The Ridged Band of the Human Prepuce

Introduction

History

Winkelmann (1959) studied the erogenous regions of the body.[1] He described two types of erogenous regions: the non-specific and the specific. The specific erogenous regions, he says, are found near the muco-cutaneous regions.

Winkelmann describes the specific regions as:

“Such specific sites of acute sensation in the body are the genital regions, including the prepuce, penis, clitoris and external vulva of the female and perianal skin, lip, nipple and conjunctiva. It is the special anatomy of these regions that require the term ‘specific’ when one speaks of erotic sensations originating in the skin. This anatomy favors acute perception. The rete* ridges of the epithelium are well formed and more of the organized nerve tissue rises higher in the dermis than is true of haired skin.”[1]

The description of the ridged band rested there until John R. Taylor, M.B., F.R.C.P., a pathologist at the Health Sciences Centre of the University of Manitoba at Winnipeg, undertook an anatomical and histological investigation of the foreskins of cadavers to determine and describe the loss to circumcision. Taylor first presented his findings in 1991 before a symposium on circumcision. Taylor named the newly described structure, the “frenar band”, but this was soon discarded in favor of the more descriptive “ridged band.”[2]

Description of the Ridged Band

Taylor et al. (1996) describe the ridged band as:

“When retracted, the inner surface of the prepuce displays two zones, `ridged' and `smooth'. The first, a transversely-ridged band of mucosa 10-15 mm wide, lies against the true skin edge, forming the outer surface of the tip of the prepuce. In the dorsal midline, the `ridged band' lies above the level of the adjacent `smooth' mucosa and merges smoothly, on either side, with the frenulum of the prepuce. When magnified, the ridged mucosa has a pebbled or coral-like appearance. Unretracted, the adult `ridged band' usually lies flat against the glans; retracted, the `ridged band' is everted on the shaft of the penis. The remainder of the preputial lining between the `ridged band' and the glans is smooth and lax. There is considerable variation in the degree of ridging: older subjects showed less and younger subjects more marked ridging. Some ridging was seen in all the prepuces examined.”[3]

Taylor and colleagues further noted that the ridged band is intensely vascularized, which is typical of components of the nervous system.

Fleiss & Hodges (2002) describe the ridged band:

“Adjacent to the smooth mucosa and just behind the lips of the foreskin is the ridged mucosa. This exquisitely sensitive structure structure consists of tightly pleated concentric bands, like the elastic bands at the top of a sock. These expandable pleats arise from the frenulum and encircle the inner lining of the foreskin. They allow the lips of the foreskin to open and roll back, exposing the glans. The ridged mucosa also gives the foreskin its characteristic taper.

“The ridged mucosa is a highly vascular zone of specialized sensory tissue containing a dense concentration of specialized erotogenic nerve receptors. Eversion and reversion of the foreskin during erection and sexual play cause the pleats of the ridged mucosa to expand and contract like the bellows of an accordion. This movement allows every surface of the pleats to come in contact with the rim of the glans. The unfolding and refolding of the ridged mucosa over the glans allows all of the erotogenic nerve endings to be stimulated, increasing sexual pleasure. If  the foreskin is fully everted, the ridged mucosa will be repositioned around the shaft of the penis.”[4] 

Innervation of the Ridged Band

It is difficult to overstate the high degree of innervation of the ridged band. Winkelmann described the innervation of the prepuce:

“The mucocutaneous end-organs [nerve-endings] extend from the distal margin of the prepuce to the site at which hairy skin begins, where they diminish and disappear. Because of the thin dermis and minimal subcutaneous tissue in the prepuce, the nerve networks are closely set”[1] 

Moldwin & Valderama (1989) also report an “extensive neuronal network within prepucial tissue which is present in birth with little change to adulthood” [7]

Taylor reports:

“Histological cross-sections of the `ridged band’ showed focal, spiky or more rounded, broader and flatter ridges interspersed with sulci. Meissner's corpuscles were more plentiful in some subjects than in others but perhaps significantly, they were only seen in the crests of ridges, occasionally in small clumps that expanded the tips of corial papillae. End-organs were not seen in sulci between ridges in this material. S100 staining showed additional end-organs and myelinated nerve fibres within papillae and confirmed the richly innervated nature of the `ridged band'. The distribution of Meissner’s corpuscles in the mucosal ridges was best seen in tangential sections through the epithelium and tips of corial papillae of some but not all specimens. Sections of `smooth mucosa' showed no ridging of the mucosal surface, slightly shallower corial papillae and few Meissner's corpuscles. Meissner's corpuscles were seen in the frenulum and glans but no at tempt was made to compare smooth with deeply ridged mucosae. Histologically, no clear demarcation line can be drawn between true skin of the penile shaft and the `ridged band' at the precise tip of the prepuce.”[3]

Sensitivity of  the Ridged Band 

“Coitus without a prepuce is analogous to a colour-blind person viewing a Renoir or Van Gogh painting.”[10]

Falliers (1970), perhaps speaking from personal experience, correctly identified the prepuce as the source of sexual pleasure:

