To understand the male penile anatomy, and the value that the individual components like the foreskin and its associated structures provide, it is instructive to carefully consider the female reproductive system since both are identical in development up to 10 weeks after fertilization. The hymen is a membrane which stretches across the vaginal orifice and tears normally after childhood due to physical activity or stimulation. Similarly, the inner surface of the prepuce (or foreskin) and the facing surface of the glans penis are covered with a thin mucous membrane which separates naturally after childhood [1]. However, despite both the hymen and the foreskin serving a purpose, claims of preventing injury have been the basis of removal of the foreskin while hymen removal is not routinely prescribed [1]. Both the male and female sexual responses are dependent on becoming engorged with blood to properly function. Removal of the foreskin system, which includes vast amounts of vessels and nerves, destabilizes heat transfer as well as blood volume in the penile compartment. The blood flow reduction is proportional not merely to the vessel radius but to the fourth power of the radius, thus massively changing blood volume delivered for development, function and protection. Similar to its role regarding the descent of the testes for viable sperm production, temperature is essential in maintaining penile stability for erection durability during sexual response.

Foreskin arterial (FA) blood flow maintains stability of heat and energy transfer while directly facilitating penile shaft capacity for rapid responsiveness of its smooth muscle cells (SMC). The endothelial glycocalyx (EG) is a delicate net which dynamically responds to biophysical and biochemical signals [2]. Inter-tissue communication was demonstrated for the first time in the aortic endothelium [3] where this system facilitates production, storage and delivery of highly volatile nitric oxide (NO) to command SMC contractility. Separately, the EG also has been found to richly express aquaporin-1 (AQP1) in the lung microvascular endothelium [4], providing a reservoir in maintaining efficient NO delivery across the vessel wall [2,5]. Stable and sufficient blood flow maintains this adjacent, bush-like structure on the endothelial cell surface and maximizes the EG surface area for responsiveness to the most subtle of external signals [2]. Injury rapidly sheds the FAEG and endothelium to expose and initiate leukocyte transmigration into the vessel wall for repair and attenuates the EG in proximity to the site of trauma due to stiffening of the adjacent surfaces [2] . In simple terms, the FAEG serves as the interface between external signals and the body’s response, directly commanding the dynamic transformation between an erect and a flaccid state. It is critical for proper blood flow and its removal via circumcision severely weakens the ability of the FAEG to serve this essential function.

The EG is required for vascular stability and organ function throughout the body [2] and especially so for penile responsiveness to stimulation leading to sensual experience/expression (sex). Despite its importance and obvious value, a search for FAEG or FG on Pubmed database returns 0 results. This system has not been investigated in a meaningful way and harmful misinformation is being promoted on the false grounds that foreskin removal serves as a prophylactic measure. The lack of literature for complications related to circumcision as compared to other amputation procedures illustrates the need for more investment in research to counter and stop misinformation of this unnecessary and deleterious procedure. 

Amputation and circumcision produce irreversible changes to tissue interconnectivity and self-renewal capacity via destroying hydrostatically driven transmural flow along with significant reduction of blood residence time and volume in the body compartments affected. This reduction of blood flow to highly responsive and sensitive genital tissue debilitates empathetic and emotional capacity as demonstrated by its use for domestication on animals or for subjugation and control of humans in our evolutionary past.  The narrative has been artificially suppressed to continue vague and misleading claims of efficacy from poorly interpreted and incomplete studies. Analysis of amputees’ signal conduction and processing illustrate how trauma is mapped into adjacent tissue after injury, potentially through the EG, and into the brain's neural map resulting in a phantom limb phenomenon long after original injury [6].  Our body does not forget the natural map of its anatomy and continues to connect to function as if whole, even when structures have been removed artificially.


[1] Anatomy and Physiology: The Unity of Form and Function, (12th edition), by Saladin, Kenneth S., McGraw-Hill Publishers, 2021.

[2] Weinbaum, Sheldon, et al. "The glycocalyx and its role in vascular physiology and vascular related diseases." Cardiovascular Engineering and Technology (2020): 1-35.

[3] Toussaint J, Raval CB, Nguyen T, Fadaifard H, Joshi S, Wolberg G, Quarfordt S, Jan KM,  Rumschitzki DS. Chronic hypertension increases aortic endothelial hydraulic conductivity by upregulating endothelial  aquaporin-1 expression. Am J Physiol Heart Circ Physiol. 2017 Nov 1;313(5):H1063-H1073. doi:  10.1152/ajpheart.00651.2016. Epub 2017 Jul 21. PMID: 28733452; PMCID: PMC5792199.

[4] Oh P, Li Y, Yu J, Durr E, Krasinska KM, Carver LA, Testa JE, Schnitzer JE. Subtractive proteomic mapping of the endothelial surface in lung and solid tumours for tissue-specific therapy. Nature. 2004 Jun 10;429(6992):629-35. doi: 10.1038/nature02580. PMID: 15190345.

[5] Herrera, Marcela, and Jeffrey L. Garvin. "Novel role of AQP-1 in NO-dependent vasorelaxation." American Journal of Physiology-Renal Physiology 292.5 (2007): F1443-F1451.

[6] Makin, T., & Plasticity Lab, L.  Phantom Limbs and Brain Plasticity in Amputees. Oxford Research Encyclopedia of Neuroscience. Retrieved 9 Jul. 2021, from