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Die Seite wurde neu angelegt: „{{NYT en}} {{GraphicWarning}} right|thumb|A human penis before and after retraction of the foreskin. In the majority of…“
{{NYT en}}
{{GraphicWarning}}
[[Image:Side by side retraction.png|right|thumb|A human penis before and after retraction of the foreskin.]]
In the majority of adult men, the [[foreskin]] normally retracts to reveal the head of the penis. In newborns, it is common for the foreskin to be fused to the head of the penis by the [[synechia]], thus rendering it non-retractable. The preputial cavity is sealed by the [[synechia]].<ref name="fleiss-hodges-vanhowe1998">{{REFjournal
|last=Taylor
|first=J.R.
|author-link=John R. Taylor
|last2=Lockwood
|first2=A.P.
|author2-link=
|last3=Taylor
|first3=A.J.
|title=The prepuce: specialized mucosa of the penis and its loss to circumcision
|journal=Brit J Urol
|date=1996
|volume=77
|issue=
|pages=291-5
|url=http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.1996.85023.x/full
|quote=
|pubmedID=8800902
|pubmedCID=
|DOI=10.1046/j.1464-410X.1996.85023.x
|accessdate=2019-12-02
}}</ref> The foreskin usually separates from the glans and becomes retractable with increasing age. There is much uncertainty among health care workers about when the foreskin of a boy should become retractable.<ref>{{REFjournal
|last=Simpson
|first=E.T.
|last2=Barraclough
|first2=P.
|title=The management of the paediatric foreskin
|journal=Aust Fam Physician
|volume=27
|issue=4
|pages=381-383
|url=http://www.cirp.org/library/hygiene/simpson1/
|quote=
|pubmedID=9613002
|pubmedCID=
|DOI=
|date=1998-05
|accessdate=2019-10-17
}}</ref> The mistaken belief that the foreskin was supposed to be retractable at the time of birth of the infant has led to a characterization of the genitalia of most infant males as defective at birth. This has led to many false diagnoses of [[phimosis]], followed by unnecessary [[circumcision]], when, in fact, the foreskin is developmentally normal.
Normally, developmental non-retractability does not cause any problems. Non-retractability may be deemed pathological if it causes problems, such as difficulty urinating or performing normal sexual functions, but even then, this is rare, and, if the non-retractability itself is not caused by pathological inflammation, it cannot be called "pathological" or "true phimosis." A foreskin that is so narrow it will retract very little or not at all, but is not the result of a pathological inflammation, is accurately termed ''preputial stenosis'' (narrow prepuce), and will respond to treatment including steroid creams, manual stretching, and changing [[masturbation]] habits.
== Geschichte ==
The first data on development of retractile foreskin were provided in 1949 by the famous British paediatrician, [[Douglas Gairdner]].<ref name="Gairdner">{{REFjournal
|last=Gairdner
|first=D.
|author-link=Douglas Gairdner
|title=The fate of the foreskin: a study of circumcision
|journal=Br Med J
|volume=2
|issue=
|pages=1433-7
|url=https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2051968&blobtype=pdf
|quote=
|pubmedID=15408299
|pubmedCID=2051968
|DOI=10.1136/bmj.2.4642.1433
|date=1949
|accessdate=
}}</ref> His data have been incorporated into many textbooks and is still being repeated in the medical literature today. [[Douglas Gairdner|Gairdner]] said that 80 percent of boys should have a retractable foreskin by the age of two years, and 90 percent of boys should have a retractable prepuce by the age of three years.<ref name="Gairdner"/>
Unfortunately, [[Douglas Gairdner|Gairdner]]’s data are inaccurate,<ref name="Wright1994">{{REFjournal
|last=Wright
|first=J.E.
|title=Further to the "Further Fate of the Foreskin"
|journal=Med J Aust
|volume=160
|issue=
|pages=134-135
|url=http://www.cirp.org/library/normal/wright2/
|quote=
|pubmedID=8295581
|pubmedCID=
|DOI=
|date=1994-02-07
|accessdate=2019-10-17
}}</ref> <ref name="Hill2003">{{REFjournal
|last=Hill
|first=G.
|author-link=George Hill
|title=Circumcision for phimosis and other medical indications in Western Australian boys
|journal=Med J Aust
|volume=178
|issue=11
|pages=587
|url=
|quote=
|pubmedID=12765511
|pubmedCID=
|DOI=
|date=2003-06-02
|accessdate=2019-10-17
}}</ref> <ref name="denniston-hill2010">{{REFjournal
|last=Denniston
|first=George C.
|author-link=
|last2=Hill
|first2=George
|author2-link=
|etal=no
|title=Gairdner was wrong
|trans-title=
|language=
|journal=Can Fam Physician
|date=2010-10-01
|volume=56
|issue=10
|pages=986-7
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954072/
|quote=
|pubmedID=20944034
|pubmedCID=2954072
|DOI=
|accessdate=2019-10-17
}}</ref> so most healthcare providers have been taught inaccurate data.<ref name="Hill2003"/> Retractability usually occurs much later than previously believed.<ref name="Wright1994"/> This page provides accurate data, derived from newer and better studies, for healthcare providers.
