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Although it was circumcision promoter [[Abraham L. Wolbarst]] (1914} once claimed that the human [[foreskin]] was filthy and harbored disease and [[infection]], <ref name="wolbarst1914">{{REFjournal |last=Wolbarst |first=Abraham L. |init=AL |author-link=Abraham L. Wolbarst |title=Universal Circumcision as a Sanitary Measure |journal=JAMA |date=1914-1-10 |volume=62 |issue=2 |pages=92-97 |url=https://jamanetwork.com/journals/jama/article-abstract/453164 |accessdate=2022-08-11}}</ref> in reality the opposite is true. The [[foreskin]] is designed by nature to be self -cleaning and to provide significant natural '''immunological and protective function''' against all types of [[infection]], including [[HIV]].
== The protective and hygienic function of the foreskin ==
The [[foreskin]], like the eyelid, also serves an important protective and hygienic function. The [[foreskin ]] protects the delicate [[glans]] of the [[penis]] and puts the [[urethra ]] at a distance form from its environment, protecting it from foreign contaminants and pathogens of all kinds while simultaneously shielding the [[penis ]] from injury. It is a double fold of [[skin ]] which offers two layers of protectionto 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
|last=Deibert
|firstinit=G.A.GA
|author-link=
|title=The separation of the prepuce in the human penis
|url=http://www.cirp.org/library/anatomy/deibert/
|journal=Anatomical Record
|date=19931933-11
|volume=57
|issue=4
|pages=387-3999
|accessdate=2019-10-20
}}</ref> The [[preputial cavity sac]] is sealed by the synechia so it cannot be infected.
In infancy, the foreskin's tubular neck (prepucial orifice) is often long and narrow while the [[Dartos]] sphincter muscle in the tip of the [[foreskin ]] keeps its opening closed. This acts as an extension of the [[urethra]].<ref>{{REFjournal
|last=Hunter
|firstinit=R.H.RH
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1249280/pdf/janat00534-0090.pdf
|title=Notes on the development of the prepuce
}}</ref><ref>{{REFjournal
|last=Glenister
|firstinit=TTW |url=https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1956.Wtb04763.x
|title=A consideration of their process involved in the development of the prepuce in man
|journal=Br J Urol
|pages=243-249
}}</ref>
Together, these properties prevent the entry of contaminants.<ref name="fleiss-hodges-vanhowe1998">{{REFjournal |last=Fleiss |first=P. |author-link=Paul M. Fleiss |last2=Hodges |first2=F. |author2-link=Frederick M. Hodges |last3=Van Howe |first3=R.S. |author3-link=Robert S. Van Howe |title=Immunological functions of the human prepuce |journal=Sex Trans Infect |date=FleissP HodgesF VanHoweRS 1998-10 |volume=74 |issue=5 |pages=364-67 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758142/pdf/v074p00364.pdf |quote= |pubmedID=10195034 |pubmedCID= |DOI= |accessdate=2019-10-15}}</ref> The [[foreskin ]] protects the infant [[glans penis ]] from ammonia in diapers (nappies) and prevents meatal ulcer and [[meatal stenosis]].<ref>{{REFjournal |last=Gairdner |first=Douglas |author-link=Douglas Gairdner |etal=no |title=The fate of the foreskin: a study of circumcision |trans-title= |language= |journal=Br Med J |location= |date=GairdnerDM 1949-12-24 |volume=2 |issue= |pages=1433-7 |url=http://www.cirp.org/library/general/gairdner/ |quote= |pubmedID=15408299 |pubmedCID=2051968 |DOI=10.1136/bmj.2.4642.1433 |accessdate=2019-01-10}}</ref> <ref name="vanhowe2006">{{REFjournal
|last=Van Howe
|firstinit=R.S.RS
|author-link=
|title=Incidence of meatal stenosis following neonatal circumcision in a primary care setting
|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
}}</ref> <ref>{{REFjournal
|last=Upadhyay
|firstinit=V
|author-link=
|last2=Hammodat
|first2init2=HM
|author2-link=
|last3=Pease
|first3init3=PW
