18
|issue=2
|article=
|page=
|pages=183e1-183-e5
|url=https://www.jpurol.com/article/S1477-5131(21)00593-3/fulltext
|archived=
|quote=
|pubmedID=34980556
|pubmedCID=
|DOI=10.1016/j.jpurol.2021.12.010
|accessdate=2023-05-11
}}</ref>
Adhesions are pathological and require treatment by a urological surgeon.<ref>{{REFdocument
|title=Freeing of Preputial (Foreskin) Adhesions
|url=https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Preputial%20adhesions.pdf
|contribution=
|last=Anonymous
|first=
|publisher=British Association of Urological Surgeons (BAUS)
|format=PDF
|date=2017-06
|accessdate=2023-05-09
}}</ref>
== Frenulum ==
A frenulum is a small frenum or bridle.<ref>{{REFweb
|url=https://medical-dictionary.thefreedictionary.com/Frenulum
|title=Frenulum
|last=
|first=
|init=
|publisher=The Free Dictionary by Farlex
|date=2012
|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
|title=Possible function of the frenulum of prepuce in penile erection
|trans-title=
|language=
|journal=Andrologia
|location=
|date=2012-12
|volume=44
|issue=1
|pages=23-5
|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>
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.
{{SEEALSO}}
* [[Development of retractable foreskin]]
{{REF}}
[[Category:Circumcision complication]]
[[Category:Circumcision risk]]
[[Category:Foreskin anatomy]]
[[Category:Penile anatomy]]