Dorsal penile frenulum not associated with penile torsion is an unusual congenital penile anomaly . Described symptomatology in the literature includes pains on foreskin retraction and dyspareunia [1, 2]. The most important finding in this case is the presence of both the dorsal and ventral frenulum in a traditionally circumcised male associated with the absence of any symptoms reported in the other two preceding case reports. Fascinatingly, the first reported case had only a dorsal frenulum and the normal ventral frenulum was absent; the second reported case and our case had both a dorsal and ventral frenulum. However, they all have in common this rare penile frenulum abnormality not associated with penile torsion.
The prepuce constitutes the anatomical covering of the glans penis. Its embryologic development is related to that of the frenulum . At 8 weeks post-conception, the ectoderm begins to develop into the penile skin and prepuce . The prepuce in particular is formed by reduplication of the distal penile ectoderm in the third month of intrauterine life [1, 2]. The preputial sac is then formed as a result of separation of the prepuce from the glans. The frenulum is formed from the persistent residual adhesions of ectoderm to the glans penis on the ventral aspect [1, 2]. Singla et al.  postulated that the dorsal frenulum may probably result from residual adhesions on the dorsal side. In our case, residual adhesions of the ectoderm on both dorsal and ventral aspects of the glans may justify the presence of two frenula.
The prepuce is a pentalaminar structure composed of an outer glabrous skin, dermis, dartos muscle, lamina propria and a squamous mucosal epithelium . This mucosal epithelium is common to the glans penis and the inner mucosal lining of the prepuce . The frenulum preputii is composed of mesenchymal tissue covered by an epithelium that unites the prepuce to the ventral region of the glans .
Penile innervation consists of the dorsal, cavernosal and perineal nerves. Dorsal nerves arise from the pudendal nerves and travel within Buck’s fascia to supply sensation to the penile skin . The prepuce has somatosensory innervation from the dorsal nerve of the penis and branches of the perineal nerve. This unique innervation of the prepuce establishes its function as an erogenous tissue . Arterial blood supply to penile skin derives from two separate origins. External pudendal artery branches supply the dorsal and lateral aspects of the penis, branches of the internal pudendal artery the ventral aspect of the penis and the scrotum via the posterior scrotal artery. The penile skin drains via the superficial dorsal vein, which drains into the saphenous vein via the superficial external pudendal veins . Lymphatic drainage from the glans and foreskin drains into the inguinal lymph nodes. Some lymphatic drainage is to the presymphyseal lymph nodes and to the lateral lymph nodes of the external iliac lymphatics .