== Aktueller Standpunkt ==
Almost all boys are born with the foreskin fused with the underlying glans penis by the [[synechia]]. Most also have a narrow foreskin that cannot retract. Non-retractile foreskin is normal at birth and remains common until after puberty (age 18). Some boys develop retractile foreskin earlier, and about 2 percent of males have a non-retractile foreskin throughout life. Non-retractile foreskin is not a disease and does not require treatment.
There are three possible conditions that cause non-retractile foreskin:
* Tightness of the foreskin orifice
* Fusion of the foreskin with the glans penis<ref name="deibart1933">{{REFjournal
|last=Deibart
|first=G.A.
|title=The separation of the prepuce in the human penis
|journal=Anat Rec
|date=1933
|volume=57
|issue=
|pages=387-99
|url=http://www.cirp.org/library/anatomy/deibert/
|quote=
|pubmedID=
|pubmedCID=
|DOI=https://doi.org/10.1002/ar.1090570409
|accessdate=2019-10-07
}}</ref>
* Frenulum breve (which is rare and cannot be diagnosed until the previous two reasons have been eliminated)
The first two reasons are normal in childhood and are not pathological in children. The third can be treated conservatively, retaining the foreskin.
== Kleinkinder und Vorschule ==
Kayaba ''et al.'' (1996) reported that before six months of age, no boy had a retractable prepuce; 16.5 percent of boys aged 3-4 had a fully retractable prepuce.<ref name="kayaba1996">{{REFjournal
|last=Kayaba
|first=H.
|last2=Tamura
|first2=H.
|last3=Kitajima
|first3=S.
|etal=yes
|title=Analysis of shape and retractability of the prepuce in 603 Japanese boys
|journal=J Urol
|volume=156
|issue=5
|pages=1813-1815
|url=http://www.cirp.org/library/normal/kayaba/
|quote=
|pubmedID=8863623
|pubmedCID=
|DOI=
|date=1996-11-01
|accessdate=2019-10-19
}}</ref> Imamura (1997) examined 4521 infants and young boys. He re-ported that the foreskin is retractile in 3 percent of infants aged one to three months, 19.9 percent of those aged ten to twelve months, and 38.4 percent of three-year-old boys.<ref name="imamura1997">{{REFjournal
|last=Imamura
|first=E.
|title=Phimosis of infants and young children in Japan
|journal=Acta Paediatr Jpn
|volume=39
|issue=3
|pages=403-405
|url=
|quote=
|pubmedID=9316279
|pubmedCID=
|DOI=
|date=1997
|accessdate=
}}</ref> Ishikawa & Kawakita (2004) reported no retractability at age one, (but increasing to 77 percent at age 11-15).<ref>{{REFjournal
|last=Ishikawa
|first=E.
|last2=Kawakita
|first2=M.
|title=Preputial development in Japanese boys
|journal=Hinyokika Kiyo
|volume=50
|issue=5
|pages=305-308
|url=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=2004
|accessdate=2019-11-08
}}</ref> Ko ''et al.'' (2007) examined 59 newborn Taiwanese boys. Not one had a retractable foreskin.<ref name="ko2007">{{REFjournal
|last=Ko
|first=Ming-Chung
|author-link=
|last2=Liu
|first2=Chih-Kuang
|author2-link=
|last3=Lee
|first3=Wen-Kai
|author3-link=
|last4=Jeng
|first4=Huey-Sheng
|author4-link=
|last5=Chiang
|first5=Han-Sun
|author5-link=
|last6=Li
|first6=Chung-Yi
|author6-link=
|etal=no
|title=Age-specific Prevalence Rates of Phimosis and Circumcision in Taiwanese Boys
|trans-title=
|language=
|journal=Journal of the Formosan Medical Association
|location=
|date=2007-04
|volume=106
|issue=4
|pages=302-7
|url=https://www.sciencedirect.com/science/article/pii/S0929664609602564?via%3Dihub
|quote=
|pubmedID=17475607
|pubmedCID=
|DOI=10.1016/S0929-6646(09)60256-4
|accessdate=2019-11-08
}}</ref>
Non-retractile foreskin is the normal, expected, and more usual condition in this age group.<ref name="agawal2005">{{REFjournal
|last=Agawal
|first=Abhnav
|author-link=
|last2=Mohta
|first2=Anup
|author2-link=
|last3=Anand
|first3=Ritesh K.
|author3-link=
|etal=no
|title=Preputial retraction in children
|trans-title=
|language=
|journal=Journal of Indian Association of Pediatric Surgeons
|location=
|date=2005
|volume=10
|issue=2
|pages=89-91
|url=http://www.jiaps.com/article.asp?issn=0971-9261;year=2005;volume=10;issue=2;spage=89;epage=91;aulast=Agarwal
|quote=
|pubmedID=
|pubmedCID=
|DOI=10.4103/0971-9261.16468
|accessdate=2019-12-09
}}</ref>
== Schulalter und Jugend ==
[[File:Kayaba.jpg|left|frame|Percentage of boys with tight ring totally non-retractile foreskin according to Kayaba ''et al''.]]<br clear="all">
[[Jakob Øster]], a Danish physician who conducted school examinations, reported his findings on the examination of school-boys in Denmark, where circumcision is rare.<ref name="Øster1968">{{Template:Jakob_Øster_1968}}</ref> Øster (1968) found that the incidence of fusion of the foreskin with the glans penis steadily declines with increasing age and foreskin retractability increases with age.<ref name="Øster1968"/> Kayaba ''et al''. (1996) also investigated the development of foreskin retraction in boys from age 0 to age 15.5 Kayaba ''et al''. also reported increasing retractability with increasing age. Kayaba ''et al''. reported that about only 42 percent of boys aged 8-10 have fully retractile foreskin, but the percentage increases to 62.9 percent in boys aged 11-15.<ref name="kayaba1996" /> Imamura (1997) reported that 77 percent of boys aged 11-15 had retractile foreskin.<ref name="imamura1997" /> Thorvaldsen & Meyhoff (2005) conducted a survey of 4000 young men in Denmark.9 They report that the mean age of first foreskin retraction is 10.4 years in Denmark.<ref name="Thorvaldsen">{{REFjournal
|last=Thorvaldsen
|first=M.A.
