| Frenulum of the penis | |
|---|---|
 | |
| Details | |
| System | Male reproductive system |
| Artery | Dorsal artery of the penis |
| Vein | Dorsal veins of the penis |
| Nerve | Dorsal nerve of the penis |
| Identifiers | |
| Latin | frenulum preputii penis |
| TA98 | A09.4.01.012 |
| TA2 | 3676 |
| FMA | 19647 |
| Anatomical terminology | |
Thefrenulum of the penis, often known simply as thefrenulum (fromLatin:frēnulum,lit. 'little bridle') orfrenum, is a thin elastic strip of tissue on the underside of theglans and the neck of thehuman penis. In men who are notcircumcised, it also connects theforeskin to the glans and the ventral mucosa.[1][2][failed verification] In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin duringerection.[3][4] In flaccid state, it tightens to narrow the foreskin opening.[2]
The penile frenulum ishomologous to theclitoral frenulum in the female.[5] It is similar to thelingual frenulum between the tongue's lower surface and the lower jaw, or the frenulum between the upper lip and the outside of the upper gum.[6]
In some men, the frenulum may appear shorter than normal, a phenomenon known asfrenulum breve. Treatment of frenulum breve may be non-surgical, or in other cases, especially with penilechordee, it may includefrenulectomy or frenulum lengthening.[7][8]
The frenulum is a highlyvascularized strip ofmucosal tissue on the ventral side of the glans and the neck of the penis. It forms the interface between the outer andinner foreskin layers.[2] Duringgestation, it forms as the lateral edges of the preputial lamina approach in the ventral midline. The two sides of the lamina do not fuse in the midline but remain separated by a thinseptum ofmesenchyme that will create the preputial frenulum.[9] As part of the glans penis, the frenulum is innervated by divisions of thepudendal nerve; thedorsal nerve of the penis and a branch of theperineal nerve.[10][11] Blood supply to the frenulum is provided by branches of thedorsal artery of the penis that curve around each side of the neck to enter the frenulum and the glans from its ventral surface.[12] It is uncertain whether the frenular artery is single or paired.[13] Veinous drainage is thought to occur around the neck of the penis from smaller paired venules.[14] The frenulum occurs on the ventral midline of the glans, where the two glans wings merge forming theseptum glandis.[15]
The role of the frenulum in penile erection has been studied in cases of men with short frenula andpremature ejaculation. Short frenulum may sometimes be associated with unsatisfied intercourse.[8] Treatment with lengthening or reconstruction of the frenulum in uncircumcised and circumcised men was reported to have positive results in satisfied intercourse, prolonged erection and time of ejaculation.[16][17]
For individuals with spinal cord injuries preventing sensations from reaching the brain, the frenulum just below the glans can be stimulated to produce orgasm and peri-ejaculatory response. It is often a way for those with spinal cord injuries to engage in sexual activities and subsequently feel pleasure.[18][19]
Frenulum breve is a condition in which the frenulum is short and restricts the movement of the foreskin, which may or may not interfere with normal sexual activity. Frenulum breve may also contribute to frenular chordee, where the glans is pulled toward the ventral body of the penis. The condition can be treated with surgical and non surgical treatment. Non surgical treatment includes stretching exercises andsteroid creams.[3] Surgical treatment includesfrenuloplasty (frenulum lengthening or reconstruction),frenectomy, orcircumcision.[4] There are a variety of different circumcision techniques in which the frenulum can be spared and left completely intact.[20]
It is possible for the frenulum to tear during sexual activities. This type of injury usually heals by itself.[21] In more severe cases, the frenular artery may be injured causing bleeding.
The frenulum may be entirely missing in cases of first degreehypospadias.
As a treatment forfrenulum breve or frenular chordee, afrenectomy orfrenulectomy can be performed to excise the frenulum from the penis.[7] This is a form of genital frenectomy.[7] This procedure results in a smooth surface. A less invasive treatment which often retains the natural appearance and function of the frenulum to some degree is afrenuloplasty orfrenulum lengthening. This procedure involves a (partial) incision of the frenulum and realigning the edges to gain more length. This makes the frenulum longer, effectively relieving pain and discomfort.[22][23]
As development proceeds the lateral ventral edges of the preputial lamina approach the ventral midline. The ventral edges of the preputial lamina do not fuse in the midline but remain separated by a thin septum of mesenchyme [...] destined to form the preputial frenulum.
The dorsal nerve of the penis innervates the glans, including the frenulum which is also innervated by a branch of the perineal nerve.
The blood supply to the frenulum arises from the dorsal artery of the penis. Branches of the dorsal artery curve around each side of the distal shaft to enter the glans and the frenulum ventrally.
It is unclear whether the frenular artery is single; in our experience, paired arteries were often evident, lying in the frenular bed
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