Mohamed A. Baky Fahmy - Normal and Abnormal Prepuce

Mohamed A. Baky Fahmy

Normal and Abnormal Prepuce

It is my honour to dedicate this unique book to my beloved wife Rula for her unremitting physical and spiritual advocacy and support.

The argument is continuous along the history, whether this piece of skin is a vestigial redundant part of human body and deserves removal, or it is rather a complex of specialised erogenous structures that work in sympathy with adjacent penile structures and merits reverence? Is the prepuce is a superfluous tag of skin, or it is a large platform for the reception and expression of sensual and sexual sensation?

Nowadays the universe divided into territories discarding the prepuce along the process of circumcision, and another concerned to preserve it in an optimal healthy condition.

We have to admit that the prepuce as an exquisitely designed, it is highly innervated and vascularised complex of specialised erogenous structures and it could be affected by different acquired diseases and congenital anomalies; but as it is removed in about 40% of men along the mankind history, so there is no previously convenient opportunity to study thoroughly the preputial diseases and anomalies. There is no accurate classification exists for preputial anomalies in children and adults, and some of these anomalies are difficult to define or diagnose, while it may significantly alter penile appearance.

Most relevant medical texts contain no or little information regarding the anatomy and physiology of the prepuce, even some do not even include the prepuce in diagrams of the penis, so our goal through this illustrative textbook is to elaborate the normal embryology, anatomy, functions, normal variations and diseases affecting this dialectical organ, without any discussion about its removal in circumcision, preserving or reconstructing it. Discussion will not only concern with male prepuce, but also it will be extended to deal with female prepuce (hood) to elucidate some lights in its normal and abnormal situations. Many new items which were not previously discussed are elaborated like microposthia (Congenital incomplete preputial development), macroposthia (akroposthia, or redundant prepuce) and the normal variations of preputial meatus will be illustrated, also the dilemma of phimosis and its confusion with other anomalies and diseases will be addressed.

During the last two decades the prevalence of circumcision declined dramatically, specially in Europe, Canada, Australia and many Asian countries. Previous trend to take off the prepuce for management of many penile and preputial diseases is moved recently for more preservation of the prepuce, and on the background of its importance, as an essential organ, we are now seeing many centers offering several procedures to restore the previously removed prepuce; so these enforce the importance of this textbook; which will collect most data available about the prepuce in health and diseases along my experience in dealing with genital anomalies during the last 35 years.

According to Oster [], there are three fundamental dates in the history of the foreskin: at 1713 BC, when Abraham was circumcised as a sign of his covenant with God; 43 AD, when the apostle Paul stated that circumcision of the heart and not that of the flesh was the only way to salvation; and AD 1949, when Gairdner published, first hand, the typical preputial development. The first two events are historically notable and have influenced millions of people, while the third seems not to have been so remarkable so far.