|last2=Meyhoff
|first2=H.
|title=Patologisk eller fysiologisk fimose?
|trans-title=Pathological or physiological phimosis?
|language=Danish
|journal=Ugeskr Læger
|volume=167
|issue=17
|pages=1858-1862
|url=http://www.cirp.org/library/normal/thorvaldsen1/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=2005
|accessdate=2019-10-17
}}</ref> Non-retractile foreskin is the more common condition until about 10-11 years of age.
[[File:Oester.jpg|left|frame|Percentage of boys with fused foreskin by age according to Øster]]<br clear="all">
Ko ''et al''. (2007) examined 1145 Taiwanese boys aged 7 to 13. Ko ''et al''. reported:
<blockquote>
Our findings indicate that the degree of preputial retractability increases with age, while the prevalence of unretractable prepuce decreases with age. By the age of 13 years, very few boys (some 0.3%) still had an unretractable prepuce (i.e. type 1 prepuce).<ref name="ko2007" /></blockquote>
The findings reported by Ko ''et al."' are consistent with the findings reported by Øster (1968), by Kayaba ''et al''. (1996), and by Thorvaldsen & Meyhoff (2005)
== Diskussion ==
Boys usually are born with a non-retractile foreskin. The foreskin gradually becomes retractable over a variable period of time ranging from birth to 18 years or more.<ref name="Øster1968"/><ref name="Thorvaldsen"/> There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health in childhood and no intervention is necessary. Many boys only develop a retractable foreskin after puberty. Education of concerned parents usually is the only action required.<ref>{{REFjournal
|last=Spilsbury
|first=K.
|last2=Semmens
|first2=J.B.
|last3=Wisniewski
|first3=Z.S.
|etal=yes
|title=Circumcision for phimosis and other medical indications in Western Australian boys
|journal=Med J Aust
|volume=178
|issue=4
|pages=155-158
|url=
|quote=
|pubmedID=12580740
|pubmedCID=
|DOI=
|date=2003-02-17
|accessdate=2019-10-17
}}</ref>
== Vermeidung frühzeitigen Zurückziehens ==
Care-givers and healthcare providers must be careful to avoid [[forced retraction|premature retraction]] of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.<ref name="Wright1994"/> <ref>{{REFweb
|url=https://www.doctorsopposingforcibleretraction.org/
|title=Doctors Opposing Forcible Retraction
|trans-title=
|language=
|last=
|first=
|publisher=
|website=Doctors Opposing Forcible retraction
|date=2019
|accessdate=2019-10-02
|format=
|quote=
}}</ref>
== Die Vorhaut zurückziehbar machen ==
Teen boys who still have a non-retractable foreskin (about 10 percent of boys) should start stretching exercises to make the foreskin retractable in preparation for adult life.
Occasionally a male reaches adulthood with a non-retractile foreskin. Some men with a non-retractile foreskin happily go through life and father children. Other men, however, may want to make their foreskin retractile.
The foreskin can be made retractable by:
* Manual stretching<ref>{{REFjournal
|last=Dunn
|first=H.P.
|title=Non-surgical management of phimosis
|journal=Aust N Z J Surg
|volume=59
|issue=12
|pages=963
|url=http://www.cirp.org/library/treatment/phimosis/dunn1/
|quote=
|pubmedID=2597103
|pubmedCID=
|DOI=10.1111/j.1445-2197.1989.tb07640.x
|date=1989
|accessdate=
}}</ref><ref>{{REFjournal
|last=Beaugé
|first=M.
|title=The causes of adolescent phimosis
|journal=Br J Sex Med
|volume=
|issue=Sept/Oct
|pages=26
|url=http://www.cirp.org/library/treatment/phimosis/beauge2/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=1997
|accessdate=2019-10-18
}}</ref>
* Application of topical steroid ointment<ref>{{REFjournal
|last=Orsola
|first=A.
|last2=Caffaratti
|first2=J.
|last3=Garat
|first3=J.M.
|title=Conservative treatment of phimosis in children using a topical steroid
|journal=Urology
|volume=56
|issue=2
|pages=307-310
|url=http://www.cirp.org/library/treatment/phimosis/orsola1/
|quote=
|pubmedID=10925099
|pubmedCID=
|DOI=10.1016/s0090-4295(00)00576-8
|date=2000
|accessdate=2019-10-18
}}</ref><ref>{{REFjournal
|last=Ashfield
|first=J.E.
