Andrew Siegel MD 7/11/2020
I’m not a betting man; however, I would wager that you probably don’t know what a frenulum is, although you probably assume—correctly so—that it is a body part. I would also bet that you do not know where your frenula (plural of frenulum) are located and what purpose they serve. For the most part, the only ones who “know” about frenula are physicians, dentists, and those unfortunates who have torn a frenula and have sought medical care for their injury.
Image by Luc Mahler from Pixabay
FRENULUM & FRENULA
What exactly is a frenulum? Simply put, it is a small fold of connective tissue that serves to secure a semi-mobile body part. The word is derived from Latin, meaning “little bridle,” — a line, rope or device used to restrain the movement of something.
Where are frenula found? Humans have frenula at a few different locales: mouth, genitals, brain and intestine. (In all honesty, I didn’t know or possibly forgot about brain and intestinal frenula; perhaps I missed that day in medical school!)
Please take a moment and listen to a Barenaked Lady song (1:40 length) that refers to frenula: There’s a word for that
SO, WHAT IS THE ISSUE WITH FRENULA?
Frenula that are anatomically normal and healthy go about their business unnoticed. However, some people are born with frenula that are short and/or thick and therefore may be too taut (think of a bridle that is too tight), and these can potentially lead to trouble. If a frenulum—whether genital or oral—is too short and/or too thick, it can result in excessive “restraint” and the over-tensioned band of tissue is easily subject to injury.
MOUTH FRENULA
In the mouth, the frenula anchor the tongue, lips, and cheeks to the gums to help maintain proper alignment. The tongue frenulum is the band of tissue anchoring the tongue to the bottom of the mouth. The lip frenula are the tissue bands between the upper and lower lips and the upper and lower gums, respectively. There are also tissue bands connecting the cheek to the gums. Open your mouth, take a peek in the mirror and explore with an index finger.
Tongue-tied: Ankyloglossia is a birth anomaly in which an unusually short, thick or tight frenulum tethers the bottom of the tongue to the floor of the mouth, affecting tongue mobility and interfering with eating, talking and swallowing. In the newborn, it can affect the ability to breast feed and can at times cause breast issues for a breastfeeding mother. This may require a tongue-tie division in which the frenulum is cut to release the tongue.
FRENULUM OF THE CLITORIS
In the female, the labia minora (minor lips) are within the labia majora (major lips). The labia minora extend from the clitoris to where they meet below at the fourchette (fork). The upper labia minora pass above the head of the clitoris where they fuse to form the clitoral prepuce (foreskin) whereas the lower division passes under the clitoris forming the clitoral frenulum, which anchors the clitoral head to the clitoral shaft.
FRENULUM OF THE PENIS (THE “BANJO STRING”)
CaptainGerro / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)
In the male, the frenulum of the penis anchors the underside of the head of the penis to the penile shaft. In men who are uncircumcised, the frenulum helps secure the foreskin to the head of the penis. When a circumcision is performed, the foreskin is removed, often with division of the frenulum. The frenulum is a region of male anatomy that is particularly sensitive to sexual stimulation. It is often referred to as the “banjo string” and tearing of it can result in pain and bleeding because of its rich blood and nerve supply.
As I am a urologist, the focus of today’s entry will be on the frenulum of the penis.
INJURIES TO THE PENILE FRENULUM: EVEN GENTLE SEX CAN BE ROUGH
When the penile frenulum (“banjo string”) is too thick, short or tight, it is more prone to injury than an anatomically normal one. This is the case in both circumcised and uncircumcised men.
The usual cause of frenulum injury is sexual intercourse, although it also may occur with masturbation. The tension and tautness of a short and thick frenulum is increased substantially with a rigid erection. The potential for trauma to the “banjo string” increases exponentially with sexual intercourse that creates intense shearing and stress forces on the penis. Certain positions angulate the penis and create more liability for injury than others. Even gentle sex can be rough with a single act of intercourse resulting in hundreds of thrusts with significant rotational, axial and torquing strains and stresses placed upon the erect penis with the possibility of traumatic injury to the frenulum.
When a frenulum is acutely torn in this manner, the symptoms that result are pain and bleeding. Because of the hardy nerve and blood supply to this little structure, the pain can be significant and the bleeding profuse. Fortunately, the bleeding usually responds well to the application of direct pressure. Obviously, after an injury to the frenulum one needs to refrain from sex until the penis is thoroughly healed, which ultimately will happen. The problem is that as a result of the healing and scarring processes, the shortening, thickening and tautness are made even worse and this may make subsequent tears even more likely.
If one experiences recurrent tears of the frenulum, he will likely need to have the problem surgically repaired. Since the pathology is an abnormally short, thick and taut frenulum, a simple repair is a frenulectomy, in which the tethering frenulum is cut across and removed. Frenulectomy is commonly done in conjunction with circumcision. Alternatively, frenuloplasty aims to maintain the frenulum, but lengthen it to reduce the risk of future tearing. This can be done using plastic surgery principles of V-Y-plasty or Z-plasty.
- Before (left) and after frenulectomy (right), Image is from Wikipedia, Creative Commons
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, banjo string, frenula, frenulectomy, frenuloplasty, frenulum, frenulum injury
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