CIN (Circumcision Information Network) 3:8

Introduction
This weekly bulletin is a project of CIN, the Circumcision Information Network (formerly CIN CompuBulletin). 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.

BABY T-SHIRTS NOW AVAILABLE
Contributed by tkimmel@hopf.dnai.com (Tina Kimmel)

NOCIRC is now distributing newborn-size white T-shirts emblazoned in red with
the "Universal No" circle-and-slash across the word CIRCUMCISION.  The
ostensible purpose, of course, is to make sure the new baby doesn't have any
"accidents" in the hospital.  But it is also a nice consciousness-raiser for
hospital staff, visiting relatives, baby-shower attendees, etc.

For more information, contact the National Organization of Circumcision
Information Resource Centers (see address below).

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,
Winnepeg. Manitoba, Canada.
(Second of a multi-part series.)

Keywords Prepuce, ridged band, Meissner's corpuscle, specialized mucosa,
circumcision.

Introduction

The prepuce is usually dismissed as skin [1.2] or, less often, it is seen as
a simple fold of skin and mucosa [3].At best. the prepuce is thought to
protect the glans penis:  at worst it is a health hazard that may be avoided
by circumcision [4-6].  Not surprisingly, articles and editorials on the
advantages and disadvantages of circumcision consistently fail to discuss the
prepuce as a tissue worthy of preservation in its own right.  'Circumcision
removes only a few millimeters of skin' is, in our experience, common and
comforting counsel but has been neither proved nor disproved for North
America or other countries where circumcision remains largely a cosmetic
procedure.

Material and methods

The prepuces of 22 adults (mean age 37 years, range 22-58) were studied
grossly and histologically at autopsy.  Ten prepuces extended to or beyond
the tip of the glans and 12 prepuces failed to reach the tip of the glans.
 The material was unselected except for the age of the subjects (20-60 years)
and for preputial length ('long' and 'short').  The outer surface of the
prepuce was measured from its tip to the sulcus of the glans; the skin of the
penile shaft extended from the sulcus to the abdominal wall.  The inner
surface of the prepuce ('mucosa') was measured with the prepuce retracted but
not stretched.  The expected preputial tissue loss to circumcision (preputial
skin plus mucosa) was reduced by 3 cm to allow for a residual mucosal cuff
(the estimated cuff at autopsy was 2-4 cm).  Ellipses of mucosa and submucosa
(15 x 5 mm) were excised from four sites: the mucocutaneous junction, to
include a cross-section of the 'ridged band' (see below); the 'smooth
mucosa'; the corona of the glans penis; and the frenulum of the prepuce.
 Mucosae were fixed in buffered 5% formol-saline, divided lengthwise into two
blocks and embedded in paraffin wax. Subserial sections, 3-5 from each block,
were stained with haematoxylin and cosin (HE).  Meissners' corpuscles of the
genitalia resemble those of finger-print skin and are identified in
H&E-stained sections as compact. pear-shaped or elongated, lamellated and
encapsulated end-organs attached to the basal lamina of the mucous membrane.
or located high in the mucosal papillae of preputial mucosa [7.8].  Similar
and additional end-organs of 'ridged' and 'smooth' mucosae were stained using
the avidin-biotin-complex peroxidase technique using an antibody (Biomeda
Corp, Foster City, CA, USA) against S100 protein [9] present in neurites and
Schwann cells.  Sections from each mucosal area were assessed
semi-quantitatively for neural end-organs.  Superficial blood vessels of the
'ridged band were filled with a silicone rubber mass placed in the
superficial external pudendal artery followed by dehydration and clearing of
the mucosa samples through graded alcohol and methyl salicylate.

Results.

Normal prepuce

The mean length of prepuce in this sample was 6.4 cm(range 4.8-9.2) and
covered 93% of the mean penile shaft (6.9 cm).  Ten prepuces were as long as
or longer than the shaft of the penis to which they belonged; three of them
were >10% longer than the shaft and glans combined.  Circumcision of these
subjects allowing for a 3 cm mucosal cuff, would have removed a mean of 3.4
cm (range 1.8-6.2) of (strictly) preputial skin and mucosa or 51% of the
length of the mean adult penile shaft, or more from nearly half the penises.
 Unknown amounts of true skin were missing from the shaft of the circumcised
adult penis.  Therefore, four circumcised babies, 1-3 years of age, who had
died for reasons unrelated to circumcision, were also reviewed.  In each
case, the cut edge of the skin of the penile shaft stopped 1-2 cm short of
the glanular sulcus, an estimated shortfall in shaft skin of 20-25%.  The
mucosa between the cut-skin edge and corona of glans was stretched and
flattened and contrasted sharply with the lax mucosa normally seen at this
location (Figs 1 and 2).

SCREAM OF THE WEEK 
(Statements Documenting Infant Circumcision Pain)
Submitted by Johnny4444@aol.com

"A newborn baby is...as able to perceive pain as any other person....  Some
babies scream frantically while being circumcised.  However, some
babies...lapse into a semi-coma ...the pain and trauma are so great that the
baby cannot cry!  This absence of crying has led many parents, doctors and
others to believe that the operation did not hurt him."  ("Circumcision," by
Rosemary Romberg, Circumcision: The Rest of the Story -- A Selection of
Articles, Letters, and Resources, 1979-1993, edited by Peggy O'Mara,
Mothering.)
 
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.

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