|last2=Nickel
|first2=K.R.
|last3=Siemens
|first3=D.R.
|etal=yes
|title=Treatment of phimosis with topical steroids in 194 children
|journal=J Urol
|volume=169
|issue=3
|pages=1106-1108
|url=http://www.cirp.org/library/treatment/phimosis/ashfield1/
|quote=
|pubmedID=12576863
|pubmedCID=
|DOI=10.1097/01.ju.0000048973.26072.eb
|date=2003-03
|accessdate=2019-10-18
}}</ref>
Male circumcision is outmoded as a treatment for non-retractile foreskin, but it is still recommended by many urologists because of lack of adequate information, and perhaps because of the [[Financial Incentive|profit to the doctor]] associated with circumcision. Nevertheless, [[circumcision]] should be avoided because of pain, trauma, cost,<ref name="Van Howe">{{REFjournal
|last=Van Howe
|first=RS
|title=Cost-effective treatment of phimosis
|journal=Pediatrics
|volume=102
|issue=4
|pages=e43
|url=https://pediatrics.aappublications.org/content/102/4/e43.full
|quote=
|pubmedID=
9755280
|pubmedCID=
|DOI=
|date=1998-10
|accessdate=2019-10-17
}}</ref><ref>{{REFjournal
|last=Berdeu
|first=D.
|last2=Sauze
|first2=L.
|last3=Ha-Vinh
|first3=P.
|last4=Blum-Boisgard
|first4=C.
|title=Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect.
|journal=BJU Int
|volume=87
|issue=3
|pages=239-244
|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1464-410x.2001.02033.x?sid=nlm%3Apubmed
|quote=
|pubmedID=11167650
|pubmedCID=
|DOI=10.1046/j.1464-410x.2001.02033.x
|date=2001-02-01
|accessdate=2019-10-17
}}</ref> complications,<ref name="Van Howe"/> difficult recovery, [[Circumcision scar| permanent injury to the appearance of the penis]], loss of pleasurable erogenous sensation,<ref>{{REFjournal
|last=Williams
|first=N.
|last2=Kapila
|first2=L.
|title=Complications of circumcision
|journal=Brit J Surg
|volume=80
|issue=
|pages=1231-1236
|url=http://www.cirp.org/library/complications/williams-kapila/
|quote=
|pubmedID=8242285
|pubmedCID=
|DOI=10.1002/bjs.1800801005
|date=1993
|accessdate=2019-10-17
}}</ref> impairment of erectile and ejaculatory functions,<ref>{{REFjournal
|last=Shen
|first=Z.
|last2=Chen
|first2=S.
|last3=Zhu
|first3=C.
|etal=yes
|title=Erectile function evaluation after adult circumcision
|journal=Zhonghua Nan Ke Xue
|volume=10
|issue=1
|pages=18-19
|url=
|quote=
|pubmedID=14979200
|pubmedCID=
|DOI=
|date=2004-01-01
|accessdate=2019-10-17
}}</ref><ref>{{REFjournal
|last=Masood
|first=S.
|last2=Patel
|first2=H.R.H.
|last3=Himpson
|first3=R.C.
|etal=yes
|title=Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly?
|journal=Urol Int
|volume=75
|issue=1
|pages=62-65
|url=http://www.cirp.org/library/sex_function/masood1/
|quote=
|pubmedID=16037710
|pubmedCID=
|DOI=10.1159/000085930
|date=2005
|accessdate=2019-10-17
}}</ref> and adverse sexual and [[Psychological issues of male circumcision| psychological]] effects.
{{SEEALSO}}
* [[Gliding action]]
* [[Forced retraction]]
* [[Phimose]]
* [[Synechie]]
{{LINKS}}
* {{REFweb
|url=http://www.nocirc.org/publish/6pam.pdf
|title=Answers to Your Questions About Premature (Forcible) Retraction of Your Young Son's Foreskin
|trans-title=
|language=
|last=Milos
|first=Marilyn
|author-link=Marilyn Milos
|publisher=
|website=NOCIRC
|date=2007-09
|accessdate=2019-12-02
|format=
|quote=The first person to retract a child’s foreskin should be the child himself.
}}
* {{REFweb
|url=http://www.cirp.org/library/normal/
|title=Normal development of the prepuce: Birth through age 18
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=''Circumcision Information Reference Library''
|website=
|date=2008-11-14
|accessdate=2019-11-08
|format=
|quote=
}}
* {{REFdocument
|title=Care of the Intact (Not Circumcised) Penis in the Young Child
|url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/01/care-of-the-intact-not-circumcised-penis-in-the-young-child-professionals.pdf
|contribution=
|last=
|first=
|publisher=''Doctors Opposing Circumcision''
|format=PDF
|date=2016-07
|accessdate=2019-11-08
}}
* {{REFweb
|url=https://www.tightforeskin.org/my-son.html
|title=Does my son have phimosis?
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=
|website=www.tightforeskin.org
|date=
|accessdate=2019-11-23
|format=
|quote=
}}
NSFW
* [http://www.circumstitions.com/Works.html How the foreskin works]
{{REF}}
[[Kategorie:Physiologie]]
[[Kategorie:Von Intactipedia]]
[[Kategorie:Von IntactWiki]]
[[en:Retraction of the foreskin]]
{{GraphicWarning}}
[[Image:Side by side retraction.png|right|thumb|A human penis before and after retraction of the foreskin.]]
