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The prepuce is a common structure of the external genitalia of all human and non-human mammals.[1] It has not disappeared or remodeled for at least 60 million years. In the last several thousands years, some cultures or traditions vilified the prepuce, and considered it to be dangerous and unhealthy, whereas other cultures have accepted the complete genitalia as normal. Now approximately one in six men in the world have been circumcised.[2] One of the well-known motives was religious circumcision. In Judaism, circumcision represents the covenant made between God and Abraham. There are no reasons to seek justification based on health or other grounds.[3] In the Islamic faith, on the contrary, circumcision was not introduced by Islam, and is not mentioned in any form in the Holy Quran. It is at most considered as an external symbol of being Muslim, a typical rite of passage in young males. Despite the fact that Jesus was born as a Jew, and was circumcised, Christianity never accepted this practice.[4] Apart from the religious rituals, circumcision was rarely carried out in the West during the Middle Age, and was considered to be a rite of minorities. In 18th century England, the rapid industrialization led to public health problems, which were inherited by Victorians in the 19th century. The Victorians have been famous for their obsession with cleanliness. Victorian physicians were determined to stop excessive sexual activity, particularly masturbation, which they believed could cause tuberculosis, seizures, psychiatric illness or blindness.[5] The description of phimosis and circumcision came to be found from the mid 19th century in medical textbooks. The most permanent treatment offered by doctors in 19th century England for the prevention of excessive sexual activity was circumcision. They believed that foreskin offered the greatest inducement for self abuse.[6]

In the mid 19th century, a doctor in the USA introduced circumcision as an important public health measure. He presented a report on the cure of leg paralysis in 5-year-old boy through circumcision.[7] His success spread through the English-speaking world, and doctors across the USA began to use circumcision as a surgical prophylaxis against all sorts of diseases, from epilepsy to mental disorders. What was once viewed as a public health measure became a symbol of American citizenship. It became a mark of distinction between those who were born in the USA and were clear, from those who were not, and were poor and unhygienic.[8]

The understanding of anatomy and function of the prepuce started only in 1930s. The prepuce is an integral part of external genitalia, protecting the glans, urethral meatus, inner prepucial epithelium and primary erogenous tissue. Although the glans penis is primarily protopathic in sensitivity, a ridged band of the prepuce has a high concentration of “fine-touch” nerve receptors.[9] Interaction between protopathic, receptor-deficient glands and the “fine-touch” receptor-rich prepuce is required for normal sexual behavior.[10] Circumcision ablates the most sensitive parts of the penis. Removal of the prepuce can cause sensory imbalance, and possibly induce aggressive intercourse.[11] If the prepuce is an inappropriate structure, mammals (including humans) that have it would have become extinct based on the Natural Selection Theory. Instead of talking about the negative effect of the prepuce, we have to take lessons from history and reconsider its positive significance.

Conflict of interest

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None declared.

References

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  3. References
  • 1
    Martin RD. Primate Origins and Evolution: A Phylogenetic Reconstruction. Princeton University Press, Princeton, NJ, 1990; 4243.
  • 2
    Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int. 1999; 83 (Suppl. 1): 112.
  • 3
    Glass JM. Religious circumcision: a Jewish view. BJU Int. 1999; 83 (Suppl 1): 1721.
  • 4
    Mattelaer JJ, Schipper RA, Das S. The circumcision of Jesus Christ. J. Urol. 2007; 178: 3134.
  • 5
    Walsham WJ. Circumcision. Surgery, Its Theory and Practice, 8th edn. Churchill, London, 1903; 10341036.
  • 6
    Warren R. Circumcision. Textbook of Surgery II, Chapt 32, Churchill, London, 1915; 630633.
  • 7
    Gollaher D. Circumcision: A History of the World's Most Controversial Surgery. Basic Books, New York, 2000.
  • 8
    Kaicher DC, Swan KG. A cut above: circumcision as an ancient status symbol. Urology 2010; 76: 1820.
  • 9
    Hunter RH. Development of the prepuce. J. Anat. 1935; 70: 6870.
  • 10
    Sorrells ML, Snyder JL, Reiss MD et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007; 100: 864869.
  • 11
    Laumann EO, Masai CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997; 277: 10521057.