research cataloged by the National Organization of Circumcision Information Resource Centers
the human urinary tract
Male and female urinary tracts are similar except for the shorter urethra in females, which leads to a higher rate of UTI (urinary tract infection) among baby girls, female children, and adult women. Intact boys and men contract UTIs to a much lesser degree than girls and women. All UTIs are treated quickly and easily with a round of antibiotics.
The foreskin contains muscle fibers arranged in a whorl to form a sphincter at the tip of the foreskin.1,2 The sphincter holds the foreskin protectively closed2 except when the child urinates and the pressure of the urine stream forces the sphincter to open, allowing outflow of the urine. Then the sphincter closes again and prevents entry of foreign matter, such as fecal material that contains bacteria. The sphincter of the foreskin keeps contaminants away from the urethra and is added protection against UTI.3
Breastfeeding adds yet another level of protection. Breastfed babies have oligosaccharides in their urine. The oligosaccharides prevent adhesion of E. coli, the fecal bacteria that causes most UTI, to the epithelium of the urinary tract.4 Bacterial adhesion is a prerequisite for infection. Intact babies who are also breastfed have doubled protection against UTI.
Parents and other caregivers should never attempt to retract the foreskin.5,6 Retraction of the foreskin opens the sphincter and allows contaminants to enter. This is especially true at bath time because baby's bathwater may very well contain E. coli from the baby's intestinal tract. The first person to retract the foreskin of a child should be the child himself.5-7
Unfortunately, hospitals in the 1980s instructed parents to retract the foreskin to wash—a procedure that has been abandoned because of the danger of contamination by E. coli.8 This may have allowed E. coli to enter the urinary tract and caused the slight increased incidence of UTI reported by Wiswell.
The foreskin has many other protective functions, including immunological properties and its own antivirals and antibacterials, that help to prevent disease and contribute to good health throughout life.3,9
E-coli bacteria during a urinary tract infection.
E-coli are transferred to the urinary tract as a result of fecal matter getting around the urethra. In intact infants, the urethra is protected by the prepuce in boys and girls, and the labia in girls. In circumcised boys (or girls), the urethra is exposed and prepuce antibodies are not present, leading to higher rate of infection. This is especially the case among diaper wearing babies during the first 12 months of life. The inset of this photo shows a cell peeling off from the urinary tract during an e-coli induced urinary tract infection. The main panel shows e-coli on the bladder wall. Photo by Harry Mobley, U of MI Medical School
For more information on circumcision and breastfeeding see:
- Jefferson G. The peripenic muscle; some observations on the anatomy of phimosis. Surgery, Gynecology, and Obstetrics (Chicago) 1916; 23(2):177-181.
- Lakshmanan, S. Prakash S. Human prepuce: some aspects of structure and function. Indian J Surg 1980;44:134-137.
- Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74:364-367.
- Coppa GV, Gabrielli O, Giorgi P, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells Lancet 1990; 335:569-571.
- Answers to your questions about your young son's intact penis. San Anselmo CA: National Organization of Circumcision Information Resource Centers, 1997.
- Fleiss PM. Hodges F. What your Doctor May Not Tell you about Circumcision: Untold Facts on America's Most Widely Performed - and most Unnecessary Surgery. New York: Warner Books, 2002. (ISBN: 0-446-67880-5)
- Wright JE. Further to the "Further Fate of the Foreskin". Med J Aust 1994; 160: 134-135.
- Wiswell TE. Prepuce care. (letter) Pediatrics 1986;7(2):265.
- Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.