BENEFITS OF FORESKIN

Written By Travis Wisdom

Author’s note: Originally published for the Childbirth and Postpartum Professionals Association (CAPPA), in the October 2010 online edition of CAPPA Quarterly.  

Introduction
There are an increasing number of American parents who are saying “no” to routine circumcision. This positive choice gives boys increased health and lifetime benefits. While the circumcision rates continue to decline in the United States, those who choose “foreskin-friendly” parenting find themselves in contrast of the greater circumcising culture. This can cause increased uncertainty about decisions of circumcision. Because of the cultural myths relating to circumcision, even physicians can provide inaccurate and misleading information on the importance of the foreskin, its health benefits and vital roles to optimum sexual function, and proper hygiene and care for intact boys and men.

This essay surveys various protective, mechanical, sensory, and sexual benefits and functions of the foreskin that would otherwise be lost to its surgical amputation. I discuss genital hygiene and care for the intact penis with hopes to help alleviate confusion and ignorance surrounding cleanliness. In anticipation, having an understanding of the benefits and functions of the human foreskin is useful for both the parents and the physicians in order to gain an appreciation and respect for intact genitalia.

Benefits of the Prepuce
The human prepuce, or foreskin, is a specialized organ that offers protective, mechanical, sensory, and sexual functions, all of which are necessary for operative sexual health [1]. All healthy functional males are born with the following preputial capabilities and should enjoy their benefits and functions throughout adulthood.

The foreskin plays a crucial role in human sexuality, which becomes dysfunctional after its amputation due to circumcision. It is necessary that the glans be covered when flaccid in order to keep it protected from pathogens in addition to maintain pleasure and sensitivity. The foreskin either partially or completely covers the glans penis in the adult male protecting it from dryness and abrasion [2]. Remaining protected from foreign stimuli, the foreskin maintains the subpreputial area wet and moist with prostatic, vesicular, and urethral secretions [2]. The subpreputial moisture contains lysozyme, which destroys pathogens [1]. It is important that the glans remain in this state of moisture and wetness because it is covered with mucosa, not skin. In addition, the prepuce guards from the process of keritinization. This otherwise would cause the glans to thicken as skin cells begin to layer, which deadens sensation [2]. In other words, when the foreskin is no longer present, male genitalia looses ability to protect the mucosa membrane of the glans and to avert the leathering, desensitizing effect of the body’s natural attempt to suffice for missing protection.

- Protection
In infant boys, the prepuce protects the meatus from ammoniacal diapers and prevents meatitis, meatal ulceration, and meatal stenosis. The meatus is the opening of the urethra at the distal end of the penis and ought to be protected from such conditions that include inflammation, ulcers, and the narrowing of the opening of the urethra. All of these are preventable and are only seen in circumcised infants [5]. E. coli that is found in feces is the most important pathogen in urinary tract infection. The muscle fibers in the foreskin act as a preputial sphincter, helping to prevent UTI in infants as it forbids contact between the meatus and feces. Additionally, the foreskin also helps to reduce incidence of non-specific urethritis and presence ofStaphylococcus aureus in the urethra [1]. Namely, the foreskin prohibits the child from sitting in his own urine and feces in a diaper and the sphincter prevents their contact with the mucosa membrane of the glans.

- Mechanical 
An important mechanical function of the foreskin is its ability to facilitate intromission and penetration [2]. As the foreskin unfolds, the penis enters his partner reducing friction, dryness, and abrasion allowing intercourse to be more comfortable [1].

Also, the presence of the foreskin allows for less forceful penetration. After penetration, the foreskin provides a unique gliding action that substantially reduces friction and orifical dryness [1].

- Sensory and Sexual  
The foreskin is a specific erogenous zone that is the most heavily innervated part of the penis with nerve endings near the surface of the ridged band. This band originates from the frenulum and encircles the opening of the foreskin [2]. The tissue whose nerve endings most sensitive to fine touch and temperature is located in the foreskin [1].

The foreskin has a layer of a smooth muscle tissue, the peripenic muscle, which comprises a portion of the dartos muscle [2]. The nerve-endings that are present in the foreskin become stimulated through motion and stretching [1]. Through the contractions of the unique muscle fibers in this tissue, the foreskin obtains strong elasticity, which is crucial to erogenous sensation. The muscle tissue must stretch to glide over the glans upon erection, later to return to its normal flaccid coverage. The stretching movement produces great sensation and pleasure. The nerve endings produce pleasurable erotic sensations, which travel to the central nervous system, inputting to the autonomic nervous system. This process plays a vital role in controlling erection and ejaculation [2].