|author3-link=
|etal=no
}}</ref>
Natural secretions of oil are achieved by sebaceous glands which are abound in the [[foreskin]]'s inner lining, these are not present in the [[glans penis]].<ref name="hyman-brownstein1969">{{REFjournal
|last=Hyman
|firstinit=A.B.AB
|last2=Brownstein
|first2init2=M.H.MH
|url=https://jamanetwork.com/journals/jamadermatology/article-abstract/530842
|title=Tyson's "glands": ectopic sebaceous glands and papillomatosis penis
|pages=31-36
|accessdate=2019-10-20
}}</ref> They are also present in the eye lid eyelid and perform the same function in both places. They secrete the oils necessary to keep the [[glans ]] surface soft, moist, smooth, warm, sensitive, and with a healthy glistening red or purple color. This moisturizer also maintains PH balance, and optimal cleanliness. This is required to keep the surface of the glans healthy and clean via the cleaning effects of mucous secretions. Again, this function is analogous to the eye lid. The [[glans penis ]] is meant to be an internal organ covered and protected from the outside world.
In the genitally [[intact ]] [[penis ]] the [[urine ]] stream flushes out the [[urethra ]] and [[foreskin ]] of foreign microbes. In healthy individuals, [[urine ]] is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of [[urine ]] as it rushes through the [[foreskin ]] flushes it out effortlessly and naturally.<ref name="parkash-jeykumar1973">{{REFjournal
|last=Parkash
|firstinit=S.
|last2=Jeykumar
|first2init2=S.
|last3=Subramanyan
|first3init3=K.
|last4=Chaudhuri
|first4init4=S.
|url=http://www.cirp.org/library/anatomy/parkash/
|title=Human subpreputial collection: its nature and formation
}}</ref>
Though [[urine ]] passes through the [[foreskin ]] every day, the inner foreskin is remarkably free of urea — a by-product of liver metabolism that is secreted in [[urine]]. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of [[seminal vesicles]], prostate, and urethral [[urethra]]l mucous glands, collectively or individually, keep the foreskin clear and clean as well.<ref>{{REFjournal
|last=Parkash
|firstinit=S.
|title=Penis: some facts and fancies
|journal=Journal of Physician's Association of Madras
}}</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" />
In comparison, due to the open wounds and raw [[bleeding ]] flesh, 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 and contaminants.<ref name="vanhowe1997">{{REFjournal
|last=Van Howe
|firstinit=R.S.RS
|author-link=Robert Van Howe
|url=https://bjui-journals.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410X.1997.00467.x
|title=Variability in penile appearance and penile findings: a prospective study
|journal=Br J Urol
|volume=80
|pages=776-782
|DOI=10.1046/j.1464-410X.1997.00467.x
|accessdate=2019-10-20
}}</ref> [[Circumcised ]] boys are also found to be more likely to develop [[balanitis]], [[meatitis]], coronal adhesions , and [[meatal stenosis]].<ref name="vanhowe1997"/> Excessive washing and the use of soap inside the [[foreskin]] should be avoided.<ref name="birley1993">{{REFjournal |last=Birley |init=HDL |author-link= |last2=Walker |init2=MM |author2-link= |last3=Luzzi |init3=GA |author3-link= |last4=Bell |init4=R |author4-link= |etal=yes |title=Clinical Features and management of recurrent balanitis; association with atopy and genital washing] |trans-title= |language= |journal=Genitourin Med |location= |date=1993-10 |volume=69 |issue=5 |pages=400-3 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195128/pdf/genitmed00029-0074.pdf |quote= |pubmedID=8244363 |pubmedCID=1195128 |DOI=10.1136/sti.69.5.400 |accessdate=2021-03-20}}</ref>
== The immunological function of the foreskin ==
The foreskin's inner fold and the [[glans ]] of the [[penis ]] are comprised of [[Preputial mucosa| mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.