In the majority of adult men, the [[foreskin]] normally retracts to reveal the head of the penis. In newborns, it is common for the foreskin to be fused to the head of the penis by the [[synechia]], thus rendering it non-retractable. The preputial cavity is sealed by the [[synechia]].<ref name="fleiss-hodges-vanhowe1998">{{REFjournal
|last=Taylor
|first=J.R.
|author-link=John R. Taylor
|last2=Lockwood
|first2=A.P.
|author2-link=
|last3=Taylor
|first3=A.J.
|title=The prepuce: specialized mucosa of the penis and its loss to circumcision
|journal=Brit J Urol
|date=1996
|volume=77
|issue=
|pages=291-5
|url=http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.1996.85023.x/full
|quote=
|pubmedID=8800902
|pubmedCID=
|DOI=10.1046/j.1464-410X.1996.85023.x
|accessdate=2019-12-02
}}</ref> The foreskin usually separates from the glans and becomes retractable with increasing age. There is much uncertainty among health care workers about when the foreskin of a boy should become retractable.<ref>{{REFjournal
|last=Simpson
|first=E.T.
|last2=Barraclough
|first2=P.
|title=The management of the paediatric foreskin
|journal=Aust Fam Physician
|volume=27
|issue=4
|pages=381-383
|url=http://www.cirp.org/library/hygiene/simpson1/
|quote=
|pubmedID=9613002
|pubmedCID=
|DOI=
|date=1998-05
|accessdate=2019-10-17
}}</ref> The mistaken belief that the foreskin was supposed to be retractable at the time of birth of the infant has led to a characterization of the genitalia of most infant males as defective at birth. This has led to many false diagnoses of [[phimosis]], followed by unnecessary [[circumcision]], when, in fact, the foreskin is developmentally normal.
Normally, developmental non-retractability does not cause any problems. Non-retractability may be deemed pathological if it causes problems, such as difficulty urinating or performing normal sexual functions, but even then, this is rare, and, if the non-retractability itself is not caused by pathological inflammation, it cannot be called "pathological" or "true phimosis." A foreskin that is so narrow it will retract very little or not at all, but is not the result of a pathological inflammation, is accurately termed ''preputial stenosis'' (narrow prepuce), and will respond to treatment including steroid creams, manual stretching, and changing [[masturbation]] habits.
== Geschichte ==
The first data on development of retractile foreskin were provided in 1949 by the famous British paediatrician, [[Douglas Gairdner]].<ref name="Gairdner">{{REFjournal
|last=Gairdner
|first=D.
|author-link=Douglas Gairdner
|title=The fate of the foreskin: a study of circumcision
|journal=Br Med J
|volume=2
|issue=
|pages=1433-7
|url=https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2051968&blobtype=pdf
|quote=
|pubmedID=15408299
|pubmedCID=2051968
|DOI=10.1136/bmj.2.4642.1433
|date=1949
|accessdate=
}}</ref> His data have been incorporated into many textbooks and is still being repeated in the medical literature today. [[Douglas Gairdner|Gairdner]] said that 80 percent of boys should have a retractable foreskin by the age of two years, and 90 percent of boys should have a retractable prepuce by the age of three years.<ref name="Gairdner"/>
Unfortunately, [[Douglas Gairdner|Gairdner]]’s data are inaccurate,<ref name="Wright1994">{{REFjournal
|last=Wright
|first=J.E.
|title=Further to the "Further Fate of the Foreskin"
|journal=Med J Aust
|volume=160
|issue=
|pages=134-135
|url=http://www.cirp.org/library/normal/wright2/
|quote=
|pubmedID=8295581
|pubmedCID=
|DOI=
|date=1994-02-07
|accessdate=2019-10-17
}}</ref> <ref name="Hill2003">{{REFjournal
|last=Hill
|first=G.
|author-link=George Hill
|title=Circumcision for phimosis and other medical indications in Western Australian boys
|journal=Med J Aust
|volume=178
|issue=11
|pages=587
|url=
|quote=
|pubmedID=12765511
|pubmedCID=
|DOI=
|date=2003-06-02
|accessdate=2019-10-17
}}</ref> <ref name="denniston-hill2010">{{REFjournal
|last=Denniston
|first=George C.
|author-link=
|last2=Hill
|first2=George
|author2-link=
|etal=no
|title=Gairdner was wrong
|trans-title=
|language=
|journal=Can Fam Physician
|date=2010-10-01
|volume=56
|issue=10
|pages=986-7
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954072/
|quote=
|pubmedID=20944034
|pubmedCID=2954072
|DOI=
|accessdate=2019-10-17
}}</ref> so most healthcare providers have been taught inaccurate data.<ref name="Hill2003"/> Retractability usually occurs much later than previously believed.<ref name="Wright1994"/> This page provides accurate data, derived from newer and better studies, for healthcare providers.
