Immunological and protective function of the foreskin

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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 its environment, protecting it from foreign contaminants of all kinds while simultaneously shielding the penis from injury. It is a double fold of skin which offers two layers of protection.

Natural secretions of oil are achieved by sebaceous glands which are abound in the foreskins inner lining, these are not present in the glans. [1] They are also present in the eye lid 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 colour. 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 are 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. [2] 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 mucous glands, collectively or individually, keep the foreskin clear and clean as well. [3] At birth, the foreskin is usually attached to the glans(head) of the penis, akin to how a fingernail is attached to a finger. [4] At infancy the foreskins tubular neck(prepucial orifice) is often long and narrow while the sphincter muscle in the tip of the foreskin keeps its opening closed. This acts as an extension of the urethra. [5] [6] Together, these properties prevent the entry of contaminants. 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.

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. [7] Circumcised boys are also found to be more likely to develop balanitis, meatitis, coronal adhesions and meatal stenosis. [8]

The immunological function of the foreskin

The foreskins inner fold and the glans of the penis are comprised of 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 defensive for the body's orifices. These mucous membranes perform many immunological and hygienic functions. Certain components such as Langerhans cells [9] plasma cells [10] apocrine glands, [11] and sebaceous glands, [12] [13] [14] [15], collectively secrete emolliating lubricants. [16] Apocrine glans perform a crucial function by secreting enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, and neutrophil elastase. [17] There is also strong research to suggest that lysozyme can protect against HIV infection [18] Apocrine glands also produce cytokine, [19] which is a very important nonantibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin. [20]

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 the HI-virus on contact. [21] 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. [22]

In infancy, simple sugars in breast milk, like antibacterial oligosaccharides, are acquired from the mothers 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 [23] , as well as infections in other parts of the body. [24] 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 of the entire urinary tract, including the foreskin and glans. For these reasons breast-milk is highly efficacious at preventing UTI. [25] Rigorous study's have repeatedly demonstrated that breast feeding protects against urinary tract infections. [26] [27] [28] Researchers have shown that premature foreskin retraction can expose the penis to hospital strains of Escherichia coli and can result in UTI. [29] 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.

References

  1. ↑ Hyman AB, Brownstien MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
  2. ↑ Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
  3. ↑ Parkash S. Penis: some facts and fancies. Journal of Physician's Association pf Madras June 1982: pp.1-13
  4. ↑ Diebert GA. The separation of the prepuce in the human penis. Anatomical Record 1993 Nov;57(4):387-99.
  5. ↑ Hunter RH. Notes on the development of the prepuce. Journal of Anatamy 1935 Oct;70(1):6875.
  6. ↑ Glenister TW. A consideration of their process involved in the development of the prepuce in man. Br J Urol 1956 Sep;28(3):243-9
  7. ↑ Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80: 776-782.
  8. ↑ Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80: 776-782.
  9. ↑ Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? Isr J Med Sci 1993 Jan;29(1);42-3
  10. ↑ Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
  11. ↑ Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
  12. ↑ Hyman AB, Brownstien MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
  13. ↑ Delbanco E. Über das gehäufte Aufreten von Talgdrusen an der Innerflähe des Präputium. Monatshefte für praktishe Dermatologie 1904; 38:536-8.
  14. ↑ Piccinno R, Carrel C-F, Menni S. et al. sebacous glands mimicking molluscum contagiosum Acta Derm Venerol1990;70:344-5.
  15. ↑ Krompecher St. Die Histologie der Absonderung fur Smegma Praeputi. Anatomischer Anzeiger 1932; 75:170-176.
  16. ↑ Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
  17. ↑ Frohlich E Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol 1993 Feb;20(1):54-60
  18. ↑ George Hill Summary of evidence that the foreskin and lysozyme may protect against HIV infection.7 September 2003 http://www.cirp.org/library/disease/HIV/hill1/
  19. ↑ Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohisto chemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands Arch
  20. ↑ Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
  21. ↑ de Witte L, Nabatov A, Pion M, et al. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med 2007 Mar;13(3):367-71 http://www.cirp.org/news/healthday2007-03-05/
  22. ↑ P M Fleiss, F M Hodges, R S Van Howe. Immunological functions of the human prepuce. SEXUALLY TRANSMITTED INFECTIONS (London), Volume 74, Number 5, Pages 364-367, October 1998.http://www.cirp.org/library/disease/STD/fleiss3/
  23. ↑ Hanson LA, Karlsson B, Jalil F, et al. Antiviral and antibacterial factors in human milk. In: Hanson LA, ed. Biology of Human Milk. New York Raven Press; 1988. pp. 141-57
  24. ↑ 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. Lemcet 1990 Mar 10;335(8689):569-71.
  25. ↑ Gothefors L, Olling S, Winberg J. Breastfeeding and biological properties of faecal E. coli strains. Acta Paediatr Scand 1975 Nov;54(6):807-12
  26. ↑ Mårild S. Breastfeeding and Urinary Tract Infections. Lancet 1990;336:942
  27. ↑ Pisacane A, et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990, p50
  28. ↑ Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.
  29. ↑ Winberg J et al. The Prepuce: A Mistake of Nature? Lancet 1989, pp.598-99.
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