Certain components such as [[Langerhans cells]],<ref>{{REFjournal
|last=Weiss
|firstinit=G.N.GN
|last2=Sanders
|first2init2=M.
|last3=Westbrook
|first3init3=K.C.KC
|url=http://www.circumstitions.com/Langerhans.html
|title=The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response?
}}</ref> plasma cells,<ref name="flower1983">{{REFjournal
|last=Flower
|firstinit=P.J.PJ
|last2=Ladds
|first2init2=P.W.PW
|last3=Thomas
|first3init3=A.D.AD
|last4=Watson
|first4init4=D.L.DL
|url=https://journals.sagepub.com/doi/abs/10.1177/030098588302000206
|title=An immunopathologic study on the bovine prepuce
}}</ref> apocrine glands,<ref>{{REFjournal
|last=Ahmed
|firstinit=A.
|last2=Jones
|first2init2=A.W.AW
|url=https://www.academia.edu/5687437/APOCRINE_CYSTADENOMA_A_REPORT_OF_TWO_CASES_OCCURRING_ON_THE_PREPUCE
|title=Apocrine Cystadenoma: a report of two cases occurring on the prepuce
}}</ref> and sebaceous glands,<ref>{{REFjournal
|last=Hyman
|firstinit=A.B.AB
|last2=Brownstein
|first2init2=M.H.MH
|title=Tyson's "glands": ectopic sebaceous glands and papillomatosis penis
|journal=Arch Dermatol
}}</ref><ref>{{REFjournal
|last=Delbanco
|firstinit=E.
|title=Über das gehäufte Auftreten von freien Talgdrüsen an der Innenfläche des Präputiums
|trans-title=About the increased occurrence of free sebaceous glands on the inner surface of the prepuce
}}</ref><ref>{{REFjournal
|last=Piccinno
|firstinit=R.
|last2=Carrel
|first2=CCh.-F. |init2=CF
|last3=Menni
|first3init3=S.
|etal=yes
|title=sebacous glands mimicking molluscum contagiosum
|last=Krompecher
|first=St.
|init=S
|title=Die Histologie der Absonderung des Smegma praeputii
|trans-title=Histology of allocation of a smegma praeputii
}}</ref>, collectively secrete emollient lubricants.<ref name="parkash-jeykumar1973"/> Apocrine glands perform a crucial function by secreting enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, and neutrophil elastase.<ref>{{REFjournal
|last=Frohlich
|firstinit=E.
|last2=Shamburg-Lever
|first2init2=G.
|last3=Klesses
|first3init3=C.
|title=Immunelectron microscopic localization of cathepsin B in human apocrine glands
|journal=J Cutan Pathol
}}</ref>
There is also some research to suggest that lysozyme may protect against [[HIV ]] infection.<ref>{{REFweb
|first=George
|last=Hill
Apocrine glands also produce cytokine,<ref>{{REFjournal
|last=Ahmed
|firstinit=A.A.AA
|last2=Nordlind
|first2init2=K.
|last3=Schultzberd
|first3init3=M.
|last4=Liden
|first4init4=S.
