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There are three mechanical conditions that prevent foreskin retraction: The tip of the foreskin is too narrow to pass over the glans penis. This is normal in children and adolescents. [26] [27] The inner surface of the foreskin is fused with the glans penis. This is normal in children and adolescents but abnormal in adults. [27]
The natural foreskin is composed of smooth dartos muscle tissue (called the peripenic muscle [16]), large blood vessels, extensive innervation, outer skin, and inner mucosa. [17] The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision, as well as provide coverage of the glans.
The frenulum is the highly vascularized elastic band of tissue located on the underside of the glans that connects the foreskin to the head of the penis. The frenulum is supple enough to allow the retraction of the foreskin over the glans and pull it back when the erection is gone. [18] In flaccid state, it tightens to narrow the foreskin ...
Preputioplasty or prepuce plasty, also known as limited dorsal slit with transverse closure, is a plastic surgical operation on the prepuce or foreskin of the penis, [1] to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a constriction which has not expanded after adolescence.
[4] [6] The foreskin may be retracted during penile examination, penile cleaning, urethral catheterization, or cystoscopy; if the foreskin is left retracted for a long period, some of the foreskin tissue may become oedematous (swollen with fluid), which makes subsequent reduction of the foreskin difficult. [citation needed]
Phimosis is an inability to retract the foreskin fully. It is normal and harmless in infancy and pre-pubescence, occurring in about 8% of boys at age 10. According to the British Medical Association, treatment (topical steroid cream and/or manual stretching) does not need to be considered until age 19.
This may be a complication of circumcision or a naturally occurring event. When it is a naturally occurring event, a short frenulum can restrict normal retraction of the foreskin during erection (a condition known as frenulum breve). The goal of treatment is to allow normal retraction of the foreskin.
The diagnosis of severe frenulum breve is almost always confused with that of phimosis and a generally tight foreskin, since the symptom is difficulty retracting the foreskin. Most men with phimosis also have frenulum breve to a certain extent. [5] A milder frenulum breve may go unrecognized, since foreskin may retract over the glans variably.