It is a remarkable fact that the description of the surface anatomy of human individuals is not complete. An example is the frenum of the prepuce, the median fold of skin that passes from the urethral surface of the glans penis, behind the orificium urethrae externum to the deep surface of the prepuce. Exact inspection shows that at each side of the frenum a small fold can be seen between the radix of the prepuce and the proximal side of the corona glandis; in other words the prepuce is inserted on the under side of the corona, at both sides of the frenum. These folds are nameless; they may be called alae freni praeputii or plicae praeputii. At both sides of the frenum a niche is formed under these folds which may be named recessus freni praeputii. In this region the sebaceous glands of the prepuce are most clearly discernable

As a rule the alae freni praeputii are more developed or better discernable in younger than in older men.

My attention was drawn to this anatomical configuration because in the course of the years I have been consulted by men who mostly after their first coition, showed an excoriation, a slight rhagade or even a slight laceration of the frenum behind the margin of the corona, or of the alae freni. Sometimes it was not during the first coition that this phenomenon occurred but during a later one, that was experienced as much more complete or more satisfactory than the foregoing. In a single case the rhagade had developed during masturbation. These excoriations may occur more than once.

The phenomenon is not fully unknown, and general practitioners as well as dermatologists may be consulted for these rhagades, especially when a secondary inflammation complicates the picture ... The excoriation is seen in cases of forced coition in older men with a rigid frenum; a young man with phimosis developed a slight laceration in a forced trial to cohabitate. The occurrence of the phenomenon is mentioned in older textbooks of surgery and in textbooks of dermatology; in the most severe cases it may cause a serious bleeding and in rare cases a suture may be necessary. This must be a very rare occurrence indeed as the phenomenon is not mentioned in modern handbooks of urology and not even in a monograph on diseases of the penis 1).

Several questions arise. Probably the phenomenon is not so rare as one would presume, taking in account that practitioners seldom see it. It may be rather frequent or even ubiquitous. Does it occur in circumcised men? I have found no answer to the question. Does it occur in people who have never masturbated, the frenum being more rigid or less resilient than in men who practised masturbation? When it occurs in masturbation the excoriation seems to be localised especially in the alae freni.

Is the fact that the alae are more manifest in younger men than in older due to the constant stretching or elongation of these formations in the course of adult life? Elasticity of the frenum seems to prevent the laceration.
That anatomical conditions play a part in the causation of traumata durante coitu is shown by the occurrence of lacerations of the underside of the orificum urethrae externum in cases where the frenulum reaches that point. ...

In view of the fact of the disruption of the anatomical continuity of the frenum during (the first) coition in some (or most?) human males, it is necessary to compare the embrology of the frenum with that of the female hymen. Embryologically the hymen develops from a fold at the point where the vaginal portion of the fused Müllerian tubes opens into the vestibulum vaginae. The frenum on the contrary is of ectodermal origin, the penis being derived from the genital eminence, as the clitoris is.

Therefore a similarity between the defloration of the female and erosion or laceration of the frenum of the prepuce does not depend on embryological identity.

It is as remarkable that a part of the surface anatomy of the man received no name, as that the phenomenon of the erosion or laceration of the frenum and its alae, though not unknown, receives so little attention, and is even manifestly neglected in medical literature. One is tempted to assume that psychological factors must play a part in both facts: not primarily prudery, but the castration complex of the physicians.

Prudery and anxiety on the part of the "patient" is an other, and probably an even stronger factor. A lesion of the penis during coition causes feelings of shame and self-reproach because of the supposed uncouth and aggressive behavior, resulting (in the opinion of the man) in an unheard of trauma; guilt feelings produce a resuscitation, the "wound" itself a revival of the castration complex.

Men are manifestly proud of the penis (a fact insufficiently mentioned in the literature), not only during their development but during an important part of their adult life, men being as proud of this organ as women are of well formed breasts. When this important organ, this source of masculine pride, is menaced, fear and anxiety arise. The "patients" are afraid to consult a doctor and await with tense fear the further development of the trauma. The speedy recovery allays their fears and may contribute to faith in the invulnerability and recuperative powers of this organ. But before this reassurance is reached their fear restrains them from consulting a physician and they are confronted with the patent possibility of castration.

As has already been mentioned, there must be a psychological reason for the fact that older men especially consult the physician concerning this lesion. The rigid frenum is not a remarkable coincidence, but merely the result of their neurosis, on account of which they have postponed the first coitus, and probably had little or no experience of masturbation. They are therefore seen by the psychiatrist as well. However, the fact that an apparently buoyant young man confided the secret of this trauma to me in his anxiety, demonstrates that he knew unconsciously that more than his penis was injured and that his castration complex was also. It is significant that he did not consult the family doctor but the psychiatrist.

In view of the great importance attached by the human male to his penis, it is surprising that so few young and older men consult the physician over these rhagades (an inquiry confirmed this opinion). It is probable that the normal man waits to see how the "disorder" develops; this does not mean that he does not ascribe any importance to it. It cannot therefore be the exaggerated importance some neurotics attach to the penis, which causes them to consult a physician after this excoriation. Only those who are haunted by a hypochondriacal fear or by panic are unable to adopt the philosophical attitude of the normal man. The shame and guilt feelings may be stronger than normal, and sudden revival of castration fear drives them to the physician.

The psychiatric aspect of this little known symptom, repressed as it has been by the medical profession itself, has never been mentioned. That excoriation of the frenum praeputii has also been neglected by psychiatrists and psychoanalysts is even more remarkable. The parallelism with the defloration of the female is too obvious to be ignored.

The psychodynamics of this repression on the part of the physicians is a striking phenomenon in itself. It cannot be masculine pride alone for this invulnerable organ and rejection of any comparison with feminine defloration which has caused the phenomenon to be neglected by male physicians and psychoanalysts, and caused it to be forgotten in dermatological literature. Probably rhagades of this anatomical region have caused a resuscitation, a revival of the castration complex in the life history of many physicians, resulting in a general or collective repression of the phenomenon.

The psychotherapist will do well to remember a symptom which may engender a real reactivation and actualization of castration fear.