== Aktueller Standpunkt ==
Almost all boys are born with the foreskin fused with the underlying glans penis by the [[synechia]]. Most also have a narrow foreskin that cannot retract. Non-retractile foreskin is normal at birth and remains common until after puberty (age 18). Some boys develop retractile foreskin earlier, and about 2 percent of males have a non-retractile foreskin throughout life. Non-retractile foreskin is not a disease and does not require treatment.
There are three possible conditions that cause non-retractile foreskin:
* Tightness of the foreskin orifice
* Fusion of the foreskin with the glans penis<ref name="deibart1933">{{REFjournal
|last=Deibart
|first=G.A.
|title=The separation of the prepuce in the human penis
|journal=Anat Rec
|date=1933
|volume=57
|issue=
|pages=387-99
|url=http://www.cirp.org/library/anatomy/deibert/
|quote=
|pubmedID=
|pubmedCID=
|DOI=https://doi.org/10.1002/ar.1090570409
|accessdate=2019-10-07
}}</ref>
* Frenulum breve (which is rare and cannot be diagnosed until the previous two reasons have been eliminated)
The first two reasons are normal in childhood and are not pathological in children. The third can be treated conservatively, retaining the foreskin.
== Kleinkinder und Vorschule ==
Kayaba ''et al.'' (1996) reported that before six months of age, no boy had a retractable prepuce; 16.5 percent of boys aged 3-4 had a fully retractable prepuce.<ref name="kayaba1996">{{REFjournal
|last=Kayaba
|first=H.
|last2=Tamura
|first2=H.
|last3=Kitajima
|first3=S.
|etal=yes
|title=Analysis of shape and retractability of the prepuce in 603 Japanese boys
|journal=J Urol
|volume=156
|issue=5
|pages=1813-1815
|url=http://www.cirp.org/library/normal/kayaba/
|quote=
|pubmedID=8863623
|pubmedCID=
|DOI=
|date=1996-11-01
|accessdate=2019-10-19
}}</ref> Imamura (1997) examined 4521 infants and young boys. He re-ported that the foreskin is retractile in 3 percent of infants aged one to three months, 19.9 percent of those aged ten to twelve months, and 38.4 percent of three-year-old boys.<ref name="imamura1997">{{REFjournal
|last=Imamura
|first=E.
|title=Phimosis of infants and young children in Japan
|journal=Acta Paediatr Jpn
|volume=39
|issue=3
|pages=403-405
|url=
|quote=
|pubmedID=9316279
|pubmedCID=
|DOI=
|date=1997
|accessdate=
}}</ref> Ishikawa & Kawakita (2004) reported no retractability at age one, (but increasing to 77 percent at age 11-15).<ref>{{REFjournal
|last=Ishikawa
|first=E.
|last2=Kawakita
|first2=M.
|title=Preputial development in Japanese boys
|journal=Hinyokika Kiyo
|volume=50
|issue=5
|pages=305-308
|url=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=2004
|accessdate=2019-11-08
}}</ref> Ko ''et al.'' (2007) examined 59 newborn Taiwanese boys. Not one had a retractable foreskin.<ref name="ko2007">{{REFjournal
|last=Ko
|first=Ming-Chung
|author-link=
|last2=Liu
|first2=Chih-Kuang
|author2-link=
|last3=Lee
|first3=Wen-Kai
|author3-link=
|last4=Jeng
|first4=Huey-Sheng
|author4-link=
|last5=Chiang
|first5=Han-Sun
|author5-link=
|last6=Li
|first6=Chung-Yi
|author6-link=
|etal=no
|title=Age-specific Prevalence Rates of Phimosis and Circumcision in Taiwanese Boys
|trans-title=
|language=
|journal=Journal of the Formosan Medical Association
|location=
|date=2007-04
|volume=106
|issue=4
|pages=302-7
|url=https://www.sciencedirect.com/science/article/pii/S0929664609602564?via%3Dihub
|quote=
|pubmedID=17475607
|pubmedCID=
|DOI=10.1016/S0929-6646(09)60256-4
|accessdate=2019-11-08
}}</ref>
Non-retractile foreskin is the normal, expected, and more usual condition in this age group.<ref name="agawal2005">{{REFjournal
|last=Agawal
|first=Abhnav
|author-link=
|last2=Mohta
|first2=Anup
|author2-link=
|last3=Anand
|first3=Ritesh K.
|author3-link=
|etal=no
|title=Preputial retraction in children
|trans-title=
|language=
|journal=Journal of Indian Association of Pediatric Surgeons
|location=
|date=2005
|volume=10
|issue=2
|pages=89-91
|url=http://www.jiaps.com/article.asp?issn=0971-9261;year=2005;volume=10;issue=2;spage=89;epage=91;aulast=Agarwal
|quote=
|pubmedID=
|pubmedCID=
|DOI=10.4103/0971-9261.16468
|accessdate=2019-12-09
}}</ref>
== Schulalter und Jugend ==
[[File:Kayaba.jpg|left|frame|Percentage of boys with tight ring totally non-retractile foreskin according to Kayaba ''et al''.]]<br clear="all">
[[Jakob Øster]], a Danish physician who conducted school examinations, reported his findings on the examination of school-boys in Denmark, where circumcision is rare.<ref name="Øster1968">{{Template:Jakob_Øster_1968}}</ref> Øster (1968) found that the incidence of fusion of the foreskin with the glans penis steadily declines with increasing age and foreskin retractability increases with age.<ref name="Øster1968"/> Kayaba ''et al''. (1996) also investigated the development of foreskin retraction in boys from age 0 to age 15.5 Kayaba ''et al''. also reported increasing retractability with increasing age. Kayaba ''et al''. reported that about only 42 percent of boys aged 8-10 have fully retractile foreskin, but the percentage increases to 62.9 percent in boys aged 11-15.<ref name="kayaba1996" /> Imamura (1997) reported that 77 percent of boys aged 11-15 had retractile foreskin.<ref name="imamura1997" /> Thorvaldsen & Meyhoff (2005) conducted a survey of 4000 young men in Denmark.9 They report that the mean age of first foreskin retraction is 10.4 years in Denmark.<ref name="Thorvaldsen">{{REFjournal
|last=Thorvaldsen
|first=M.A.
