The man's foreskin is divided into an inner sheet and an outer sheet. They are not fused together, but can be moved relative to one another and practically folded together at the tip of the penis when they are not retracted. The outer sheet consists of outer skin (cutis), the inner sheet is a mucous membrane (tunica mucosa) with an uncornified squamous epithelium. The boundary between the inner and outer sheets is called the mucocutane boundary. In newborn mammals, including humans, the inner layer of the foreskin is often still glued to the glans ( preputial gluing and rarely called conglutination ), as the separation only takes place after birth.
On the underside of the foreskin, a line of adhesion, the foreskin suture ( raphe praeputii ), is visible. It continues over the foreskin ligament ( frenulum praeputii penis ) into the penis suture . The foreskin ligament is a fold of skin between the glans and the inner layer of the foreskin. In the male horse ( stallion ) the foreskin even has an additional reserve fold ( plica preputialis ), which enables the penis to be considerably lengthened during erection .
The foreskin, along with the glans and (in men) the foreskin frenulum, is one of the most important erogenous zones of both sexes. It contains numerous Meissner's tactile bodies that are stimulated by stretching. In this way, the foreskin plays a role in man's sexuality. It is assumed that the foreskin ligament is involved in the ejaculation reflex and in maintaining an erection .
In men, it also serves as a skin reserve for the extension of the penis during erection and, thanks to a special sliding effect, prevents unnecessary friction during sexual intercourse. The foreskin keeps the glans soft and moist throughout life and protects it from injuries, dirt, harmful environmental influences, dehydration and loss of sensitivity. In infancy, the foreskin glued to the glans protects against dirt and pathogens.
Exfoliated epithelial cells of the foreskin, which can accumulate with insufficient hygiene , form the smegma . If the smegma is not removed regularly, fungi and other pathogens can multiply, and inflammation of the foreskin and glans ( balanoposthitis ) can occur. The transmission of sexually transmitted diseases to the sexual partner is also easier with unprotected sexual intercourse .
A Balanitis may occur with excessive personal hygiene. Basically, one to a maximum of two cleanings a day should be sufficient. Men (as well as women) should also not use soaps, wet wipes or intimate deodorants for their intimate areas. Basically, clear water is best for cleaning.
Development in childhood and adolescence
At birth and up to toddler age, the foreskin usually completely encloses the glans. Foreskin and glans are "glued" together and the foreskin opening is still so narrow that the glans does not fit through. This condition is called physiological phimosis or preputial adhesion . According to the medical guidelines of the German Society for Pediatric Surgery and other specialist societies, about half of the boys by the age of 7 and two thirds of the boys by the age of 10 have a resolution of the physiological phimosis, but it is also in 8% of the 13-year-olds can still be found.
Various studies show:
- Gairdner reported in 1949 that less than 5% of the British boys he studied had a fully retractable foreskin at birth. This number increased to 15% after 6 months, 50% after 1 year, 80% after 2 years, and about 90% after 3 years.
- In 1968, Jakob Øster found in the context of his investigation of Danish schoolboys between the ages of 6 and 17 years that 8% of the boys in the age group 6–7 years had phimosis and 63% had residues of adhesions. This decreased to 1% and 3% in the 16-17 year olds.
- In 1996, Kayaba et al. Found in their study of 603 Japanese boys between the ages of 0 and 15 years that in the age group 11-15 years the foreskin was completely retractable in 62.9% of the boys examined. Ishikawa and Kawakita examined 242 Japanese boys and found a retractable foreskin in 77% of cases in the 11–15 age group in 2004.
- A 2007 study by Ko et al. That examined a sample of 1,145 Taiwanese boys between the ages of 7 and 13 found 71.1% boys with fully moveable foreskin by the age of 7, which is 84.1% in the Age increased from 13 years. Only 0.3% of 13-year-olds had a completely immobile foreskin.
- Concepción et al. Examined 1200 Cuban boys between the ages of 0 and 16 years and found a non-retractable foreskin in only 0.9% of the cases in the age group 11-16 years in 2008; 80.9% of the cases had a completely retractable foreskin.
- In 2009, Yang researched the foreskin mobility in 10421 Chinese boys between the ages of 0 and 18 years. They reported a completely immobile foreskin ( called phimosis in the publication ) at birth in 99.7% of cases, which decreased to 6.81% in the 11-18 year old age group ( defined as adolescence in the study ). A completely mobile foreskin was found in 0% of cases at birth and in 42.26% of cases in adolescence. In addition, however, 17.28% were circumcised in the 11 to 18 age group.
The spontaneous release of preputial adhesions occurs through erections, growth and personal hygiene. An indication for the doctor to detach the foreskin is in the case of recurrent inflammation or urinary problems.
Diseases of the male foreskin
If the foreskin cannot be withdrawn or can only be withdrawn with difficulty, a too short foreskin ligament ( frenulum breve ) can be the cause, which can be cut, lengthened or removed in a small surgical procedure . However, there are different lengths of foreskin ligament. As long as the foreskin can be pulled behind the glans, no problems during sexual intercourse are to be expected.
