THE FRENULAR MUCOSA (by a Neurobiologist)

To Robin Stuart
Arc U.K.

Dear Robin ,

Back the other day I paid a visit to an urologist here in Tübingen due to dyspareunia i.e. pain during intercourse. I'm in my early thirties and I sometimes "suffer" from a milder form of frenulum breve, a condition that has only recently been dutifully recognized by urologists and is still very far from being completely understood. At least that was the impression I got from the urologist I visited, who revealed poor knowledge when he proposed to abblate the frenulum i.e. he proposed a frenectomy.

Being a cautious person by nature and also someone very familiar with medical issues I told the doctor I had to think about it. In fact being a biochemist, who had taken human anatomy, human physiology, neurobiology and histology during his training, and presently a researcher in the field of neurobiology and electrophysiology, I knew of course what that "minor" surgical intervention would most certanly imply. On top of it I'm male and thus "not being completely deprived" of my senses and sensitivity during intercourse or masturbation, I know what the frenulum means in terms of erogenous areas.

What was probably a minor problem, if at all, for the urologist I consulted, was a major concern for me. I started to wonder about how many of those urologists performing that kind of microsurgery would in fact be aware of what they were really doing, possibly destroying or excising a lot of "precious" mechanoreceptors, nerve-fascicles and blood vessels.

I started my quest for more information in the University's Medical library and came upon important articles such as those by Dr. C. Cold and Dr. Taylor on the prepuce and its function and sensitivity. Unfortunatelly I could find only very little information concerning the frenulum and even less on the condition of frenulum breve. Several books on Urology and Andrology refer to this condition but don't know how to make a correct diagnose nor what the surgical correction may be. Some books - even new books from the nineties still advance the idea of a circumcision as the only available and correct surgical intervention which I needless to say find very unfortunate. I found one single article on the technique of Z-plasty.

A further quest for more information through the internet led me to your homepage and all that enormous collection of information about frenulum breve. I think urologist - and of course myself also - would really have to congratulate you and thank you for the excellent job you did and you are still doing. In a letter to the German Chamber of Urologists asking them for more information on my condition, I referred your homepage to them ! Until now I haven't had any reply from them, but I had an e-mail from an acquaintance of mine - an urologist - to whom I wrote asking several things about frenulum breve and its correction. I'm enclosing his letter below. Unfortunatelly it is in German but I hope you'll be able to understand most of it.

Since you stated that cases of frenulum breve were of major interest to you I will take the time to give you a complete discription of my condition and the observations I made. My frenulum is attached to the ventral part of the glans approximately 0,2 in from the meatus ventral end. The first part of the frenulum, i.e. the first 0,5 in downwards from the point where it is attached to the glans, is membranous, quite thin in fact, and whitish. If one carefully pulls at the most distal point it unfolds forming a nearly equilateral triangle under the corona i.e. vertical to the penis shaft. One side of the triangle is attached to the basis of the corona, the other to the prepuce mucosa, and the third side is the unattached one, the frenulum central ridge so to speak. In fact it seems to be a bit thicker, cordy like and presents itself like a white hem. In this unfolded, rather translucent triangle there are some visible tiny blood vessels running parallel to the penis shaft but much of it is empty membranous area. I suppose this triangle is actually the part of the frenulum which rips or is suppose to rip during the first months of intercourse but then again to what cost. Since it rips under a 90° to the penis shaft those few blood vessels I mentioned are torn apart and maybe also some important nerve fascicles.

Unfortunately I wasn't able to access the true sensitivity of this part of the frenulum, but from what I felt it does seem to respond to stimulation. As for the rest of the frenulum - ca. 0,4 in - it blends like a spreading root into the ridged band of the prepuce, forcing the folded prepuce to a certain obliquacity. In the flaccid state I can retract my prepuce completely but my frenum is under a lot of tension and forces my glans to take a ventral bent of about 50°. This is not the the bent of 90° which according to what I read is a bona fide indicative of frenulum breve, but all the same. In the erect state it is possible for me to partially withdraw the prepuce along the penis that is past the corona (ca. 3 cm) but with the hold from my fingers the prepuce - due to the tense built upon the frenulum - recedes up to the corona forming a ridged band of about 0,5 inch. None the less there is a gap of unpleated prepuce of ca. 0,2 in between the corona and the ridged band. Having attained the position the frenulum is no longer under tension. Since I have read about rippings of the frenulum and mine never did along several years of intercourse I think it must be quite a thick frenulum but then again I have no means of comparison and from my research in the literature I suppose no one probably has ?!!! Just for the record : I definitely don't suffer from phimosis since there is no difficulty in getting the prepuce to cover the glans even during full erection.