“The sensory pleasure induced by tactile stimulation of the foreskin is almost totally lost after its surgical removal. The surface of the exposed glans, as we know, has no capacity to receive and transmit any fine sensations of touch, heat, etc. Consequently, the fundamental biological sexual act becomes, for the circumcised male, simply a satisfaction of an urge and not the refined sensory experience that it was meant to be.”[11] 

Sorrells et al. (2007) evaluated adult male volunteers, with no history of penile pathology or diabetes, with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Nineteen positions on the penis were tested. The lowest pressure required to produce sensation (and representing the most fine-touch sensitive areas) were recorded at points 3, 4, 5, 13, and 14, which are 3) the orifice rim of the prepuce, 4) the muco-cutaneous junction, 5) the ridged band, 13) the frenulum near the ridged band, and 14) the frenulum at the muco-cutaneous junction.[12]

Blustein et al. (2003)  carried out a study to determine whether intact males or circumcised males are more sensitive to fine touch. Blustein retracted the foreskin of the intact males and did not test it. They report, “there are no significant differences in penile sensation between circumcised and uncircumcised men with respect to vibration, spatial perception, pressure, warm and cold thermal thresholds in both patients with and without erectile dysfunction.”[13] Payne et al. (2007)  carried out a similar study of penile sensitivity in circumcised and intact males during sexual arousal. No part of the foreskin was tested for sensitivity. Payne et al. report, “In sum, the present study found no difference in genital sensation between uncircumcised and circumcised men.”[14] 

Function of the Ridged Band

“It is logical to anticipate that some individuals will have cutaneous hyperneuria, and also to expect eventually to find some individuals with actual diminution in organization of the cutaneous nerves for sensation. Certain pathologic states may be explicable on the basis of diminished or augmented cutaneous nerve supply. Examples of these might be satyriasis, priapism, nymphomania, impotence and frigidity. …Since adequate data are not available on these subjects, one can only speculate that an anatomic basis for these various clinical syndromes may some day be found.…”[1]

Taylor (2000) points out that the ridged band is “designed to respond to movement of adjacent mucosa and the skin of the penis,[16] and (2003) “stretching the prepuce and its ridged band triggers reflex contraction of muscles of the bulb of penis known to be associated with ejaculation and, not insignificantly, erogenous sensation.”[17] 

Effects of Excision of the Ridged Band

"Our study corroborates the importance of penile sensibility for erectile (patho)physiology as suggested by others and supports the concept of sensory deficit impotence as an important cause of erectile dysfunction."[18]

Immerman & Mackey (1998) hypothesize, based on the demonstrated changes after the loss of sight in one eye, that the loss of so much sensory tissue, would cause structural changes in the brain.[19] The neural reorganization might be expected to produce behavioral changes.  More research is necessary to prove their hypothesis. Male circumcision clearly produces changes in human behavior,[20] however, it is not yet known if brain changes are involved.

Several researchers report that circumcised men (who do not have a ridged band) have more difficulty with erection and ejaculation. Coursey et al. (2001) report worsened erections in a control group of circumcised men.[21]  Fink et al. (2002) investigated erectile function in men who had been circumcised to treat a pathological condition.They report worsened erectile function, decreased penile sensitivity, and, oddly, increased satisfaction.[22] It must be noted that this group of men had a circumcision to treat a pathological condition and the treatment of that pathological condition may have resulted in improved satisfaction.

Shen et al. (2004) investigated erectile function after circumcision in 95 Chinese men. Although 18 subjects had mild erectile dysfunction before circumcision 28 subjects had mild to moderate erectile dysfunction after circumcision. Thirty-one reported prolonged intercourse.[23]

Denniston (2004) surveyed 38 men who  had experienced sexual intercourse before and after circumcision. Twenty-two of the 38 men (58%) felt that the pleasure of intercourse was lessened and they would not have circumcision again.[24]

Senkul et al. (2004) investigated the effect of circumcision in healthy young Turkish men who had been circumcised for cosmetic or religious reasons. Senkul et al. reported significantly longer ejaculatory time after circumcision.[25]

Thorvaldsen & Meyhoff (2005) surveyed  Danish men. They report that young Danish men have more difficulty reaching ejaculation and orgasm after circumcision.[26] 

Conclusion

The ridged band was completely unknown when circumcision was introduced into medical practice. For many decades medical doctors believed that circumcision has no effect on sexuality. That belief very clearly is incorrect. The real importance of the ridged band “lies in an ability to trigger a reflex contraction of muscles responsible for ejaculation.”[29]

It now is clear that excision of the ridged band by circumcision has a maleficial effect on erection, ejaculation, and sensation. Parents should be informed that a neonatal circumcision would adversely affect their son's adult sex life.[28] This factor requires that the practice of non-therapeutic circumcision of children be reevaluated in the light of contemporary standards of medical ethics.

In the case of adults who are requesting circumcision, doctors have a responsibility to warn adults, as part of the informed consent process, about the sexual changes that would be experienced, if the ridged band were to be amputated by circumcision.[28] [30]

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