The prepuce: specialized mucosa of the penis and its loss to circumcision (Taylor)
The Taylor study was published in the British Journal of Urology (BJUI), Volume 77, Issue 2, pages 291–295, February 1996. DOI: 10.1046/j.1464-410X.1996.85023.x A copy of the Taylor study is available at the The Circumcision Reference Libarary. Wiley Online Library maintains the journal copy of the study.
The authors, Taylor and Cold, dissected cadavers to thoroughly study the male prepuce (foreskin). They documented the innervation ofthe ridged band at the opening of the foreskin. The objective of the study was to assess the type and amount of tissue missing from the adult circumcised penis.
The effect of circumcision on penile anatomy
Surgical amputation of the prepuce removes many of the fine-touch corpuscular receptors from the penis and clitoris. In males, circumcision is essentially a partial penile mucosectomy. The residual exposed glans mucosa becomes abnormally keratinized with an increase in the number of cell layers in glanular mucosal epithelium. The urethral meatus is exposed and prone to irritation. Meatal stenosis can be a complication after circumcision. During circumcision, the frenular artery may also be ablated, depriving the anterior urethra of its major blood supply. The combined effect of urethral ischaemia and irritation results in the development of meatal stenosis in 5-10% of circumcised males . The risk of glanular injury when tearing the fused penile mucosa, and the development of meatal stenosis, makes circumcision in the newborn period inadvisable.
Discussion
The prepuce is a specialized, specific erogenous tissue in both males and females. Therefore, surgical excision [circumcision] should be restricted to lesions that are unresponsive to medical therapy, such as lichen sclerosis of the penis (balanitis xerotica obliterans) or vulva, which is unresponsive to other therapies (e.g. topical clobetasol, intralesional corticosteroids, topical testosterone propionate ointment, etretinate, and carbon dioxide or laser vaporization) . Preputial plasty should be considered in place of circumcision whenever possible, so as to preserve the corpuscular sensory receptors, dartos muscle, penile mucosa and complete function of the penis, while avoiding abnormal exposure and keratinization of the glans penis. Although some cultures celebrate the abnormal anatomy caused by circumcision, many women and men have reported this abnormal penile/clitoral exposure to be uncomfortable.
The loss of the prepuce ridged band and the formation of an amputation neuroma are two further complications associated with male circumcision. . . . Excision of normal, erogenous genital tissue from healthy male or female children cannot be condoned, as the histology confirms that the external genitalia are specialized sensory tissues.
The complex anatomy and function of the prepuce, along with the fused prepuce/glans penile mucosa in the immature penis, dictates that neonatal circumcision be strictly avoided, as recommended by the Australasian Paediatric surgeons, Canadian Paediatric Society, and a paediatric urology textbook. Removal of normal genital anatomy in children and infants should be deferred until the individual can make an informed decision
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