|url=https://link.springer.com/article/10.1007%2FBF01105803
|title=Immunohistochemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands
|accessdate=2019-10-20
}}</ref> which is a very important non-antibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin.<ref name="flower1983"/>
It is also very important to note that [[Langerhans cells ]] that are present in the [[foreskin ]] produce ''Langerin'', a substance that has been proven to kill human immunodefiency viris immunodeficiency virus ([[HIV]]) on contact.<ref>{{REFjournal |last=de Witte |first=L. |last2=Nabatov |first2=A. |last3=Pion |first3=M. |DeWitte etal=yes |url=http://www.cirp.org/news/healthday2007-03-05/ |title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells |journal=Nat Med |date=2007-03 |volume=13 |issue=3 |pages=367-371 |accessdate=2019-10-20}}</ref>
All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998" />
{{SEEALSO}}
* [[Breastfeeding]]
* [[Circumcision and STDs]]
* [[Circumcision and HIV]]
* [[Development of retractable foreskin]]
* [[Foreskin]]
* [[Foreskin sensitivity]]
* [[Immunological protection of breastfeeding]]
* [[Keratinization]]
* [[Penis]]
* [[Pheromone]]
* [[Preputial sac]]
* [[Smegma]]
* [[Transudation]]
<!--In infancy, simple sugars in breast milk, like antibacterial oligosaccharides, are acquired from the mother's milk and excreted in urine. University studies have shown that these substances cling to the mucosal lining of the inner foreskin and protect against urinary tract infections,<ref>Hanson LA, Karlsson B, Jalil F, ''et al''. Antiviral and antibacterial factors in human milk. In{{LINKS}}* {{REFweb |url=http: Hanson LA, ed//www. ''Biology of Human Milk''intactaus. New York Raven Press; 1988. pp. 141-57<org/information/ref> as well as infections in other parts of the body.<ref>Coppa GV, Gabrielli O, Giorgi P, Catassi C, Montanari MP, Veraldo PE, Nichols BL. Preliminary study of breast feeding and bacterial adhesion to uroepithelial cells. ''Lancet'' 1990 Mar 10;335(8689):569-71.<functionsoftheforeskin/ref> Babies excrete in their urine about 300-500 milligrams of oligosaccharides each day. These compounds prevent virulent strains of ''Escherichia coli'' from adhering to the mucosal lining |title=Functions of the entire urinary tract, including the foreskin and glans. For these reasons breastForeskin |last=Helard |first=Lou |author-milk is highly efficacious at preventing UTI.<ref>Gothefors L, Olling S, Winberg J. Breastfeeding and biological properties of faecal ''E. coli'' strains. ''Acta Paediatr Scand'' 1975 Nov;54(6)link=Lou Helard |publisher=Intact Australia |website=http:807-12.</ref> Rigorous studies have repeatedly demonstrated that breast feeding protects against urinary tract infections.<ref>Mårild S. Breastfeeding and Urinary Tract Infections. ''Lancet'' 1990;336:942.</ref> <ref>Pisacane A, ''et al''www. Breastfeeding and urinary tract infectionintactaus. ''The Lancet'', July 7, 1990, p50 </ref> <ref>Pisacane A, Graziano L, Mazzarella G, ''et al''. Breastorg |date=2014-08-01 |accessdate=2020-feeding and urinary tract infection. ''J Pediatr'' 1992;120:8706-89.</ref>05}}
Researchers have shown that premature foreskin retraction can expose the penis to hospital strains of ''Escherichia coli'' and can result in UTI.<ref>Winberg J ''et al''. The prepuce: A mistake of nature? ''Lancet'' 1989, pp.598-99.</ref> Hence the protective function of the foreskin is in the child's best interest, especially during chemically treated diaper wearing years where feces mixed with urine can not only contaminate the permanently exposed urinary meatus but also the amputation wound from the circumcision surgery itself.
 
It is important to note that women have a higher risk of UTI. This is because the shorter urethra offers less protection via the immunological function of the urethra's mucosal lining. By the same observation we see that the tubular tip of the foreskin and its mucosal lining act as an extension of the urethra, hence providing more of that same protection via mucosa immunology and the adherence of antibacterial substances in breast milk. Understandably, removal of the foreskin destroys all this functionality.-->
{{SEEALSO}}
 
* [[Circumcision and Sexually Transmitted Diseases (STD)]]
* [[Foreskin]]
{{REF}}
[[Category:Education]]
[[Category:Foreskin anatomy]]
[[Category:Immunology]]
[[Category:Parental information]]
[[Category:Physiology]]
[[Category:Immunology]]
[[Category:From Intactipedia]]
[[Category:From IntactWiki]]
[[Category:Foreskin anatomy]]
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