THE CIRCUMCISION REFERENCE LIBRARY
Dear Dr. Wilkoff:
You indicated that family doctors are in a dilemma because there are not clear guidelines on the benefits and hazards of infant male circumcision ("The Foreskin Wars," May 2000, p.27).
This is true, if only for the reason that existing guidelines are oblivious to the idea that the prepuce may be worthy of preservation in itself, irrespective of other considerations.
My associates and I have made a few observations: The true skin surface of the prepuce provides the distal half of the penis with its only means of detecting light touch, heat, and cold. A distinctive band of mucosa lining the tip of the prepuce is deeply ridged, highly vascular, and especially rich in Meissner (genital) nerve endings (Brit. J. Urol. 77: 291-95, 1996).
We have postulated that this "ridged band" is designed to respond to movement of adjacent mucosa and the skin of the penis. Similar nerve ending are found in the glans and it seems likely that the sensory and reflex functions of the ridged band are much the same as, but spatially distant from, those of the glans.
Parents should be left in no doubt that circumcision always removes a large sexually significant portion of the penis.
John R. Taylor, M.B.
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