Keratinization: Etiology and Relationship to Age
Etiology — The glans (head) of the penis is a genital structure that is normally protected from external contact by the foreskin of the natural penis. When the penis is modified by amputation of the foreskin, then this natural protection is lost and a process called keratinization proceeds to protect the delicate glans surface tissue from drying and the abrasion of the external environment. In other words, the normally delicate and smooth glans external membrane becomes calloused, or keratinized.
Relationship to Age — Although keratinization is an expected age-related change in the circumcised penis, it is not a manifestation of normal aging in the intact penis, as shown in the illustrations above. We document this fact using men of substantially different ages and opposite circumcision status as models. There is no evidence of keratinization in the 71 year old intact penis, and obvious keratinization in the 40 year old circumcised penis.
Effects of Keratinization
Delayed Clinical Presentation — Although the adaptation of glans surface tissue to exposure to the external environment necessarily begins soon after the trauma of circumcision, the process of keratinization progresses for decades and is rarely, if ever, seen as a source of presenting complaints by the OB-GYN or pediatrician who performs the circumcision surgery.
Loss of Glans Sensitivity — However, there are clinical problems due to keratinization that present long after childhood. This is because in protecting the unnaturally exposed glans, keratinization decreases its sensitivity. Research has documented that many different areas of the intact penis are more sensitive than the most sensitive area of the circumcised penis – which is the circumcision scar itself (see Sorrells, M, et al, ‘Fine touch pressure thresholds in the adult penis.’ The full text of this scientific publication is available: http://www.nocirc.org/touch-test/touchtest.php ). Thus, there is no question that the glans of the circumcised penis is a less sensitive structure than that of the intact penis.
Sex Partner Complaints — Not only has decreased glans sensitivity been associated with complaints of decreased sexual pleasure in men, their partners also suffer consequences of circumcisions. Anecdotal evidence includes complaints of pounding sex, dry unpleasant sex, and vaginal abrasion or lesions that are commonly heard from older women sex partners of circumcised men. The etiology of these complaints involves loss of penis sheath mobility and loss of glans sensitivity in the circumcised penis.
Erectile Dysfunction — Decreased glans sensitivity has also been associated with erectile dysfunction (ED). Men have complained that sexual stimulation during intercourse has been insufficient for them to maintain an erection firm enough for coitus, and have sought relief through the use of prescription medications for treatment of ED.
The National Organization of Restoring Men (NORM) lists more than 16 physical attributes of the foreskin and adjacent structures, including the frenulum, that are commonly destroyed by circumcision (The “Lost List”: http://www.norm.org/lost.html ). Among those that NORM considers restorable are glans color and texture, which is a restoration result that reverses keratinization. Thus, NORM cites foreskin restoration results that “… closely mirror natural glans coloration and smooth glossy appearance of the glans seen in intact men.’ In conjunction with this reversal of keratinization, the gliding action of the skin sheath of the penis, which is lost in the circumcised penis and is consequently a common source of sex partner complaints, can be regained as one of the primary benefits of foreskin restoration, providing “… greater levels of comfort and pleasure during intercourse.” For ongoing discussion of foreskin restoration please see http://www.uncutting.tumblr.com and http://www.restoringtally.tumblr.com .