|last2=Meyhoff
|first2=H.
|title=Patologisk eller fysiologisk fimose?
|trans-title=Pathological or physiological phimosis?
|language=Danish
|journal=Ugeskr Læger
|volume=167
|issue=17
|pages=1858-1862
|url=http://www.cirp.org/library/normal/thorvaldsen1/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=2005
|accessdate=2019-10-17
}}</ref> Non-retractile foreskin is the more common condition until about 10-11 years of age.
[[File:Oester.jpg|left|frame|Percentage of boys with fused foreskin by age according to Øster]]<br clear="all">
Ko ''et al''. (2007) examined 1145 Taiwanese boys aged 7 to 13. Ko ''et al''. reported:
<blockquote>
Our findings indicate that the degree of preputial retractability increases with age, while the prevalence of unretractable prepuce decreases with age. By the age of 13 years, very few boys (some 0.3%) still had an unretractable prepuce (i.e. type 1 prepuce).<ref name="ko2007" /></blockquote>
The findings reported by Ko ''et al."' are consistent with the findings reported by Øster (1968), by Kayaba ''et al''. (1996), and by Thorvaldsen & Meyhoff (2005)
== Diskussion ==
Boys usually are born with a non-retractile foreskin. The foreskin gradually becomes retractable over a variable period of time ranging from birth to 18 years or more.<ref name="Øster1968"/><ref name="Thorvaldsen"/> There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health in childhood and no intervention is necessary. Many boys only develop a retractable foreskin after puberty. Education of concerned parents usually is the only action required.<ref>{{REFjournal
|last=Spilsbury
|first=K.
|last2=Semmens
|first2=J.B.
|last3=Wisniewski
|first3=Z.S.
|etal=yes
|title=Circumcision for phimosis and other medical indications in Western Australian boys
|journal=Med J Aust
|volume=178
|issue=4
|pages=155-158
|url=
|quote=
|pubmedID=12580740
|pubmedCID=
|DOI=
|date=2003-02-17
|accessdate=2019-10-17
}}</ref>
== Vermeidung frühzeitigen Zurückziehens ==
Care-givers and healthcare providers must be careful to avoid [[forced retraction|premature retraction]] of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.<ref name="Wright1994"/> <ref>{{REFweb
|url=https://www.doctorsopposingforcibleretraction.org/
|title=Doctors Opposing Forcible Retraction
|trans-title=
|language=
|last=
|first=
|publisher=
|website=Doctors Opposing Forcible retraction
|date=2019
|accessdate=2019-10-02
|format=
|quote=
}}</ref>
== Die Vorhaut zurückziehbar machen ==
Teen boys who still have a non-retractable foreskin (about 10 percent of boys) should start stretching exercises to make the foreskin retractable in preparation for adult life.
Occasionally a male reaches adulthood with a non-retractile foreskin. Some men with a non-retractile foreskin happily go through life and father children. Other men, however, may want to make their foreskin retractile.
The foreskin can be made retractable by:
* Manual stretching<ref>{{REFjournal
|last=Dunn
|first=H.P.
|title=Non-surgical management of phimosis
|journal=Aust N Z J Surg
|volume=59
|issue=12
|pages=963
|url=http://www.cirp.org/library/treatment/phimosis/dunn1/
|quote=
|pubmedID=2597103
|pubmedCID=
|DOI=10.1111/j.1445-2197.1989.tb07640.x
|date=1989
|accessdate=
}}</ref><ref>{{REFjournal
|last=Beaugé
|first=M.
|title=The causes of adolescent phimosis
|journal=Br J Sex Med
|volume=
|issue=Sept/Oct
|pages=26
|url=http://www.cirp.org/library/treatment/phimosis/beauge2/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|date=1997
|accessdate=2019-10-18
}}</ref>
* Application of topical steroid ointment<ref>{{REFjournal
|last=Orsola
|first=A.
|last2=Caffaratti
|first2=J.
|last3=Garat
|first3=J.M.
|title=Conservative treatment of phimosis in children using a topical steroid
|journal=Urology
|volume=56
|issue=2
|pages=307-310
|url=http://www.cirp.org/library/treatment/phimosis/orsola1/
|quote=
|pubmedID=10925099
|pubmedCID=
|DOI=10.1016/s0090-4295(00)00576-8
|date=2000
|accessdate=2019-10-18
}}</ref><ref>{{REFjournal
|last=Ashfield
|first=J.E.
