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Why we work so hard to provide foreskin-friendly education
The foreskin is a functional and natural part of the penis. We believe that they belong together.
Often, familiarity with the intact penis (whether personal or clinical) may be lacking. Few medical students have had any education about the intact penis during their training. Though with all good intentions, this lack of knowledge can lead to damaging care practices and erroneous advice being given, which can be more likely to cause problems with the foreskin than to promote good health.
This is why for over 10 years 15 Square have provided placements for students from local medical schools. This educates students wishing to expand their knowledge in this particular area of men’s health.
Despite foreskin pathologies being fairly commonplace in children, it is clear that there is a lot of misunderstanding and ignorance relating to the function of the foreskin. There is an obvious need for better education.
More clinical research on the natural function of the foreskin is needed, and it is important that both parents and patients are well-informed about the disadvantages of circumcision. Better information can then be given to patients and carers by well-educated clinicians.
Normal Anatomy and Foreskin Function
- At birth, the normal foreskin (prepuce) is attached to the glans and has a tight opening (preputial ring) at the distal end. It is not retractable in most newborns.
- Retractability increases with age, with full retraction possible in
- 10% of boys at 1 year
- 50% of boys at 10 years
- 99% of boys at 17 years
- A non-retractable foreskin is a normal variant and needs no intervention. It is different from true phimosis.
- The foreskin should never be forcibly retracted for cleaning. Once it becomes freely retractable naturally, then the child should retract it as part of routine bathing, ensuring immediate replacement over the glans to prevent paraphimosis.
Safe and sensible care recommendations for the intact penis must stem from an accurate understanding of its anatomy, development, and protective functions; knowledge of the science of skin health and skin care; and common sense. It is also helpful to have a perspective on the history of mistaken beliefs about foreskin care.
As it turns out, the health professional’s task is often not to teach parents how to care for the foreskin but use their medical education to undo years of misinformation and paranoia about the natural penis.
Foreskin-Friendly Medical Education – Key points
- A non-retractable foreskin is a normal variant and needs no intervention. It is different from true phimosis.
- The foreskin should never be forcibly retracted for cleaning.
- Acute surgical interventions are rarely necessary.
- Red flags include urinary retention, swollen red penis with a fever and blue/black distal penis.
Foreskin-friendly information is lacking in medical textbooks
The following section is from the blog of David Balashinsky
The 2004 study entitled “An Analysis of the Accuracy of the Presentation of the Human Penis in Anatomical Source Materials” by Gary L. Harryman, MA (published in Flesh and Blood, edited by Denniston et al. [Kluwer Academic / Plenum Publishers, New York, 2004]; reviewed 90 different sources intended for medical education that included representations of the penis, including “definitions, photos, illustrations and drawings.”
The study was based on sources “available to medical students and medical professionals in five Los Angeles, California campus bookstores and two biomedical libraries” and included “medical textbooks, life-sized medical models, medical study aids, medical charts, medical dictionaries, medical encyclopedias, medical catalogues and (medical) general interest books.”
This is what the study found:
In the 90 sources, we found . . . 365 images of the penis. Of these 365 images, [only] 33%, showed anatomically correct depictions of the foreskin, while . . . 67%, showed penises from which the foreskin had been amputated. Of those . . . images [i.e., those in which the prepuce had been removed], only one includes an explanation of why the foreskin was absent.
The study further found that.
Out of . . . 272 primary images of the penis [i.e., those that “present the penis as the direct subject of study or discussion”], only . . . 29% were anatomically correct in their depiction of the foreskin. . . . 71%, were anatomically incorrect (i.e., foreskin absent). . . . Out of . . . 93 secondary images of the penis, . . . 54% were anatomically incorrect in their depiction of the foreskin.
The study concluded that, more often than not,
The penis is misrepresented in the medical literature used in medical schools. The penis is routinely defined and depicted in a partially amputated condition, as if this were a natural state, without explanation or caveat. This study concludes that students are being misinformed about fundamental anatomy.
Medical Reasons to Avoid Circumcision
Risks of circumcision surgery include bleeding, infection and injury to the penis or urethra.
The foreskin protects the tip of the penis. When the foreskin is removed, the tip may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be corrected by an operation.
The foreskin has more nerve endings than the glans or sensitive tip of the penis, and its removal decreases sensitivity to touch.
Almost all intact boys can be taught proper hygiene that can lower the chance of getting infections, cancer of the penis and sexually transmitted diseases.
The foreskin as self-protecting and self-cleaning – Just like the vagina, the foreskin is well designed to stay clean and healthy with very little outside intervention.
It must be re-emphasized that there is never a medical indication for forceful retraction of the foreskin and that it is incorrect for health professionals to apply any force at all, or to encourage parents to do so.
The harms of forcible foreskin retraction are many and come from disruption of the normally tight and fused prepuce, which will always work best in its undisturbed state to protect the end of the penis.
- Forcing the foreskin open when it would normally be closed introduces the risk of infection.
- Tearing the foreskin away from the glans leaves raw areas on both surfaces.
- Forcible stretching of the inelastic foreskin outlet (the normal state in childhood) may cause micro-tearing.
- Tearing produces pain and bleeding.
- Healing of these tears may lead to scarring of the foreskin outlet, as well as re-adhesion of the raw surfaces of the foreskin to the glans by scar tissue.
- The scar tissue that may be produced is permanently inelastic and can contribute to a pathological state of non-retractability (phimosis), which may not resolve as it naturally would with normal development.
- Forcing a tight foreskin opening behind the coronal ridge can lead to entrapment of the foreskin proximal to the glans, called paraphimosis. This causes swelling of the tissues, pain, and loss of circulation to the glans and is considered a medical emergency – in this case, iatrogenically caused.
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