Ask Marilyn—What are Langerhans Cells?

The penis advice columnDear Marilyn:

I have read that the foreskin produces anti-microbial agents, including Langerhans cells. Is that true? What are Langerhans cells?

—Richard in Virginia

Dear Richard:

Yes, Richard, Langerhans cells have important immunological properties.

Langerhans cells reside in the epidermis of the foreskin, the body’s outermost and thinnest layer of skin and the layer responsible for protecting you from the outside world. Langerhans cells determine the appropriate adaptive immune response (inflammation or tolerance) by interpreting the microenvironmental context in which they encounter foreign substances. In a normal physiological, “non-dangerous” situation, Langerhans cells coordinate a continuous state of immune tolerance, preventing unnecessary and harmful immune activation. But when they sense a danger signal, for example during infection or when the physical integrity of skin has been compromised as a result of a trauma, they instruct T lymphocytes of the adaptive immune system to mount efficient responses against the danger.

Thus, Langerhans cells in the foreskin play an important role in fighting infections and protecting the rest of the penis.

—Marilyn Milos, RN

Ask Marilyn—Kiddo Is Having Painful Erections

The penis advice columnDear Marilyn,

My almost 5 year old keeps having erections and is complaining that it’s hurting. Is that normal for an intact kiddo? My oldest is circed as is hubby so this is new to me and hubby. What can I do to help him?

—Emily in Indiana

Dear Emily,

How does your son’s penis look? Are there any changes in his foreskin? Is it red or swollen? If not, then your son’s painful erections may need to be directly addressed. Erections are normal and begin in babies in utero. If your son’s erections are painful, then the development of his penis needs to be explained to him. When he understands that at birth the foreskin is usually non-retractile because the foreskin and glans (head of the penis) are attached when they develop. These two structures will separate over time. Once the foreskin and glans separate, the foreskin becomes retractable. As the foreskin becomes retractable, erections may cause sensations as the foreskin separates from the glans or because the opening of the foreskin is not yet large enough to accommodate retraction of the glans. Discussion of these aspects of his penile development should help determine where the pain is coming from so that your son can consider and accept the sensations as a part of the developmental process or something that needs to be addressed.


Ask Marilyn—Can a Tight Foreskin be Treated without Circumcision?

The penis advice columnDear Marilyn:

I’m a 35-year-old man. I have been having trouble with a very tight foreskin. My doctor says it’s phimosis, and the only treatment is circumcision. Is there any other remedy? I’d really like to keep my foreskin.

—Harold, New Orleans, LA

Dear Harold:

The word phimosis means muzzled, to indicate that the glans (head of the penis) is muzzled by the foreskin. At birth, most babies have “physiological phimosis,” a normal condition because the glans and foreskin have not yet separated. The foreskin separates from the glans over time, usually by adolescence.

Sometimes a retractable foreskin of an adult male will close down; this condition is called “pathological phimosis.” From your letter, I cannot determine why your foreskin has closed down, so I will suggest a number of possible causes and cures.

  1. Exposure to soap, shampoos, and chlorinated water in swimming pools or hot tubs can kill normal, beneficial bacteria on the foreskin, which can result in yeast overgrowth, inflammation, itching, and stinging with urination; it can also make the foreskin close down. This condition can be corrected by eliminating soap and shampoo, or by using barriers creams on the foreskin before swimming. To help the healing process. liquid Acidophilus culture purchased from the health food store or pharmacy can also be applied to the foreskin by pouring some of the liquid into the palm of the hand, dipping the foreskin into the solution, and letting it drip dry; do this six times a day for 3 or 4 days.
  2. Sometimes the foreskin will close down if a male has been too vigorous sexually, which can cause small tears in the foreskin. The opening will become tight while the tissue heals. Time and gentleness are the cure for this.
  3. Pathological phimosis can result from a condition called “lichen sclerosus” (formerly called “BXO”), characterized by the presence of small, shiny, and smooth white patches on the foreskin. These patches may become larger, and the skin may become itchy, thin, and wrinkled, and may tear easily and bleed. A dermatologist can diagnose lichen sclerosus, which is commonly treated with two creams, Clotrimazole and hydrocortisone, both available over-the-counter at your local pharmacy or by prescription, depending upon the desired strength.
  4. Finally, before considering circumcision, ask your urologist about a Y-V- or Z-plasty—a surgery in which small slits are cut in the foreskin, and then they are sewn together in a way that widens the opening. This surgery saves the foreskin and its specialized nerve endings that allow for full sexual sensations and enjoyment.

So, you can see, Harold, that finding the reason for your phimosis is a critical step to solving the problem and avoiding the loss of your foreskin.


Ask Marilyn—Is It Normal to Have Hair on Your Penis?

The penis advice columnDear Marilyn:

I have hair going up the shaft of my penis. Is this normal?