|last2=Nickel
|first2=K.R.
|last3=Siemens
|first3=D.R.
|etal=yes
|title=Treatment of phimosis with topical steroids in 194 children
|journal=J Urol
|volume=169
|issue=3
|pages=1106-1108
|url=http://www.cirp.org/library/treatment/phimosis/ashfield1/
|quote=
|pubmedID=12576863
|pubmedCID=
|DOI=10.1097/01.ju.0000048973.26072.eb
|date=2003-03
|accessdate=2019-10-18
}}</ref>
Male circumcision is outmoded as a treatment for non-retractile foreskin, but it is still recommended by many urologists because of lack of adequate information, and perhaps because of the [[Financial Incentive|profit to the doctor]] associated with circumcision. Nevertheless, [[circumcision]] should be avoided because of pain, trauma, cost,<ref name="Van Howe">{{REFjournal
|last=Van Howe
|first=RS
|title=Cost-effective treatment of phimosis
|journal=Pediatrics
|volume=102
|issue=4
|pages=e43
|url=https://pediatrics.aappublications.org/content/102/4/e43.full
|quote=
|pubmedID=
9755280
|pubmedCID=
|DOI=
|date=1998-10
|accessdate=2019-10-17
}}</ref><ref>{{REFjournal
|last=Berdeu
|first=D.
|last2=Sauze
|first2=L.
|last3=Ha-Vinh
|first3=P.
|last4=Blum-Boisgard
|first4=C.
|title=Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect.
|journal=BJU Int
|volume=87
|issue=3
|pages=239-244
|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1464-410x.2001.02033.x?sid=nlm%3Apubmed
|quote=
|pubmedID=11167650
|pubmedCID=
|DOI=10.1046/j.1464-410x.2001.02033.x
|date=2001-02-01
|accessdate=2019-10-17
}}</ref> complications,<ref name="Van Howe"/> difficult recovery, [[Circumcision scar| permanent injury to the appearance of the penis]], loss of pleasurable erogenous sensation,<ref>{{REFjournal
|last=Williams
|first=N.
|last2=Kapila
|first2=L.
|title=Complications of circumcision
|journal=Brit J Surg
|volume=80
|issue=
|pages=1231-1236
|url=http://www.cirp.org/library/complications/williams-kapila/
|quote=
|pubmedID=8242285
|pubmedCID=
|DOI=10.1002/bjs.1800801005
|date=1993
|accessdate=2019-10-17
}}</ref> impairment of erectile and ejaculatory functions,<ref>{{REFjournal
|last=Shen
|first=Z.
|last2=Chen
|first2=S.
|last3=Zhu
|first3=C.
|etal=yes
|title=Erectile function evaluation after adult circumcision
|journal=Zhonghua Nan Ke Xue
|volume=10
|issue=1
|pages=18-19
|url=
|quote=
|pubmedID=14979200
|pubmedCID=
|DOI=
|date=2004-01-01
|accessdate=2019-10-17
}}</ref><ref>{{REFjournal
|last=Masood
|first=S.
|last2=Patel
|first2=H.R.H.
|last3=Himpson
|first3=R.C.
|etal=yes
|title=Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly?
|journal=Urol Int
|volume=75
|issue=1
|pages=62-65
|url=http://www.cirp.org/library/sex_function/masood1/
|quote=
|pubmedID=16037710
|pubmedCID=
|DOI=10.1159/000085930
|date=2005
|accessdate=2019-10-17
}}</ref> and adverse sexual and [[Psychological issues of male circumcision| psychological]] effects.
{{SEEALSO}}
* [[Gliding action]]
* [[Forced retraction]]
* [[Phimose]]
* [[Synechie]]
{{LINKS}}
* {{REFweb
|url=http://www.nocirc.org/publish/6pam.pdf
|title=Answers to Your Questions About Premature (Forcible) Retraction of Your Young Son's Foreskin
|trans-title=
|language=
|last=Milos
|first=Marilyn
|author-link=Marilyn Milos
|publisher=
|website=NOCIRC
|date=2007-09
|accessdate=2019-12-02
|format=
|quote=The first person to retract a child’s foreskin should be the child himself.
}}
* {{REFweb
|url=http://www.cirp.org/library/normal/
|title=Normal development of the prepuce: Birth through age 18
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=''Circumcision Information Reference Library''
|website=
|date=2008-11-14
|accessdate=2019-11-08
|format=
|quote=
}}
* {{REFdocument
|title=Care of the Intact (Not Circumcised) Penis in the Young Child
|url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/01/care-of-the-intact-not-circumcised-penis-in-the-young-child-professionals.pdf
|contribution=
|last=
|first=
|publisher=''Doctors Opposing Circumcision''
|format=PDF
|date=2016-07
|accessdate=2019-11-08
}}
* {{REFweb
|url=https://www.tightforeskin.org/my-son.html
|title=Does my son have phimosis?
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=
|website=www.tightforeskin.org
|date=
|accessdate=2019-11-23
|format=
|quote=
}}
NSFW
* [http://www.circumstitions.com/Works.html How the foreskin works]
{{REF}}
[[Kategorie:Physiologie]]
[[Kategorie:Von Intactipedia]]
[[Kategorie:Von IntactWiki]]
[[en:Retraction of the foreskin]]