Diabetes and Foreskin Tears: the Connection and Solutions

Solutions for Diabetic Phimosis and Lacerations

A young man discovered a fissure in his foreskin and, feeling anxious, sought consultation at the urology department.
After a thorough medical history taken by the physician, diabetes was suspected as the underlying cause.
Blood tests later confirmed that he indeed had diabetes.
Mr.
Liao, 23 years old and slightly overweight, had just graduated from school.
As a newcomer in the workplace, he was always nervous and eager to perform well.
In mid-September, Mr.
Liao shyly visited Dr.
Zhu Lang-Hsuan at the Taichung City Hospital's urology department.
He reported that he had noticed inflammation of the foreskin for some time.
Although he had purchased ointment from a pharmacy to apply, he was unable to achieve healing.
Due to prolonged recurrent inflammation, the foreskin had become fibrotic and thickened, resulting in a narrowed opening and ultimately leading to phimosis, where the glans could not be exposed.
In an attempt to clean the glans, he forcibly retracted the foreskin, which caused it to crack further, worsening the wound and necessitating medical attention.
Mr.
Liao also mentioned that he had not visited any adult entertainment venues and had not engaged in unsafe sexual practices, leaving him puzzled about the occurrence of his foreskin inflammation.
After a detailed inquiry, Dr.
Zhu suspected that Mr.
Liao had diabetes and arranged for blood tests, which revealed that his fasting blood sugar exceeded 300 mg/dL, and his HbA1C (glycated hemoglobin) was as high as 6%.
Indeed, as Dr.
Zhu suspected, Mr.
Liao was diagnosed with diabetes.
Therefore, in addition to treating the foreskin inflammation, he was referred to the diabetes department for further evaluation and management.

I have experienced less glans inflammation before the diagnosis of diabetes.
My foreskin opening was originally narrow, and after the onset of the condition, I frequently suffered from fissures after cleaning.
My HbA1C levels range between 7 and 8, and my fasting blood sugar exceeds 200 to 300 mg/dL.
I would like to ask the physician if undergoing a circumcision could reduce the likelihood of foreskin fissures?

mmxx, 30~39 year old female. Ask Date: 2016/07/16

Dr. Li Xinyi reply Urology

The issue with the foreskin should ideally be assessed in person, but in your case, the primary focus is on controlling diabetes with topical medication and oral medication as adjuncts; otherwise, the condition may worsen with repeated surgeries.

Reply Date: 2016/07/16

More Info

Diabetes is a chronic condition that can lead to various complications, including issues related to the skin and mucous membranes, such as the foreskin. In the case of Mr. Liao, his experience with recurrent foreskin tears and inflammation is indeed concerning and highlights the connection between diabetes and urogenital health.

Understanding the Connection
Diabetes can significantly affect the body's ability to heal and maintain healthy tissues. High blood sugar levels can lead to a condition known as diabetic neuropathy, which can impair sensation and healing in various parts of the body, including the genital area. Additionally, diabetes can cause changes in the skin and mucous membranes, making them more susceptible to infections and inflammation.
In Mr. Liao's case, the repeated inflammation of the foreskin likely resulted from a combination of factors, including high blood sugar levels, which can lead to an overgrowth of yeast and bacteria, and the anatomical predisposition of a narrow foreskin. The inflammation can cause fibrosis, leading to a thickening of the foreskin and further narrowing of the opening, creating a vicious cycle of irritation and injury.

Treatment and Surgical Options
When it comes to managing Mr. Liao's condition, addressing both the diabetes and the foreskin issue is crucial. Here are some considerations:
1. Diabetes Management: The first step is to control blood sugar levels effectively. This may involve lifestyle changes such as diet and exercise, as well as medication or insulin therapy as prescribed by a healthcare provider. Achieving better glycemic control can help reduce the risk of infections and improve healing.

2. Topical Treatments: For the immediate issue of foreskin inflammation, topical antifungal or antibacterial creams may be prescribed to treat any underlying infections. However, these treatments may not be sufficient if the anatomical issue persists.

3. Surgical Intervention: Considering Mr. Liao's recurrent issues with foreskin tears and the narrowing of the foreskin, a circumcision may be a viable option. Circumcision involves the surgical removal of the foreskin and can significantly reduce the risk of future tears and infections. It can also improve hygiene, as it eliminates the area where moisture and bacteria can accumulate.

4. Post-Surgical Care: If Mr. Liao undergoes circumcision, proper post-operative care is essential. This includes keeping the area clean, monitoring for signs of infection, and following the surgeon's instructions for care and recovery.

Conclusion
In summary, Mr. Liao's experience with foreskin tears is likely linked to his undiagnosed diabetes, which has led to recurrent infections and anatomical changes. By managing his diabetes effectively and considering surgical options like circumcision, he can significantly reduce the likelihood of future complications. It is essential for him to work closely with his healthcare team, including endocrinologists and urologists, to ensure comprehensive care that addresses both his diabetes and urogenital health.
Regular follow-ups and monitoring of blood sugar levels, along with education on diabetes management, will empower Mr. Liao to take control of his health and potentially prevent further complications.

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