Nerve Sparing Esthetic Circumcision
Prepucium is the most sensitive part of penis. It provides sensation and lubrication for the penis and contains numerous (between 20.000 and 70.000) super-specialized nerve endings and nerve corpuscules:
- Meissner’s corpuscles, (sensitive to fine-touch and probably the most important in terms of erogenous sensation,
- Paccinian corpuscles (responsible for sensing pressure);
- Ruffini’s corpuscles (mechanoreceptors);
- free nerve endings (pain receptors);
- end-bulbs of Krause (probably responsible for sensing cold). l-2
These tiny structures are related to the perception of touching, erogenous stimulus followed by orgasm and ejaculation.The regions such as tip of fingers, lips, prepucium and glans in which Meissner’s corpuscles are found profoundly are much more sensitive than the other parts of body.3
Frenulum, a skin band below the glans penis is highly innervated with Meissner’s corpuscles. It is the most sexually sensitive area of penis so that he most important function of the frenulum ispleasure.
Unfortunately, It is frequently cut off partially or totally by traditional circumcision techniques.
- Male and Female Circumcision, Denniston et. Al, Kluwer Academic I Plenum Publishers, New York, 1999. pp. 9-18.
- Juskiwenski S. A study of the arterial blood supply to the penis. Anatomia Clinica 1982;4:101-7.
- Winkelmann RK. The erogenous zones: their nerve supply and its significance. Proceedings of the Staff Meetings of the Mayo Clinic 1959;34:39-47.
- Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007 Apr;99(4):864-9. http://www.ncbi.nlm.nih.gov/pubmed/17378847
- Kaneko S. Penile Electrodiagnosis penile peripheral innervation. Urology 1987;30:210–2.
- Winkelmann RK. The cutaneous innervation of human newborn prepuce. J Invest Dermatol 1956;26:53-67.
- Ghmori D. Uber die Entwicklung der Innervation der Genitalapparate als Peripheren Aufnahmeapparat der Genitalen Reflexe. Zeitschrift far Anatomie und Entwicklungsgeschichte 1924;70:347-410.
- De Girolano A, Cecio A. Contributo alla conoscenza dell’innervazione sensitiva del prepuzio nell’uomo. Bollettino della Societa Italiana de Biologia Sperimental. 1968;44:1521-2.
- Bazett HT, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature; thermometric conductivity. Archives of Neurology and Psychiatry 1932;27:484-515.
- Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5.
- Density and structural variations of Meissner’s corpuscule at different sites in human glabrous skin (Gh. Mohd Bhat*, Mohd. Akbar Bhat**, Kulbeer Kour*, Bashir Ahmad Shah* *Govt. Medical College, Srinagar, Jammu and Kashmir, **Department of Cardiovascular and Thoracic Surgery, Sher-eKashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir)
- Depth, Distributioin and Probably Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity,” (H.C. Bazett, et. Al., Archives of Neurology and Psychiatry 27 (1932), pp. 489-517)
- Fine-touch pressure thresholds in the adult penis, Sorrells ML1, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS., BJU Int. 2007 Apr;99(4):864-9.)
- A nerve sparing circumcision with minimal foreskin mucosa (NSCMFM), C. Mmeje, J.L. Marmar, Urology, Robert Wood Johnson Medical School at Camden, Camden, NJ
Hakan ERDOGAN, M.D
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