Dry or dried out

[Derek]

I've just found  this article on the net.
https://medium.com/@circumscience/the-timeless-myth-of-keratinization-cb7b465a2e23
What do you think?

The timeless myth of glans "keratinization."
A folk tale that just won't go away.
Introduction
A common folk tale within anti circumcision circles is that the glans of a circumcised penis will keratinize over time due to its exposure following the removal of the foreskin (circumcision) [1]. Since this claim is made over and over again, sometimes with absolute certainty, there should be some convincing evidence whether visibly or histologically that clearly indicates that formation of keratin forms layers atop the glans post — circumcision, right? Well... the available medical data paints a very different picture, in fact it indicates the exact opposite.

Stephen Moreton, PhD writes [2] :

" A quick internet search will show that this myth is everywhere, sometimes accompanied by cherry-picked, and possibly photoshopped, pictures of a shiny non-circumcised glans juxtaposed against a dried out wrinkly circumcised one. In fact the myth predates the Internet, even turning up in textbooks, but without any scientific evidence to support it. " [2]

&

" The idea spread by intactivists is that years of exposure, and rubbing against underwear, results in a thickening of this keratinized, or cornified, layer on the glans, and consequently a loss of sensation in this important part of the penis. An analogy may be the toughening of the skin on the hands of manual workers. " [3]

Anti circumcision activists who make this allegation will often display comparative imagery of penises that are and aren't circumcised side by side. The penis that is not circumcised will usually have a glossy or moist glans while the circumcised penises glans will be in a state of exaggerated dryness and neglect.

Assessment
As usual, it is the research part which anti circumcision activists aren't very fond of [4].

So where is the evidence that glans of the penis will keratinize after circumcision? Well there is none, literally none at all, this claim is completely absent from the medical literature. There is not a single scientific publication that indicates or proves that keratin forms on the surface of a circumcised penis in any amount greater than that of an uncircumcised penis, however, there IS scientific evidence which indicates that it does NOT [5].

As of the writing of this post there has only ever been a single conducted examination which compared the amount of keratin on the glans between penises that were and weren't circumcised. In June of 2000, Robert Szabo and Roger Short published an examination of HIV and of it's potential infectious interactions with the human penis [6].

They summarized their findings on the matter of keratinization in the following quote :

" There is controversy about whether the epithelium of the glans in uncircumcised men is keratinised; some authors claim that it is not 15, but we have examined the glans of seven circumcised and six uncircumcised men, and found the epithelia to be equally keratinised. In circumcised males only the distal penile urethra is lined with a mucosal epithelium. However, this is unlikely to be a common site of infection because it contains comparatively few Langerhans' cells. " [7]

Stephen Moreton, PhD writes :

" The only way to tell to what extent skin is keratinized is to take actual samples of the skin, section them, stain them for keratin, and measure them down a microscope. And, to date (November 2016), only one study has attempted something like this. Using cadavers Szabo & Short (2000) took skin samples from the glans of 7 circumcised, and 6 non-circumcised men, examined them for keratin, and found no difference. " [8]

&

" The glans of the non-circumcised member is certainly moist, and that of the circumcised one dry, but dry is not the same as keratinized. All external skin is dry (at least when not washing, swimming, etc.) but this is a separate thing from keratinization, which refers to the build-up of layers of dead skin cells, composed of a protein called keratin. " [9]

Andrew Gross writes :

" Intactivists seem to be confused over the difference between a dry organ and one that is dried out. Dry means free from moisture. A ​​dry penis is a good thing, as harmful bacteria thrive in a moist environment. Urologist Dr. George Lee explained that "the moist glans of the penis can create the ideal environment for pathogens to incubate, making it susceptible to infections. This may include bacteria, fungus and sexually transmitted infections such as herpes and HIV. " [10]

&

" Keratinization — dried out — refers to a thickened skin. The only study on keratinization found no difference between circumcised and uncircumcised men. It's been demonstrated that a dry glans is less susceptible to infection than a wet glans, even with good hygiene. " [11]

One can't tell whether skin is keratinized merely by looking at it, as Stephen Moreton, PhD writes :

" So what is the evidence? In short there isn't any ... only mere anecdotes. One cannot tell how keratinized skin is just by looking, a point made by Dinh & Hope (2010) in relation to the inner versus the outer foreskin. Appearance is misleading, and further confused by the moist vs. dry contrast. " [12]

I must emphasize, once again, that a dry glans is a very good thing [13] [14] [15]. Often times when individuals reference the concept of " keratinization " they are actually indirectly referencing the transformation of the penile biome into a state which is less likely to harbor harmful pathogens and is thus less prone to both infection and inflammation. An undoubtably positive outcome regarding a male's reproductive and genital health.

It is worth noting that anti circumcision activists frequently cherry pick or selectively cite [16] sources to provide foundations for their arguments and allegations. Anti circumcision activists who regularly claim that the glans of a circumcised penises ' keratinizes ' and that this is somehow a harm caused by circumcision will likely be dismissive to the fact that the late pathologist John Taylor, an opponent of circumcision himself, clearly had doubts about keratinization, describing it as, " Probably not to any significant extent. " [17] [18]

Bossio et al. (2015) wrote PDF :

" Given that we found no significant between-groups differences in the sensitivity of the glans penis across the varied stimuli employed in the current study, these results suggest that the keratinization hypothesis is not supported: it is unlikely that circumcision decreases penile sensitivity by the keratinization of the permanently exposed glans penis via an increase of cell layers. " [21]

( " The Glans Penis and the Keratinization Hypothesis " page 86 )

Conclusion
No scientific evidence indicates that the glans of a circumcised penis will ever go through a process of " keratinization " following circumcision; whether the procedure is preformed in childhood, infancy, or adulthood. There IS evidence which directly opposes this claim. Considering that both a histological examination [6] and glans stimuli test [21] could not find evidence to support this allegation, all claims that it does happen are false, unfounded, disingenuous speculations that are in denial of the most up to date & available medical literature on this topic.

[Kylar]

If so — and I mean I'm not a researcher, if that's the finding, so be it —, what is the apparently permanent and non-reversible change that happens to the glans that is exposed, how and what doesn't return to the original shine even if kept covered and protected and moist?

[jafar_t]

Thank you very much for your sharing this interesting article with us. Being circumcised as an adult, I never believe the theories of these anti-circumcision activitists. In addition, the whole idea of the so-called "ridged bands" is also only imagined. Foreskin basically plays on role in sexual function.

[jafar_t]

If so — and I mean I'm not a researcher, if that's the finding, so be it —, what is the apparently permanent and non-reversible change that happens to the glans that is exposed, how and what doesn't return to the original shine even if kept covered and protected and moist?

Like the article said, the glans is dry but it does not mean that its surface is keratinized. Keratin is dead protein. Your hair and nails are made of keratin.

[Kylar]

Like the article said, the glans is dry but it does not mean that its surface is keratinized. Keratin is dead protein. Your hair and nails are made of keratin.

But I mean when it's covered and moist again, it does not return to the original state, so surely something (something else) changes irreversibly, and I wonder what that might be.

[Pulled Back Foreskin]

Nothing is truly irreversible, it may just take an extremely long time to accomplish.

Perhaps consider a sponge, it will soak up water very quickly, but for it to completely dry out again takes a lot longer. Once it dries out, it takes longer for it to fully absorb water again. So what if the same principle applies to the glans? It might not be a case of irreversible change, it might just take much longer than you would expect?

Who knows🤷‍♂️

It will definitely be something to consider doing more research into!