R.S. I believe your prominent frenular ridge is what has hindered the ripping, if this tough sinewy hem ripped or was cut, the translucent triangle (how poetic) would rip easily, -- I remember particularly Peter S. in his document describing how the translucent triangle part started thinning out until there developed an eye hole, and then one day the string just broke ...(see "Peter S. an expert" - https://www.male-initiation.net/letters.html).

During my readings on the condition of frenulum breve including the information I found on your homepage I came to the conclusion that the one incision technique of Manrique is in fact a partial frenectomy and who knows what is really lost during this intervention ?!!! With two clamps attached to the sides of the frenular triangle I mentioned above and cutting through it vertically to the penis shaft, this technique leaves two membranous flaps to die and dry out. A lot of blood vessels are cut and most probably important nerve fascicles. The Y-V-frenuloplasty and the Z-plasty operate differently and are certainly no frenectomies since there are several Y or Z like incisions in the upper part of the frenulum which are then sawn to the shaft in a way so as to make the frenulum flatter.

But I wonder what really happens to the nerve connections and blood vessels. Unfortunately the descriptions of these two techniques are not very precise and leave a lot of decisions to the urologist, needless to say on the basis of trial and error, I'm very much afraid to say. A lot of the frenuloplasties done here in Europe seem to be done in the emergency rooms of hospitals, i.e. when it rips during intercourse, and therefore certainly under time pressure and profuse bleeding of the area, and thus no conditions to study the frenulum breve under hands and conclude on the best way to deal with it. From the little information I could gather on the subject and I think I searched extensively enough I suppose urologists have still a lot to investigate or even to catch up.

Some of the questions which still prevade my mind and up to now none of the urologists I talked to could answer, I much doubt you can, but none the less I copied them. Maybe you'll be able to get some sense out of them, and if you want, you are free to present them in your homepage.

>1. Are there precise anatomical studies of the frenulum praeputii concerning its lengh, its thickness, its point of attachment on the glans which seems to vary enormously, its two niches a bit downwards from the corona, its rootlike spreading, its ending points, its venoles and arterioles, its nerve fascicles, its mechanoreceptors (probably pinkus-ingo and Meissner corpuscules) ?

R.S. I searched back to 1920 - ALL the studies which were available through the German libraries are presented frenulum_studies.html , so the answer is no, no and there are none - the frenulum does not always spread out in root form and as far as "pinkus-ingo" goes I`ve never seen the word in all my research ...

2. Where can I find descriptions of the expected normal functioning of the frenulum? Is it supposed to be such that it lets the inner mucosa of the prepuce to lie in a flat way along the shaft ??? This would certainly be advantageous in many ways during intercourse i.e. no ripping, less friction, a better gliding of the shaft in the vagina, enhanced sensitivity since all of the inner prepuce mucosa is exposed or has contact with the vaginal mucous walls!!! On the other side I gather that one of the functions of the frenulum is to avoid an unwanted exposition and drying out of the epithelium of the glans during nocturnal erections or emissions.

R.S. The anti circ sites have various theories on the function and purpose of the frenulum however it certainly isn`t to hold the foreskin forward, some men are born without a frenulum and the foreskin still comes forward! --- sure it has different effects and thus at times can be considered to serve a function, and that will be different depending on length or shortness of frenulum relative to length of foreskin etc. - personally I doubt if the frenulum evolved with any set "purpose" or function, (except when it is too short or persistant - to simplify the mating games in some mammal groups see evolution.html) it appears all higher mammals have frenular strings, which usually rip during the embryonic period, so I suspect the structure is related to secondary skin dvelopments such as webbed feet ... we could debate more on such themes ... it probably is a more primitive structure than phimosis ...

3. Since the frenulum is apparently a complex structure I wonder if its ripping near the glans corona is intended by nature like the ripping or tearing of the female hymen. These structures are certainly not homologous and so I do not dare the make any predictions but an answer to this would certaintly be crucial, not only in respect to sexual education of the younger but also as a medical issue i.e. concerning circumcision and even a health-wellness issue since more pleasure can be derived from a completely unfolded prepuce during intercourse. And I do not deny that it were the two scientific papers by Dr. C. Cold and Dr. Taylor published in the BJU, one in 1996, the other in 1999, that made me think about this in this way !

