Penile frenulum explained

Frenulum of the penis
Latin:frenulum preputii penis
System:Male reproductive system
Artery:Dorsal artery of the penis
Vein:Dorsal veins of the penis
Nerve:Dorsal nerve of the penis

The frenulum of the penis, often known simply as the frenulum (from) or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa.[1] In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection.[2] [3] In flaccid state, it tightens to narrow the foreskin opening.[4]

The penile frenulum is homologous to the clitoral frenulum in the female.[5] It is similar to the lingual frenulum between the tongue's lower surface and the lower jaw, or the frenulum between the upper lip and the outside of the upper gum.[6]

In some men, the frenulum may appear shorter than normal, a phenomenon known as frenulum breve. Treatment of frenulum breve may be non-surgical, or in other cases, especially with penile chordee, it may include frenulectomy or frenulum lengthening.[7]

Structure

The frenulum is a highly vascularized strip of mucosal tissue on the ventral side of the glans and the neck of the penis. It forms the interface between the outer and inner foreskin layers. During gestation, it forms as the lateral edges of the preputial lamina approach in the ventral midline. The two sides of the lamina do not fuse in the midline but remain separated by a thin septum of mesenchyme that will create the preputial frenulum.[8] As part of the glans penis, the frenulum is innervated by divisions of the pudendal nerve; the dorsal nerve of the penis and a branch of the perineal nerve.[9] Blood supply to the frenulum is provided by branches of the dorsal artery of the penis that curve around each side of the neck to enter the frenulum and the glans from its ventral surface.[10] It is uncertain whether the frenular artery is single or paired.[11] Veinous drainage is thought to occur around the neck of the penis from smaller paired venules.[12] The frenulum occurs on the ventral midline of the glans, where the two glans wings merge forming the septum glandis.[13]

Research

The role of the frenulum in penile erection has been studied in cases of men with short frenula and premature ejaculation. Short frenulum may sometimes be associated with unsatisfied intercourse. Treatment with lengthening or reconstruction of the frenulum in uncircumcised and circumcised men was reported to have positive results in satisfied intercourse, prolonged erection and time of ejaculation.[14] [15]

For individuals with spinal cord injuries preventing sensations from reaching the brain, the frenulum just below the glans can be stimulated to produce orgasm and peri-ejaculatory response. It is often a way for those with spinal cord injuries to engage in sexual activities and subsequently feel pleasure.[16] [17]

Clinical significance

Frenulum breve is a condition in which the frenulum is short and restricts the movement of the foreskin, which may or may not interfere with normal sexual activity. Frenulum breve may also contribute to frenular chordee, where the glans is pulled toward the ventral body of the penis. The condition can be treated with surgical and non surgical treatment. Non surgical treatment includes stretching exercises and steroid creams. Surgical treatment includes frenuloplasty (frenulum lengthening or reconstruction), frenectomy, or circumcision. There are a variety of different circumcision techniques in which the frenulum can be spared and left completely intact.[18]

It is possible for the frenulum to tear during sexual activities. This type of injury usually heals by itself.[19] In more severe cases, the frenular artery may be injured causing bleeding.

The frenulum may be entirely missing in cases of first degree hypospadias.

Frenectomy and frenuloplasty

As a treatment for frenulum breve or frenular chordee, a frenectomy or frenulectomy can be performed to excise the frenulum from the penis. This is a form of genital frenectomy.[20] This procedure results in a smooth surface. A less invasive treatment which often retains the natural appearance and function of the frenulum to some degree is a frenuloplasty or frenulum lengthening. This procedure involves a (partial) incision of the frenulum and realigning the edges to gain more length. This makes the frenulum longer, effectively relieving pain and discomfort.[21] [22]