Nerve endings of the glans are concentrated in the corona. Likewise, they intrude against the corona during intercourse [2]. The foreskin protects the corona from direct stimulation, and because it is the most highly innervated part of the glans penis, this helps to prevent premature ejaculation [1].

In short, stimulation occurs through stretching and motion. The foreskin’s great elasticity is vital for erogenous pleasure. The relationship between the nerve endings and the autonomic nerve systems is important to control erection and ejaculation in order for functional sexuality. The nerve endings in the corona are among the most sensitive and the foreskin protects from direct stimulation. Without the foreskin, latency time is adversely affected.

Genital Hygiene
The foreskin is one of the most easiest cared for parts of the human anatomy, and the most important rule to remember is: only clean what is seen [3]. Proper infant hygiene, for both boys and girls, is just that straightforward. In fact, Marilyn Milos, RN describes the cleaning of the intact penis as very similar to cleaning one’s finger [4]. Only clean the external genitalia, what is exposed, using warm water. Soap is not needed. Intrusive or interior cleaning is absolutely never needed. The boy’s foreskin will naturally retract at a point in his maturation that is unique to him, usually around puberty. It is utterly imperative to note that forcible retraction should always be avoided, as it causes trauma, pain, and destruction of the developing tissue and natural flora [4]. Of course the penis is immature at birth, and the foreskin is connected to the glans via a special membrane that ensures cleanliness and protection of the underlining penile structures [3]. In addition, this membrane also protects the high nerve supplied and erogenous foreskin of the developing penis from foreign stimuli, such as those found in feces, the ammonia in urine, and invading pathogens [3].

Both John V. Geisheker and John W. Travis in the article, “Only Clean What Is Seen: Reversing the Epidemic of Forcible Foreskin Retractions,” agree that while the foreskin is different in structure, it is appropriate to conceptualize it as the male’s hymen, protecting the internal sexual organ during the years when they are not needed for sexual purposes. In time, the membrane within will disappear as the child matures [3].

Once the boy has discovered that his foreskin is (naturally) retractable, he can easily care for his body through three easy steps: retract, rinse, and replace [4]. First, he can retract his foreskin. Using only warm water, he should not apply soap or any other substances on the mucosa membrane of the glans or the inner lining structure of the foreskin. Then, release the foreskin and allow it to naturally glide to its position [4].

- Conclusion
Having an accurate understanding and appreciation of the advantages of the male foreskin provides parents the opportunity to empower their own lives and child birthing and child rearing experiences. It is important that physicians be given current, relevant, and accurate information on just how vital the foreskin is in protecting against disease and invading pathogens [1]; and in providing functional sexual organs the necessary skin mobility for intercourse as well as the opportunity to enjoy the full potential of the pleasures of sexual intimacy [1]. Also, the care for such a uniquely viable organ is extraordinarily simple. The prepuce can be cleaned and cared for with warm water, without the use of any artificial substances like soap, or invasive internal cleaning [3]. The first person to retract a boy’s foreskin should be the boy himself. Everyone else should leave it alone and let nature function in its own right. The membrane embedded under the foreskin is the male’s first line of defense against infection, and the foreskin’s forcible retraction disrupts this protective order, causing unnecessary and avoidable trauma and pain [4].

The advocacy for better knowledge of the male sexual organs helps to dispel myths about the human body and male sexuality. These available resources allow for an informed decision on foreskin-friendly parenting based on awareness and education as opposed to common inaccurate and misleading beliefs that can otherwise promote damage to the male body or cause unreasonable guilt for protecting boys from the damages of non-therapeutic circumcision.

References:

[1]        Hill, G. (2007). The Case against circumcision. Journal of Men’s Health and Gender, 4(3), 318-323

[2]        Foreskin Sexual Function/Circumcision Sexual Dysfunction. Circumcision information resource pages. Retrieved (2009, September 07) from http://www.cirp.org/library/sex_function/

[3]        Geisheker, JV, & Travis, JW. (2008, May 30). Only clean What is seen – reversing the epidemic of forcible foreskin retractions. Kindred Community, 28-33.

[4]        Milos, MF. (2010). Letters to the Editor: Re: Provencio-Vasquez, E. & Rodriguez, A. (2009). Collaborative practice: Circumcision revisited. Journal for Specialists in Pediatric Nursing, 14(4), 295-297. . (2010). Wiley periodicals, Inc.

[5]        Denniston, GC, & Reiss, MD. (2004). The Medical Director’s Guide to Male Circumcision. Doctors opposing circumcision. Retrieved (2010, January 4) from http://www.doctorsopposingcircumcision.org