The foreskin is the most special and precious “gift” given by God to primates, especially to humans, and it has remained on the primate body for more than 100 million years without degeneration or evolution. It is evident that its function and structure have been refined through the ages and have always been indispensable.
I. The development of foreskin
Within 1 year of age, the glans reveals itself 50%, at 3 years of age, the glans reveals itself 89%, at 6 to 7 years of age, the incidence of prepuce 8%, at 16 to 18 years of age, the incidence of prepuce is 1%.
Second, the anatomy of the foreskin
The foreskin is the most sensitive sexual sensory tissue on the male body, with a surface area of about 12 to 15 square inches, 10,000 to 20,000 nerve endings, a total length of 240 feet of innervated nerves, and a total length of 3 to 4 feet of distributed blood vessels. The foreskin has four special structures: the ligament, the ligament triangle, the ring of folds (ligament ring), and the meatus. The ridge belt emanating from the penile tether is rich in sensory vesicles, ensuring a high degree of sensitivity in the tethered area. The outer and inner plates of the foreskin are continuous, and there is a junction line between the outer and inner plates, which is commonly referred to as the circumcision ring. The part outside the ring belongs to the outer plate, and the part inside the ring up to the coronal sulcus is the inner plate. When the penis is weak, most men’s foreskin covers the glans or part of it. However, during an erection, the length of the penis changes and so does the position of the foreskin. As the hardness of the erection increases, the foreskin gradually retracts and the glans is gradually revealed.
Third, the function of the foreskin
The foreskin has a protective function, it can secrete lysozyme (natural antibacterial substances), immunoglobulin (antibodies), Langerhans cells (one of the components of the body’s immune system), sebaceous glands and their secretion of sebum (similar to emollient cream, increase local skin moisture) and other substances, these substances help prevent mucosal tissue and glans skin hyperkeratosis, in early childhood, can protect the urethra, to avoid occurrence of urethral contamination, external stenosis and urinary tract infections. The foreskin itself also has the following functions: to protect the mucosal tissue and glans from injury; to protect the sensitivity of the mucosal tissue and glans area; and to protect the glans from sunburn, frostbite, and other environmental factors. In addition, the foreskin can provide skin for cosmetic reconstructive surgery (e.g., hypospadias, eyelid burns).
Fourth, the role played by the foreskin in sexual life
The foreskin contains a large number of specific fine sensory nerve endings (Meissner “s corpuscles), which secrete natural lubricating fluid to keep the vagina lubricated. The role of the external genitalia of the spouse. Therefore, we should cherish their foreskin, do not use violence to force the foreskin up (male penis foreskin often flip back before puberty), do not use irritating disinfectant or medicine to clean the foreskin.
V. Circumcision
1, the definition of circumcision penis head completely wrapped by the foreskin, but can be upturned to reveal the urethral opening and the head of the penis, erection state can not be turned up and reveal the head of the penis.
2.The definition of prepuce is narrow or the foreskin and the head of the penis are attached, so that the foreskin cannot be turned up to reveal the urethral opening and the head of the penis.
3.Category of prepuce
(1) primary prepuce: physiological prepuce, no scar formation.
(2) Secondary prepuce: pathological prepuce, with scar formation, such as dry glans.
4.The benefits of circumcision in medicine can reduce the incidence of penile cancer, reduce the incidence of urinary tract infection, reduce the infection rate of sexually transmitted diseases, and reduce the incidence of cervical cancer in female spouses; in life, you can pursue beautiful appearance, and circumcision can avoid the trouble of repeatedly cleaning the penis.
5.Circumcision indications
(1) Secondary circumcision (absolute indication).
(2) Primary circumcision: recurrent glansitis of the foreskin, urinary tract abnormalities combined with recurrent infections.
(3) Post-pubertal overcircumcision, combined with recurrent infection, adhesions or overturned foreskin. This type of patient, despite not having a prepuce, is affected by repeated infections, adhesions, or tight foreskin ring after upturning the foreskin, which affects sexual life. This situation is also possible to do circumcision.
6, circumcision of contraindications
(1) coagulation dysfunction.
(2) local acute infection.
(3) congenital abnormalities of the penis: hypospadias, occult penis, etc. A large proportion of patients with occult penis are not circumcised but appear to be circumcised because the penis is hidden in the subcutaneous tissues, and if circumcision is performed, the circumcision will appear to be too short. Hypospadias is a congenital developmental abnormality that cannot be solved simply by circumcision.
7, after circumcision precautions after circumcision, the head of the penis may be tingling or hypersensitive, and there may be a little yellow discharge from the wound for a day after the operation. On the third day after surgery, you should go to the hospital to change the dressing and check the condition of the wound. When dressing the wound, first cover the wound with Vaseline gauze wrapped with erythromycin ointment to prevent the dressing from sticking to the wound. The wound is usually healed in 7 to 10 days after circumcision. Hospital treatment is required if.
(1) Inability to urinate for more than 6 to 8 hours after annuloplasty.
(2) Persistent bleeding.
(3) Those who have the following signs of infection: swelling, foul-smelling discharge, redness and swelling of the head of the penis 3 to 5 days after the operation and progressive aggravation.
8.Circumcision may occur with complications
(1) Individual patients reduce male sexual pleasure.
(2) Individual patients have an increased chance of erectile dysfunction, but the rate of occurrence is relatively low.
(3) Individual patients have to change their previous sexual habits and may increase the female partner’s worries about sexual life. This is mainly due to the fact that after circumcision, the foreskin becomes shorter and the sliding mechanism disappears, in this case, the patient has to change the previous sexual habits.
9.Surgical complications
(1) scar formation.
(2) unevenness at the surgical incision.
(3) the presence of penile adhesions after 15% of circumcisions
(4) lymphedema.
(5) Bridge formation: can form during the slow healing process after circumcision. These bridges are harmless, but often cause physical and psychological discomfort and can be corrected surgically.
(6) Urethral fistula, hypospadias, and epispadias.
(7) Incorrectly performed circumcision of the occult penis, resulting in a short foreskin.
(8) Penile disconnection.
10.Possible causes of penile necrosis after circumcision
(1) Improper use of intraoperative monopolar electrocoagulation. For circumcision, it is generally not recommended to use electrocoagulation, if you do use electrocoagulation, it is recommended to use bipolar electrocoagulation to reduce unnecessary complications.
(2) Intraoperative local anesthetic solution preparation with an excess of epinephrine. When preparing the local anesthetic during surgery, some doctors will add epinephrine, which can prevent bleeding, but the amount of epinephrine should not be too large, too much will lead to excessive arterial constriction, ischemic necrosis.
11, circumcision in childhood is a potential risk of complications, if there are no special medical reasons, surgery is not recommended. For primary circumcision, if there is no indication for surgery you can choose conservative treatment (often suitable within 6 to 7 years old).
12, circumcision surgery treatment principles prepubescent children regardless of circumcision or prepuce, if there is no recurrent infection or adhesion, surgery is not advocated; post-pubescent males need surgery if they have prepuce; post-pubescent male circumcision, if combined with recurrent infection, adhesions or upturned foreskin is too tight, surgery is required; circumcision requires mastery of surgical indications, skilled trained urology, male Physicians are required to perform the operation; choose the surgical method and standardize the surgical steps according to the length and state of the penile foreskin. We generally use special absorbable thread sutures to eliminate the pain of stitch removal and use cuffed circumcision to avoid the longer-term complications of traditional circumcision such as edema, easy bleeding, and rubber swelling.