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  #1  
Old April 14th, 2010
alibi alibi is offline
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Default Anatomical Question - Foreskin Innervation

Hello,

I have one question that has been bugging me for quite some time and which I was unable to answer (even after going trough a lot of material) - maybe you can help me (since there are a lot of people around here who have a lot of medical knowledge).

How is the inner foreskin innervated (supplied with nerves). Every medical text i have seen, mentions only the dorsal nerves and sometimes a few nerves within the skin. Assuming that those nerves run from the base of the penis to the glans (which would be the most efficient), how is the inner foreskin connected to the nervous system after circumcision?

There are some reports that it takes up to a year after a circumcision for sensitivity to return - is this due to the cut nerve supply? If those nerves reattach themselves after some time - wouldn't it be possible (or probable) that this reattachment isn't perfect i.e. sensitivity is diminished?

Thank you

Andreas
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  #2  
Old April 14th, 2010
Arthur Arthur is offline
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Default Re: Anatomical Question - Foreskin Innervation

Either way it's still better than no foreskin at all. I think it's interesting that people get so caught up in the little details like this. Personally I'm grateful that we can improve the situation at all, and that we have people like Ron and Chuck working to help us all improve our lives.
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  #3  
Old April 14th, 2010
admin admin is offline
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Default Re: Anatomical Question - Foreskin Innervation

Quote:
Originally Posted by alibi View Post
Assuming that those nerves run from the base of the penis to the glans (which would be the most efficient), how is the inner foreskin connected to the nervous system after circumcision?
The nerves emanate from the core of the penis, not along the skin.
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Old April 15th, 2010
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z726 z726 is offline
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Default Re: Anatomical Question - Foreskin Innervation

It would make logical sense to assume the nerve endings and blood vessels of the inner foreskin connect with the rest of the penis at the sulcus, right underneath the corona. Since its connection with the shaft skin is severed during circumcision, and the remaining inner foreskin doesn't die off or become numb forever, this would be the only way for the inner foreskin to survive and maintain any sensitivity.

As far as I can tell from a quick search, the dorsal penile nerve runs underneath the Buck's fascia of the penis, which is not attached to the foreskin at all. It would be untouched by circumcision (or at least one not severely botched).

The amount of blood vessel connection between outer and inner foreskin after circumcision (if any - I'm just guessing here) most likely depends on the amount of scar tissue formed.
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Old April 15th, 2010
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Default Re: Anatomical Question - Foreskin Innervation

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  #6  
Old April 15th, 2010
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Default Re: Anatomical Question - Foreskin Innervation

As you can see from the illustration, the dorsal nerves are within the deep fascia of the penis, not in the skin that is removed by circumcision, although I suppose there could easily be trauma to the deeper regions of the penis that could damage them-- in which case, there would be some type of numbness, I am sure.

The feeling in the surface of your penis is due to nerve endings, not the nerves themselves. Think of it like the leaves of a tree. The nerve is the trunk and the branches, while the nerve endings are the leaves that sprout out to suck in sunlight. In this case, the sunlight is stimulation. Depending on the type of nerve ending, we perceive differences in temperature, force and duration of physical contact, whether something is wet or dry, smooth rough, etc.

During skin expansion (and even skin transplants) the nerves will send out new nerve endings to innervate the newly grown (or transplanted) tissue. This is why our restored foreskins have sensation and do not grow more and more numb as we create more skin.

One wonderful aspect of our bodies' capacity to generate new nerve endings is that we seem to have a pre-programmed "blue print" in our nervous system. The body knows what nerves are supposed to innervate which regions, so the dorsal nerve of the penis would generate foreskin area specific nerves... while, in your face, you would generate the nerves associated with your facial nerves. Pretty cool, huh?

Doctors have found that, even when skin is harvested from one region of the body and transplanted to another (for example, the thigh to the scalp), the ruling nerves of the recipient body region infiltrate the transplanted tissue with its own pre-programmed nerve endings. In other words, if you have tissue harvested from your hand and transplanted onto your penis, within a few years that skin would start hosting erogenous nerve endings. There are some issues with degraded nerve conduction, but skin expansion is far less traumatic than skin transplants.

In my opinion, and based of the observations of many veteran restorers, our restored foreskins are almost as sensitive and erogenous as an intact man's natural foreskin. One restorer I used to chat with, who was circumcised as an adult and then restored, swore his restored foreskin felt just as good as his original, although it didn't recover the glans as well.

The bottom line is: the saying that nerves do not grow back is somewhat disengenuous. Nerves DON'T grow back very well when they are damaged, but NERVE ENDINGS have a remarkable ability to re-innervate and restore sensation to traumatized tissue.
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Old April 15th, 2010
alibi alibi is offline
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Default Re: Anatomical Question - Foreskin Innervation

Thank you for all the information. Unfortunately I used the wrong terms or didn't express myself clearly. I understand that nerves will reconnect and that the dorsal nerves aren't cut during circumcision (sorry for that), but I still don't know where the nerve supply (or connection) for the inner foreskin comes from.

Does it originate from the sulcus beneath the corona, or is it connected to the nerves originating at the base of the penis. Since all nerves supplying shaft skin and foreskin have to travel through the skin, those must be cut during circumcision.

My intention is not to bemoan the loss of those nerves or complain about it (at least not in this thread), i just want to know and even after reading through the articles at cirp.org and in other journals, i couldn't find an answer. (My interest in this was triggered when i came across a discussion, whether freehand circumcision is more nerve-sparing than the techniques used on children).

Thank you very much!
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  #8  
Old April 15th, 2010
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Default Re: Anatomical Question - Foreskin Innervation

The nerve endings work their way up toward the skin surface from the dorsal nerves, kind of wiggling in between the individual skin cells. The doral nerve enters the penis from the base and terminates at the glans. The dorsal nerves are not cut during circumcision unless the circumciser cuts into the deep fascia, although the nerve endings are severed along with the removed tissue.

I hope that helps. Otherwise, I'm not sure what you're asking.

The nerve endings do not travel up the length of the shaft, but radiate out from the central dorsal nerve, sort of like the spokes on a wheel.
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Old April 15th, 2010
alibi alibi is offline
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Default Re: Anatomical Question - Foreskin Innervation

Hello Cobra,

thank you for your patience. If the nerve endings would travel from the dorsal nerve, then the "gliding motion" would be impossible (or you would have a tangle of nerves between the two layers of skin, rubbing against each other...). I read here

http://www.cirp.org/library/anatomy/yang1/

that there is no connection between the dorsal nerve and the cutaneous layer. So, that's what confuses me. But maybe I'm getting everything wrong and should just ask my urologist next time i see him - I'm clearly out of my depth here...

Thank you!

Update: Found the information i wanted.

"Somatic nerve supply to the penis comes by way of the pudendal nerves, which eventually produce the dorsal nerves of the penis on each side. Although cutaneous innervation to the penis is primarily from branches of the pudendal nerve, the proximal portion is supplied by the ilioinguinal nerve after it leaves the superficial inguinal ring. The prepuce has somatosensory innervation by the dorsal nerve of the penis and branches of the perineal nerve. The glans is primarily innervated by free nerve endings and has poor fine-touch discrimination."

http://emedicine.medscape.com/article/442617-overview

Last edited by alibi; April 15th, 2010 at 13:17. Reason: added info
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  #10  
Old April 15th, 2010
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cobra cobra is offline
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Default Re: Anatomical Question - Foreskin Innervation

Technically, there is not two layers of skin. There is just one long layer, that folds over the glans.
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