R.S. Dr. Taylor studied 21 corpses whatever findings he made, he missed the fact that he was describing fibrotic phimotic rings and however many sensitive nerves they have a ring which is as tight as some of his pictures is simply painful, I`m afraid the advantages of common sense somehow slipped past the BMJ editors on this point.

In Bolivia, the Indian youths describe themselves as "cartridged" and eagerly await their first intercourse when their frenulum rips, and they can claim to be "uncartridged" (I eagerly await further news from an anthropoligist who is writing a paper on this) - interesting from our perspective is that in Bolivia the frenulum size and shape is so predictable that it develops a "meaning" and is viewed on a par with losing the virginity thus with breaking the hymen -

4. Unfortunately there seems still to be much confusion even among urologist concerning frenulum breve and phimosis. Where does one condition end, where does the other begin ??? From the case studies I read about very often both conditions are refered to occur simultaneously. It may very well be so ! None the less phimosis even partial phimosis is a condition very well defined by the phimotic ring which has very little or nothing to do with the frenulum. That a short frenulum certainly worsens the phimotic condition that is another thing. Understanding the interplay of prepuce and frenulum would surely shed new light on surgical interventions like circumcision, frenectomy and frenuloplasty.

R.S. Indeed this is true This point is not adequately covered in my site, (but please not too much self-criticism it was necessary first to describe the conditions separately) ... But yes, I believe that frequently men suffer a mixture of the two, - the phimotic ring seems always or often? to branch round like a hangman`s noose and lead into the frenulum, - if you have contact with a practical urologist he should be able to tell us if this is typical seldom or always, I believe the phimotic ring always curves back into the frenulum as two branches of the frenulum even when the frenulum is long enough ... I`d like to know, I very much feel that the visible external features of the frenulum are so vaguely described in the literature that well, it would probably be typical for our upside down culture to start studying the internal nervous systems before they even put on their spectacles and look.

BTW: If phimotic ring and frenulum are the same or similar skin tissue then frenulum breve may also respond to Betamethasone.

Since there are still a lot of men and youngsters being circumcised for unclear medical conditions such as phimosis and frenulum breve, and since the frenulum is truely the male G-point,

I don't suppose my questions are major issues compared to all what is going on in the U.S. concerning circumcision. And I dare say a lot of urologists just don't seem to think or care enough about these issues. According to the results of Dr. Christopher Cold's and Dr. J. R.Taylor's research on the prepuce mucosa I really think that circumcision or any kind of excision or abblation of preputial or frenular tissue should only be performed when nothing else works and in any case the patient should be completely and extensively informed by the urologist of what is going to happen and what the consequences might be. I don't know about Great Britain, but here in Germany an urologist told me circumcision among adult males - specially gay males - is starting to become a trend. I cannot really imagine why ???

Thank you once more for your excellent homepage.

With best regards __________

P.S. : The answer from a German urologist I wrote to. ( You may present this as well in your homepage)

Sehr geehrter Herr ______,
Sie haben sich offensichtlich mehr Gedanken über das Fenulum gemacht als alle Urologen. Wenn Sie bislang keine Probleme mit dem Bändchen hatten, gibt es m.E. keinen Grund sich darum Sorgen zu machen oder irgend etwas zu unternehmen.

Operative Eingriffe am Frenulum werden nur durchgeführt wenn der Patient damit Probleme hat, dann wenn es einreißt (dann meist im Notdienst) oder wenn Beschwerden von Seiten eines kurzen Frenulums auftreten (meist nachdem es bereits eingerissen und narbig verheilt ist). Dann erfolgt eine Frenulumplastik, die in der Weise erfolgt, dass das Frenulum quer inzidiert und anschließend längs vernäht wird. Anschließende Probleme (insbesondere was das Gefühl angeht) sind mir nicht bekannt.

Ihre Fragen kann ich nur recht allgemein beantworten: Genaue anatomische Studien (über das hinausgehend was Sie im Anatomiebuch finden) gibt es meines Wissens nicht, ebensowenig über spezielle nervale Versorgungen. Auch besondere Untersuchungen über die "normale" Funktionsweise des Frenulums sind mir nicht bekannt.

Mit freundlichen Grüßen
(Name of the urologist)