CIRCUMCISION INFORMATION NETWORK Volume 3, Number 9, 2 March 1996 E-mail: CircInfoNe@aol.com The purpose of this weekly bulletin is to educate the public about and to protect children and other non-consenting persons from genital mutilation. Readers are encouraged to copy and redistribute it, and to contribute written material. --Rich Angell, Editor. FROM THE OFFICE OF: NOCIRC, RE: NATURE PROJECT Contributed by PAHadrian@aol.com Dear Friends, In preparation for the 4th International Symposium on Sexual Mutilation at the University of Lausanne, 9-11 August 1996, NOCIRC is mounting an international publicity campaign. The purpose of the symposium is to tell the world what is happening to our children and to enlist world support to save our children from the threat of sexual mutilation. Europeans are largely unaware that circumcision is even practiced in the United States. International pressure will help the American medical community to stop this practice. NOCIRC will be placing several detailed and beautifully designed advertisements in the internationally acclaimed science journal Nature. They will appear in the April 21 and March 11 issues of Nature. Nature has a regular international readership of 400,000. In addition, the issues in which our ads will appear will be distributed gratis to the attendees of three separate international medical conferences, one in Zurich, one in Washington, DC, and one in Vancouver. This means that an additional ten to twenty thousand North American and European physicians and science professionals will see the ad, learn about the issue, learn about the Symposium, and be enticed to attend. NOCIRC needs your help to pay for these important ads. We need a total of $1,170.00 by March 10 to make this important publicity campaign possible. The success of the symposium is dependent upon enlisting international support in order to strengthen the world-wide movement against the genital mutilation of our children. Please give generously. All contributions are tax deductible. Together we can make this happen. The cost of the Nature advertisements is a small price to pay for the first step towards the world-wide eradication of genital mutilation. Please send your contribution to NOCIRC [see address below], and please remember to write "Nature Project" on your check. For the Children, Frederick Hodges, Special Projects Director THE PREPUCE, SPECIALIZED MUCOSA OF THE PENIS, AND ITS LOSS TO CIRCUMCISION British Journal of Urology, February 1996, Vol. 77, P291-5. Contributed by dyks96a@prodigy.com (George Hill) Article by R.TAYLOR, A.P.LOCKWOOD and A.J.TAYLOR, Department of Pathology, Health Sciences Centre, University of Manitoba, Winnipeg. Manitoba, Canada. (Third of a multi-part series.) Ridged and smooth mucosal surfaces When retracted, the inner surface of the prepuce displays two zones, 'ridged' and 'smooth' (Fig. 3). The first, a transversely-ridged band of mucosa 10-15 mm wide, lies against the true skin edge, forming the outer surface of the tip of the prepuce. In the dorsal midline. the 'ridged band' lies above the level of the adjacent 'smooth' mucosa and merges smoothly, on either side, with the frenulum of the prepuce. When magnified, the ridged mucosa has a pebbled or coral-like appearance. Unretracted. the adult 'ridged band' usually lies flat against the glans; retracted, the 'ridged band' is everted on the shaft of the penis. The remainder of the preputial lining between the 'ridged band' and the glans is smooth and lax. There is considerable variation in the degree of ridging: older subjects showed less and younger subjects more marked ridging. Some ridging was seen in all the prepuces examined (Figs 4-6). The intense vascularity of the 'ridged band' was best seen in transilluminated mucosa (Fig. 7). Mucsoal histology The inner surface of the prepuce is lined by variably-keratinized squamous epithelium similar to frictional mucosa of the mouth. vagina and oesophagus. The epithelium is papillated by stromal or 'corial' tissue and is rich in nerves, Schwann cells, lymphoid cells and capillaries. Papillae are continuous with a highly vascular, loose-knit tissue layer that resembles the corium of oral mucosa. Perputial musosa also lacks the dense collagenous zone seen in most areas of true (skin) dermis and, again unlike true skin of the penile shaft and outer surface of the prepuce, the mucosal surface of the prepuce is completely free of lanugo hair folicles, sweat and sebaceous glands. Smooth muscle bundles are common to both shaft skin and preputial mucosa. Histological cross-sections of the 'ridged band' showed focal, spiky or more rounded, broader and flatter ridges interspersed with sulci. Meissner's corpuscles were more plentiful in some subjects than in others but significantly they were only seen in the crests of ridges, occasionally in small clumps that expanded the tips of corial papillae [Fig.8] End-organs were not seen in suIci between ridges in this material. S100 staining (Fig. 9) showed additional end-organs and myelinated nerve fibres within papiliae and confirmed the richly innervated nature of the 'ridged band'. The distribution of Meissner's corpuscles in the mucosal ridges was best seen in tangential sections through the epithelium and tips of corial papillae of some but not all specimens. Sections of 'smooth mucosa' showed no ridging of the mucosal surface, slightly shallower corial papillae and few Meissner's corpuscles. Meissner's corpuscles were seen in the frenulum and glans but no attempt was made to compare smooth with deeply ridged mucosae. Histologically, no clear demarcation line can be drawn between true skin of the penile shaft and the 'ridged band' at the precise tip of the prepuce. SCREAM OF THE WEEK (Statements Documenting Infant Circumcision Pain) Submitted by Johnny4444@aol.com "I know that the circumcisions I have done, without exception, have been painful for the baby. In medical school I was taught that the baby's nervous system is not developed sufficiently to be aware of the pain....But my experience in doing it and observing the baby's reactions tell me otherwise." (Howard Marchbanks, MD [quoted], Circumcision: The Painful Dilemma, p. 133) FOR ADDITIONAL INFORMATION call NOCIRC, the National Organization of Circumcision Information Resource Centers at (415) 488-9883, fax (415) 488-9660. Ask about the resource provider nearest you. For written information, write NOCIRC, PO Box 2512, San Anselmo, CA 94979, with SASE and/or donation if possible.