THE COMPLETE FRENULUM STUDIES

Part One:
Introduction (Grewel)
Basic Human Studies
Part Two:
Modern Treatment (Z plasty etc.)
Ancient treatment (Bryk, Luo Rites)
The Animal Studies

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PART ONE
The HUMAN Studies

Campbell's Urology Edited by Patrick C. Walsh (et al.), Part IX Chapter 51: Normal and Anomalous Development of the Urinary Tract Max Maizels, M.D. Seventh Edition London W B Saunders 1998 page 1582-3

"The preputial and urethral folds fuse on the ventrum of the glans as the frenulum. ... Failure of fusion of the urethral folds blocks development of the prepuce ventrally, especially the frenulum."

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Anatomical Effects

Ohjimi T and Ohjimi H Special surgical techniques for relief of phimosis J Dermatol Surg Oncol 1981 Apr;7(4):326-30

"... a short, thick frenulum that tends to pin and tie down the foreskin."

This is a confusing condition especially for the men who have it.

Bradford B. Schwartz, M.D. Lysis of frenum Urology 1979 Feb;13(2):195

"Patients requesting circumcision frequently do so because of pain associated with stretching and tearing of the frenum during coitus. These patients attribute their symptoms to the presence of a redundant prepuce. However, the prepuce itself is not usually the cause of their pain. A tight frenulum and its tethering effect during penile erection and penetration can be the basis for their complaints."

A short frenulum often rips

Prof. Dr. Med. Hartmut Porst Was jedermann über Sexualität und Potenz wissen sollte - (German text) What Everyman should know about Sexuality and Potency Georg Thieme Verlag Stuttgart, Trias (1991) p.60

"Frenulum breve (When the band is too short)
Among a percentage of men the band called "the frenulum" (which runs between the foreskin and underneath the opening of the urethra), is too short, so that on erection it tightens to its limit and can even rip. To add to the confusion this usually happens during the first sexual encounter causing a moment of great alarm for both participants at the resultant bleeding."

A Yip, et al, Injury to the Prepuce Br J Urol 1989 May;63(5):535-8

"The tethering effect of the short frenulum during penetration was presumably the cause of the injury."

June Reinisch. The Kinsey Institute New Report on Sex. Penguin (1990) p.39

"Tearing the frenulum ... is not unusual. Such a tear may produce a great deal of blood, but it usually heals spontaneously. These tears require surgery only if any scar tissue that forms hinders movement of the penile skin or causes discomfort."

It may rip repeatedly

Wabrek and Wabrek. Dyspareunia Journal of Sex and Marital Therapy Spring 1975: Vol.1, No.3, Pages: 234-41

"A tight frenulum can also cause dyspareunia. In the course of healing, scar tissue forms which shortens the frenulum even more and predisposes it to even more tearing and scarring, and a vicious cycle is set up."

Sometimes it leads to premature ejaculation.

S. Rejasse Ejaculation prématurée - (French text) Premature Ejaculation J Urol (Paris) 1987;93(9-10):557-60

"There is nothing which leads to premature ejaculation more often than in those specific cases where the frenulum of the prepuce is too short. If it is still present following the first sexual encounters this anomaly frequently leads to premature ejaculation, however it is easy to cure under local anaesthetic without being admitted to hospital. Therefore it is the responsibility of every doctor and surgeon to detect this and to enquire after the sexuality of the man concerned, because most of the time, the patient himself will not dare confront the problem. In this matter the doctor has a truly prophylactic role in averting a catastrophic development."

Quénu gives us a good summary and a few interesting speculations

Louis Quénu Cure chirurgicale des désordres fonctionnels liés aux altérations du prépuce - (French text) Surgical treatment of functional disorders related to changes in the prepuce J Urol Nephrol (Paris) 85(10-11), 755-759 (1979)

"The rupture of the frenulum is an accident which, in certain circumstances, can be very serious, even leading to death."

"Certain ruptures are "successful" in the sense that no corrective measure is necessary. The others leave a persisting shortness of the frenulum and at the same time a fragile scar which may rip in a repeated manner. In these cases it is necessary to operate."

"In the majority of cases, it is difficulty during copulation which brings the patients (to me). It is rare that the shortness of the frenulum is alone the cause. Generally speaking, that which is the cause is an insufficient diameter of the preputial opening, preventing or hindering retraction, and this is often associated with a shortness of the frenulum."

"In effect, the shortness of the frenulum plays an obvious role in the inability to retract, by imposing a too great obliqueness at the ring of the preputial opening. In certain cases "relative" phimosis is due to a shortness of the frenulum."

Quénu's use of the word "relative" in the above passage may be confusing. At times frenulum breve may occur simultaneously with a relative phimosis (phimotic ring) and this complicates the anatomical and sexual effects as any combination of such conditions does. Quénu points out that the short frenulum leads to an oblique effect which may be confused with a phimosis.

"Among older children, I have noticed that a short frenulum was often the origin of an extensive symphysis around the neck (or collum), of the glans penis and because of this, I have assumed that the shortness of the frenulum plays a role in the emergence and perpetuation of the balanoposthitis which creates and sustains the phimosis."

