CIN (Circumcision Information Network) 3:10

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.

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.
(Final of a four-part series.)

Discussion

Teaching on the anatomy of the prepuce has undergone little change since that
of Niccolo Massa, Alessandro Benedetti and other masters of the 15th century.
 'The skin covering the penis is remarkable for its thinness, its dark
colour. and its looseness of connexion with the fascial sheath of the organ.
 At the neck of the penis, it is folded upon itself to form the prepuce or
foreskin, which covers the glans for a variable distance' [10].  The current
tendency to eliminate the prepuce from anatomy textbooks [1] reflects the
popular emphasis on the glans; perhaps the wrinkling and pleating of the
retracted prepuce, like unwanted hair, is an affront to good taste or simply
superfluous to requirements.

The present findings support the view that the lining of the prepuce is
identical to and a prolongation of the common squamous mucosa of the glans
and the balano-preputial sulcus [11].  The 'ridged band' may be key to the
persistent mislabelling of the inner lining of the prepuce as 'skin'; it is
clearly visible on inspection of the retracted prepuce, it is continuous with
the wrinkled true skin of the tip of the prepuce, and it looks like skin.
 Histology aside, the 'wrinkles' of the ridged band are regularly transverse
and are difficult to efface by gentle stretching.  A vascular blush is
usually present.

The vascular ridges of the 'ridged band' and its Meissner's corpuscles firmly
separate preputial epithelium from true skin and place preputial mucosa
amongst other mucocutaneous mucosae.  Winkelmann [12,13] emphasized the
structural and functional importance of junctional regions of the body and
focused on mucocutaneous end-organs, or 'genital corpuscles', of the glans
penis and prepuce.  Some of these end-organs resemble Krause end-bulbs;
others resemble Meissner's corpuscles.

Meissner's corpuscles of the prepuce may be compared with similar
nerve-endings in the finger-tips and lips, which respond in a fraction of a
second to contact with light objects that bring about deformation of their
capsules [14].  However, complex sensation, at least in the glans penis, may
be mediated by free nerve-endings rather than by specialized end-organs [15].
 The mode of transmission of stimuli from the prepuce and glans penis has not
been completely elucidated.

The present findings suggest that a part of the prepuce differs in several
ways from the rest of the prepuce; no attempt was made to quantify the
specialized nerve endings of the 'ridged band' because they should be seen in
the context of their function and location in the crests of ridges.  The
present study examined the area as a whole rather than analysing it point by
point.  Clearly, the penis is a complex organ with many different parts, each
specialized for a specific role.  The prepuce provides a large and important
platform for several nerves and nerve endings.  The innervation of the outer
skin of the prepuce is impressive [16];  its sensitivity to light touch and
pain are similar to that of the skin of the penis as a whole.  The glans, by
contrast, is insensitive to light touch, heat, cold [17] and, as far as the
authors are aware, to pin-prick.  Le Gros Clark [18] noted that the glans
penis is one of the few areas on the body that enjoys nothing beyond
primitive sensory modalities.

Here, the overall anatomy of the prepuce is partly repeated, to provide a
framework for the 'ridged band' of mucosa and ancillary structures; one of
these, the Dartos fascia, keeps the delicate mucosal surface of the prepuce
pressed flat against the glans [19].  Whether this flattening, or closure, is
important depends on the the functions of glans and prepuce.  We postulate
that the 'ridged band' with its unique structure, tactile corpuscles and
other nerves, is primarily sensory tissue and that it cooperates with other
components of the prepuce.  In this model, the 'smooth' mucosa and true skin
of the adult prepuce act together to allow the 'ridged band' to move from a
forward to a 'deployed' position on the shaft of the penis.  In short, the
prepuce should be considered a structural and functional unit made up of more
and less specialized parts.  It is generally thought that the prepuce
protects the glans.  However, it is equally likely that the glans shapes and
protects the prepuce.  In return, the glans and penile shaft gain excellent
if surrogate sensitivity from the prepuce.  Possibly, the 'ridged band' helps
mediate the afferent limb of the ejaculatory reflex.  Another use has to be
found for the infantile prepuce, which contains muscle bundles, blood vessels
and nerves in profusion:  its internal organization is poorly understood but
a case can be made for sensory tissue with the rigidity and form associated
with specific function.

[REFERENCES omitted];

Authors J.R Taylor, MB, ChB, MRCPEd. FRCPC. Pathologist.
A.P. Lockwood, MD, FRCSC. Plastic Surgeon.
A.T. Taylor, RT, Pathology Assistant.

Correspondence: Dr J.R. Taylor. Department of
Pathology,Health Sciences
Centre. University of Manitoba. 770 Bannatyne Avenue.
Winnipeg. Manitoba,
Canada R3E OW3.

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

"After witnessing many circumcisions, I can say: Yes, it hurts. It's pure and
simple torture."  ("A Nurse's View on Circumcision," by Terry Schultz,
Circumcision: The Rest of the Story) 

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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