—Daniel F., Tulsa, OK

Dear Daniel:

Hair on human bodies varies by individual. Penile shaft hair is rare but most frequently it is the result of circumcision, which pulls scrotal skin onto the shaft. Men with this problem sometimes manually remove the hairs one-by-one with a tweezer, or resort to electrolysis to eradicate unwanted hair growth on the shaft. If we stop doing circumcisions, this problem will end.


Ask Marilyn—Is a second circumcision advisable?

The penis advice columnDear Marilyn,

The doctor cut off only a little bit of foreskin—way less than I’ve noticed in other circumcised babies his age (4 months)—when she circumcised my son. Should I take him for a second circumcision? Should I do it now or wait until he is older? How old?


Dear Sophia, 

Many doctors are beginning to understand that the extreme removal of foreskin tissue also removes the ability to have a normal, full erection. Without that tissue, men suffer from tight and painful erections. The foreskin is meant to cover and protect the glans (head of the penis) and the urinary meatus (opening). The tissue at the opening of the foreskin contains thousands of nerve endings that provide a male with the ability to ride the wave to orgasm the same way women do. These are cut off with circumcision. This is what doctors should tell parents as part of an “informed” consent, but they often do not understand the protective, immunological, sensitive, and sexual benefits of the foreskin because they themselves are likely circumcised or their spouse is. Hopefully your son’s remaining foreskin will protect enough of his glans to maintain its sensitivity. Many circumcised males are using stretching techniques to re-cover the glans to regain sensitivity and, when your son grows up, should he want to do that, he’ll have a head start.


Ask Marilyn—What’s the impact of intactivism conferences?

The penis advice columnDear Marilyn:

I’m looking forward to attending Intact 2022, the 16th International Symposium on Child Genital Cutting, in Atlanta this week. Can you tell me how child genital cutting symposia have impacted intactivism since you began organizing them in 1989?

—Larry, St. Louis, MO

Dear Larry:

I first witnessed a circumcision in 1979. I was horrified and immediately began researching the subject. Our local libraries, including those at the hospital and universities, had little or no relevant information. Then in 1980, Edward Wallerstein sent me a copy of his book, “Circumcision: An American Health Fallacy.” This book became the foundation of my work. I told everyone what I was learning and appeared on local radio and television shows. I was contacted by an attorney who wanted to file a lawsuit asking if parents have a right to consent to a child’s circumcision, or if the baby’s body belonged to the baby. I found a plaintiff, and our lawsuit got publicity.

The publicity likely prompted a couple of local doctors—urologist Aaron Fink and Edgar Schoen, a pediatrician—to join forces and begin their campaign to validate both cultural and religious circumcision, in the form of a pro-circumcision resolution that Fink introduced to the California Medical Association (CMA) and Schoen took to the American Academy of Pediatrics (AAP).

Fink introduced his resolution to the CMA at its yearly convention in 1987, but the Scientific Committee voted it down. Fink came back in 1988 with Arthur Dick, a urologist, who circumcised a banana in front of the CMA membership, and the resolution passed. This was followed by a counter-resolution from Dr. John Hardebeck, who planned to present it at the CMA convention the following year. I knew that meeting was being held at the Disneyland Hotel. So I booked a hotel across the street for our First International Symposium on Circumcision.

I invited Dr. Michel Odent, a French obstetrician and childbirth specialist, to give the keynote presentation. He asked if there would be other international presenters and, when I told him I didn’t have any, he said, “Well then, you need me.” I invited Fink and Schoen, but neither came or even responded to my invitation. But those who did were eager to share their work or their experiences. This was the first time that experts from various disciplines—religion, anthropology, psychology, medicine, law, and ethics—gathered around the subject of circumcision. We were all thrilled by what had transpired. Dr. Paul Fleiss, a popular Los Angeles pediatrician who was both a breastfeeding and anti-circumcision advocate, also attended, and—at the end of the symposium—declared: “Marilyn, now we need to take this show on the road.”

The second symposium was held in 1991 in San Francisco, and Dr. Ashley Montagu, anthropologist and humanist, gave the keynote address. Presenters and attendees alike were amazed at the quality, breadth, and depth of the presentations on this crucial human rights issue.

The joy of each symposium is the new material that has been presented, the medical research that has been done, and the focus on how we treat children at the beginning of life and how this affects society. Those who have attended our symposia have been enriched with important information about the issue and what’s being done to end an anachronistic blood ritual. By coming together, we learn from one another, and become secure in knowing we’re not alone. We have become Intactivists together and we have become a family.

In the following years, we held 13 more symposia around the world including Switzerland, England, Australia, Italy, and Finland; six books of the proceedings were published by Springer—the same company that published Wallerstein’s groundbreaking book decades earlier. Our books are now in universities worldwide and being used in classrooms.

The Atlanta symposium (August 2022) will be the first I will not attend in person. While I’m sorry for that, that’s life! And I’m thrilled to know these gatherings will continue—this time because of David Llewellyn and Georganne Chapin—as will the movement I initiated all those years ago just because I couldn’t keep my mouth shut. As you can see, I still can’t. Please, carry on…

—Marilyn Milos, RN