Grewel questions the effects during masturbation and coitus

F. Grewel The Frenum Praeputii and the Defloration of the Human Male Folia Psychiatrica, Neurologica et Neurochirurgica Neerlandica 61(2) p123-126 1958

"My attention was drawn to this anatomical configuration because in the course of the years I have been consulted by men who mostly after their first coition, showed an excoriation, a slight rhagade or even a slight laceration of the frenum behind the margin of the corona, or of the alae freni. ..." "Sometimes it was not during the first coition that this phenomenon occurred but during a later one, that was experienced as much more complete or more satisfactory than the foregoing. In a single case the rhagade had developed during masturbation. These excoriations may occur more than once."

"The excoriation is seen in cases of forced coition in older men with a rigid frenum; a young man with phimosis developed a slight laceration in a forced trial to cohabitate."

"Does it occur in people who have never masturbated, the frenum being more rigid or less resilient than in men who practised masturbation? When it occurs in masturbation the excoriation seems to be localised especially in the alae freni."

"Is the fact that the alae are more manifest in younger men than in older due to the constant stretching or elongation of these formations in the course of adult life? Elasticity of the frenum seems to prevent the laceration."

A better description would be that a short frenulum causes penile incurvation when the foreskin is retracted.

Chitale and Whelan give some interesting but some inaccurate information

VR. Chitale, MS, FICS, Z Plasty for Short Frenum of Prepuce of Penis Ann Plast Surg 1991 Feb;26(2):196-7

"Short frenum of the prepuce of penis is a common condition. It gives rise to the following problems: 1) bleeding after sexual intercourse; 2) tear of frenum resulting in a small painful ulcer over the frenum, which does not heal easily; 3) a small ventral chordee, which produces pain after erection; and 4) all the above conditions cause psychoneurotic problems."

P. Whelan Male dyspareunia due to short frenulum: an indication for adult circumcision. Br Med J 1977 Dec 24-31;2(6103):1633-4

" ... a short frenulum that becomes painfully tight on erection ... "

"Indications for circumcision in 48 patients 1975-76 and number with pain on intercourse:

Hygiene

Para- phimosis

Phimosis

Phimosis with balanitis

Balanitis alone

Short frenulum

No of cases No with pain on intercourse

3

2

25 10

6 3

2

10 10

"The normal frenulum is a mucous membrane on the ventral surface of the glans penis, through which runs the frenular artery. A short frenulum may apparently be congenital, when it is of normal thickness, or secondary to recurrent infection or trauma, when it can be felt in the flaccid state as a thickened band. When the penis is erect the short frenulum restricts the prepuce and causes downward curvation of the glans. During intercourse this means that there is an element of chordee and the abnormal position of the glans penis causes pain. Tension in the short frenulum itself is also painful and the band may be torn and then heal by fibrosis, thus aggravating the situation."

"Short frenulum should be sought as a cause for dyspareunia in patients who do not have phimosis or questionable hygiene and who may erroneously be labelled as having psychosexual problems."

Chitale and Whelan have a rather questionable understanding of frenulum breve, suggesting it is the "ventral chordee, which produces pain ..." and even that "the abnormal position of the glans penis causes pain."

These conclusions are incorrect. Correct is that the "tethering" effect of frenulum breve pulls the foreskin forward. Pain, bruising, tension and soreness are caused by the foreskin being pulled backwards straining the very sensitive frenulum.

This pain occurs principally through nerves in the frenulum itself; rather than the underside of the glans which is also usually very sensitive. I would like to establish from other men's personal experience to what extent individual differences exist on this point.. Please contact me personally about this.

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The Specific Effects of Frenulum Breve
among Circumcised Men and Boys

AS. Griffin and RL. Kroovand Frenular chordee: implications and treatment Urology 1990 Feb;35(2):133-4

"In 28 percent of our pediatric population undergoing elective circumcision we have demonstrated a previously undescribed ventral chordee of the glans, the result of a tethering effect of an unusually prominent frenulum." ... "Twenty of the 70 boys (28%) demonstrated a ventral glandular tilt (glandular chordee) due to an unusually prominent frenulum."

Elective circumcision means when it is requested rather than routinely performed etc. Therefore the statistics of 28% are perhaps a guide to how often circumcision is requested when actually frenuloplasty is necessary - It helps us little in any guess at the overall statistics.

"Persistent frenular chordee after circumcision may result in deformity of the penis on erection making sexual intercourse difficult or uncomfortable."

This study suggests that among circumcised men when there is no foreskin for the tension of a short frenulum to displace and pull forward upon, during erection a short frenulum may cause the glans to bend downwards. The study is called "... implications ..." I feel sure that if this was a large problem the anti circumcision groups would have recorded it. One e.mail letter reports this

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Age When Operated

This is apparently the only study which indicates the age when men are operated for frenulum breve. I suspect that special permission would be required under 18 yrs. of age, and therefore such may have been automatically excluded from the sample group.

There may be some difference in the age of the patient and which type of specialist they seek for treatment. An urologist told me that among his patients "basically the average age group is around 17 to 27 years old" (Dr. for Urology Dieter Behling, Hamburg July 1995 in conversation. Quoted with permission). On the other hand a surgeon told me most of his operations were performed throughout puberty and in old age (Dr. med. Markau Hamburg Aug. 1994).