This site discusses phimosis in its specific forms of phimotic ring, frenulum breve, adhesions or skinbridges. During erection these conditions inhibit the relationship between foreskin and glans. This functionally restricts the erection, and thus has an effect on the sexuality. With our culture's attitudes on health care, it would be appropriate to monitor boys before puberty and encourage early prevention or specific illness related treatment.

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THE EPITHELIUM OF THE PREPUCE
(INFANT ADHESIONS)

Among infants the foreskin normally sticks to the glans. This epithelium or adhesive layer is natural, normal. It usually degenerates freeing the foreskin in early infancy. Sometimes it does not release in which case it is almost always recognised at the beginning of puberty when during erection the adhesive layer between foreskin and glans makes movement of the foreskin intensely painful.

Care must be taken with these epithelial adhesions. Not only can an attempt to release them cause intense pain but if they are broken and if the sticky skin surfaces are allowed to rest in contact with each other again, they can fuse together causing skin bridges.

(Epithelium: tissue forming the outer layer of skin, lining alimentary canal and other hollow areas).

The adhesive layer between the inner foreskin and the glans is natural and normal in babies. This epithelium or layer will usually release of its own accord, sometimes this happens before birth, often within the first six months, and usually by the age of three years old (4). The layer releases last around the coronal ridge and in the area of the frenulum.

There are different degrees of adherence. Boys often release the foreskin themselves during childhood or at the beginning of puberty, the experience can be compared to the sensation of peeling elastoplast from sensitive skin and can be a relatively interesting exploration leading to the welcome discovery of the glans. Doctors also perform this separation occasionally without anaesthetic which is reported as an extremely painful experience.

After separation, sometimes a white film can form on the glans which has the tendency to re-stick and needs re-releasing and regular washing.

Occasionally the pain which a boy experiences when attempting to release these infant adhesions can be so intense that it completely hinders attempts with retraction and sometimes a full adherence will continue through puberty and even until adulthood.

One man described the pain during erection as intense or immanent. He requested circumcision at 13 yrs. old and was advised to "wait and see what happens" by his doctors. He limited his enjoyment and exploration to manipulating the phallus by gently stroking or applying pressure to the area round the glans, He was eventually circumcised after a renewed request as soon as he was legally eligable at 18.

In "Symbolic Wounds" Bettelheim reports a case where during masturbation "painful adhesions interfered with full functioning of the penis" (6). Bettelheim failed to recognise the degree of pain this causes, even though the boy "wanted the operation very badly" obviously a period of time elapsed before "Eventually we had to arrange for his circumcision".

Infant adhesions should be released at an early age. The inhibitive influence of pain throughout childhood erections cannot be expected to have a positive effect on the behavioural habits and psychological attitudes of a child.

In addition from a practical perspective, a childs natural exploration and manipulation is severly hindered by the immanence of pain. He cannot explore and indulge in the natural early exercise which he would otherwise enjoy. We could normally expect this early exercise to encourage the development of a healthy and supple foreskin which may subsequently be more resistant to stiffening processes.

Possibly because the sensation of pain is so obvious for the young men with this condition, they actively desire to be circumcised, therefore infant adhesions are usually treated during adolescence or at latest as a young adult.

Adhesions and Early Learning discusses the effects of pain from this adhesive layer on psychological development.

Solutions offers a web of files which discuss how to encourage the release of the adhesive layer.