Education And Debate

ABC of General Surgery in Children: PROBLEMS WITH THE PENIS AND PREPUCE

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7026.299 (Published 03 February 1996) Cite this as: BMJ 1996;312:299
  1. Mark Davenport

    Natural history of the foreskin

    Non-retractile foreskin of infant boy (normal for age).

    The foreskin envelops the glans from the fifth month of gestation. It begins dorsally and ends by fusing ventrally to cover the newly formed urethra. Actual fusion between the two epithelial layers of glans and foreskin is apparent at birth and has been termed physiological phimosis. This non-retractility remains in most boys for at least the first two years of life until natural separation ensues.

    Two conditions that are related to the process of preputial separation may give cause for concern. Firstly, the process may be uneven, with adhesions between glans and prepuce persisting even up to adolescence. Secondly, the desquamation of epithelial cells between the glans and non-retractile foreskin leads to accumulation of “pearls” of a white smegma-like substance. Both conditions are usually without actual symptoms and, as they are usually harmless, should not precipitate undue intervention.

    View this table:

    Natural course of foreskin separation

    History of circumcision

    Circumcision is one of the earliest operations, being recorded by the ancient Egyptians and other peoples of the Near East. Neonatal circumcision on the eighth day of life is a tenet of the Jewish faith and is performed by a mohel, often a vocation which is passed from father to son. In order to emulate the prophet Mohammed, Muslims also perform circumcision, and, though the timing is less strict, it is usually done well before puberty.

    “And God said unto Abraham, Thou shalt keep my covenant therefore, thou and thy seed after thee in their generations.

    This is my covenant, which ye shall keep, between me and you and thy seed after thee; Every man child among you shall be circumcised.

    And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you.”

    Holy Bible. Genesis xvii, 9-11

    The …

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