See also

Notes and References

  1. Book: Jensen C . Can I Just Ask?. 2011. Hay House. 9781848502468. 58.
  2. Web site: Penis Frenulum: Location, Function & Conditions . 2023-01-01 . Cleveland Clinic . en.
  3. Web site: 2020-01-21 . Short Frenulum - Frenulum Breve Metromale Clinic & Fertility Center . 2023-01-01 . en-US.
  4. Web site: 2007. Male circumcision: Global trends and determinants of prevalence, safety and acceptability. World Health Organization. 2009-06-12. 2015-07-15. https://web.archive.org/web/20150715135808/http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf. live.
  5. Book: Baky Fahmy, Mohamed. Normal and Abnormal Prepuce . Springer International Publishing . 2020. 269. October 29, 2023 . 978-3-03037-621-5 .
  6. Iwanaga . Joe . Takeuchi . Naoshi . Oskouian . Rod J. . Tubbs . R. Shane . 2017-06-29 . Clinical Anatomy of the Frenulum of the Oral Vestibule . Cureus . 9 . 6 . e1410 . 10.7759/cureus.1410 . free . 2168-8184 . 5574632 . 28856075.
  7. Web site: 2018-06-26 . What should I do if my penis is torn? . 2023-01-01 . nhs.uk . en.
  8. Liu . Xin . Liu . Ge . Shen . Joel . Yue . Aaron . Isaacson . Dylan . Sinclair . Adriane . Cao . Mei . Liaw . Aron . Cunha . Gerald R. . Baskin . Laurence . 2018-09-01 . Human glans and preputial development . Differentiation . Development of human male and female urogenital tracts . en . 103 . 86–99 . 10.1016/j.diff.2018.08.002 . 30245194 . 6234068 . 0301-4681 . "As development proceeds the lateral ventral edges of the preputial lamina approach the ventral midline. The ventral edges of the preputial lamina do not fuse in the midline but remain separated by a thin septum of mesenchyme [...] destined to form the preputial frenulum. ".
  9. Yang . Claire C. . Bradley . William E. . 1999-01-01 . Innervation of the human glans penis . Journal of Urology . 161 . 1 . 97–102 . 10.1016/S0022-5347(01)62075-5 . 10037378 . "The dorsal nerve of the penis innervates the glans, including the frenulum which is also innervated by a branch of the perineal nerve.".
  10. Hinman . F. . 1991 . The blood supply to preputial island flaps . The Journal of Urology . 145 . 6 . 1232–1235 . 10.1016/s0022-5347(17)38584-1 . 0022-5347 . 2033699 . "The blood supply to the frenulum arises from the dorsal artery of the penis. Branches of the dorsal artery curve around each side of the distal shaft to enter the glans and the frenulum ventrally.".
  11. Gyftopoulos . Kostis I. . 2018 . Meatal stenosis after surgical correction of short frenulum: Is the "pull-and-burn" method the way to go? . Urology Annals . 10 . 4 . 354–357 . 10.4103/UA.UA_25_18 . 0974-7796 . 6194789 . 30386085 . "It is unclear whether the frenular artery is single; in our experience, paired arteries were often evident, lying in the frenular bed " . free .
  12. Gyftopoulos . Kostis I. . 2018 . Meatal stenosis after surgical correction of short frenulum: Is the "pull-and-burn" method the way to go? . Urology Annals . 10 . 4 . 354–357 . 10.4103/UA.UA_25_18 . 0974-7796 . 6194789 . 30386085 . free .
  13. Özbey . Hüseyin . Kumbasar . Ali . 2017 . Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications . Turkish Journal of Urology . 43 . 4 . 525–529 . 10.5152/tud.2017.00334 . 2149-3235 . 5687219 . 29201519.
  14. Song . B. . Cai . Z.-M. . 2012 . Possible function of the frenulum of prepuce in penile erection . Andrologia . 44 . 1 . 23–25 . 10.1111/j.1439-0272.2010.01099.x . 1439-0272 . 22126255. 32268548 .
  15. Song . Bo . Hou . Zhen-hui . Liu . Qun-long . Qian . Wei-ping . 2015 . [Penile frenulum lengthening for premature ejaculation] ]. Zhonghua Nan Ke Xue = National Journal of Andrology . 21 . 2 . 149–152 . 1009-3591 . 25796689.
  16. Rehabilitation of Persons With Spinal Cord Injuries . Saulino MF . WebMD . 2006 .
  17. Pryor JL, LeRoy SC, Nagel TC, Hensleigh HC . Vibratory stimulation for treatment of anejaculation in quadriplegic men . Archives of Physical Medicine and Rehabilitation . 76 . 1 . 59–64 . January 1995 . 7811177 . 10.1016/S0003-9993(95)80044-1 .
  18. 4717729 . 2015 . Shenoy . S. P. . Marla . P. K. . Sharma . P. . Bhat . N. . Rao . A. R. . Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique . Journal of Clinical and Diagnostic Research . 9 . 12 . PC01–PC03 . 10.7860/JCDR/2015/14972.6860 . 26816940 .
  19. Web site: 2020-05-29 . Frenulum tear: Causes, first aid, and when to see a doctor . 2023-06-23 . www.medicalnewstoday.com . en.
  20. Griffin AS, Kroovand RL . Frenular chordee: implications and treatment . Urology . 35 . 2 . 133–134 . February 1990 . 2305537 . 10.1016/0090-4295(90)80060-Z .
  21. Web site: Frenuloplasty what is it and how is it performed? . 2023-06-23 . Top Doctors . en-GB.
  22. Web site: Lengthening of the penile frenulum (frenuloplasty) . 2023-06-23 . Cambridge University Hospitals . en-GB.

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