Often, too tight a foreskin ( phimosis ) is the reason for difficulties when pulling back the foreskin. Phimosis can be treated surgically or conservatively: Surgical treatment methods include partial or complete removal of the foreskin ( circumcision ) as well as procedures that preserve the foreskin (such as the so-called triple incision ). If there is no acute need for action (e.g. paraphimosis ), phimosis can be prevented by conservative measures such as B. a treatment with steroid-containing ointments can be treated. The research efforts of the last few years clearly show that these conservative (non-operative) measures are very inexpensive and effective.
In childhood and adolescence a distinction must be made between the congenital (“primary”) and the acquired, scarred (“secondary”) form of phimosis from the physiological preputial adhesions. Both are in need of therapy. In primary phimosis, the urethral opening cannot be seen and the foreskin cannot be retracted. At the same time, based on age, for example, the existence of a developmental physiological condition can be ruled out. Secondary phimoses can occur after tears due to forcible pulling back of the foreskin, which in connection with glans and foreskin inflammation give rise to extreme scarring and stenosis . Another possible background is the sclerotic narrowing of the foreskin caused by lichen sclerosus , which typically occurs at school age .
An inflammation of the foreskin ( posthitis ) due to phimosis, adhesions, poor hygiene or inappropriate manipulations usually occurs in combination with an inflammation of the glans ( balanoposthitis ). It can then be accompanied by severe symptoms and require acute therapy.
Artificially induced changes in the foreskin
Circumcision ( medical : circumcision ) is understood to be the partial or complete surgical removal of the foreskin. In addition to medical reasons, circumcision is carried out in many cultures , primarily for religious (Islam, Judaism) and ritual , but also cosmetic and cultural motives, at birth or in early childhood at the latest by the onset of puberty . In Judaism this is referred to as Brit Mila .
The company TransCyte processes the foreskins removed during circumcisions into skin replacement products that are used in skin transplants after burns. In their processed form, they are also part of various cosmetic anti-wrinkle creams .
The foreskin is also culturally important. a. in the form of the holy foreskin as a Christian relic.
Literature and Sources
- A. Benninghoff, D. Drenckhahn (Ed.): Anatomie. 16th edition. Urban & Fischer, Munich 2004, ISBN 3-437-42350-9 .
- U. Gille: Male reproductive organs. In: F.-V. Salomon, H. Geyer, U. Gille (ed.): Anatomy for veterinary medicine. Enke, Stuttgart 2004, ISBN 3-8304-1007-7 , pp. 389-403.
- HU Schmelz, C. Sparwasser, W. Weidner: Specialist knowledge of urology: Differentiated diagnostics and therapy. Corrected reprint, Springer, Berlin 2006, ISBN 3-540-20009-6 .
- JR Taylor, A. Lockwood, A. Taylor: The prepuce: specialized mucosa of the penis and its loss to circumcision. In: British Journal of Urology . 1996, Volume 77, pp. 291-295, doi: 10.1046 / j.1464-410X.1996.85023.x .
- Information brochure of the Federal Association of Pediatricians (PDF; 0.6 MB)
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- Mario Lichtenheldt: un-heal. Foreskin, Phimosis & Circumcision. Up-to-date answers for boys, parents and multipliers. tredition, Hamburg, 2012, ISBN 978-3-8424-9540-1 , p. 36 f.
- Gesundheit-heute.de ( Memento of the original from November 3, 2010 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.
- S2k guideline “Phimosis and Paraphimosis”. (PDF; 279 KiB) German Society for Pediatric Surgery, September 15, 2017, archived from the original on December 11, 2017 ; accessed on July 20, 2018 .
- Yutaro Hayashi, Yoshiyuki Kojima, Kentaro Mizuno, Kenjiro Kohri: Prepuce: Phimosis, Paraphimosis, and Circumcision . In: The Scientific World JOURNAL . tape 11 , 2011, p. 289-301 , doi : 10.1100 / tsw.2011.31 , PMID 21298220 .
- Jakob Oster: Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys . In: Archives of Disease in Childhood. (Arch. Dis. Child.) . tape 43 , no. 228 , 1968, pp. 200–203 , doi : 10.1136 / adc.43.228.200 , PMID 5689532 , PMC 2019851 (free full text).
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- MC Ko, CK Liu, WK Lee, HS Jeng, HS Chiang, CY Li: Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys . In: Journal of the Formosan Medical Association. (JFMA) (J Formos Med Assoc.) . tape 106 , no. 4 , April 2007, pp. 302-307 , PMID 17475607 .
- Jump up JC Concepción, PG Fernández, AM Aránegui, MG Rodríguez, BM Casacó: The need of circumcision or prepuce dilation. A study with 1200 boys . In: Archivos españoles de urología. (Arch. Esp. Urol.) . tape 61 , no. 6 , July 2008, p. 699-704 , PMID 18705191 .
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