Phimosis: When to Consider Treatment Options

Prepuce issues

Hello, I apologize for bothering you during your busy schedule.
I would like to ask about my personal situation.
When I am not erect, my foreskin completely covers my penis, but I can easily retract it with my hand without much discomfort.
However, when I am fully erect, my glans is only partially exposed and cannot be fully revealed.
I can also push the foreskin down to the coronal sulcus with my hand, but it feels tight.
I read online that maintaining an erect state like this could potentially lead to glans necrosis, so I always push it down for a while and then pull it back up.
After researching online, I found some sources suggesting that this could be due to a small opening, and that if I manipulate it a few times while showering, over time it might not feel tight anymore.
However, others strongly recommend circumcision.
Personally, I am not keen on undergoing surgery.
I would like to ask for your advice on this matter.
Lastly, does my condition qualify as true phimosis? Thank you for your help.

Mr. Li, 20~29 year old female. Ask Date: 2016/09/14

Dr. Sun Hongshun reply Urology

Hello, what you described may indeed be phimosis.
Whether surgery is necessary depends on whether you have symptoms (such as pain during erection or intercourse, infections, etc.).
It is recommended that you visit a urology clinic for a physical examination and consultation.

Reply Date: 2016/09/14

More Info

Phimosis is a condition where the foreskin cannot be easily retracted over the glans (the head of the penis). It can be classified into two types: physiological phimosis, which is common in infants and young boys and usually resolves naturally as they grow older, and pathological phimosis, which occurs due to scarring, inflammation, or other medical conditions. Based on your description, it seems you are experiencing some degree of phimosis, particularly when erect, as you can retract the foreskin when flaccid but feel tightness when erect.

The concern you mentioned about the potential for the glans to become necrotic (or die) if the foreskin remains tight during an erection is valid. While this is a rare complication, it can occur if there is significant constriction and reduced blood flow. However, in most cases, tightness alone does not lead to such severe outcomes, especially if you can still retract the foreskin with some effort.

Regarding treatment options, there are a few approaches you can consider:
1. Conservative Management: If you are not experiencing pain, recurrent infections, or other complications, you might consider a conservative approach. This includes practicing gentle stretching exercises of the foreskin over time, which can help increase elasticity. This can be done during bathing or showering when the skin is more pliable. Regularly cleaning the area is also important to prevent infections.

2. Topical Steroid Creams: Some healthcare providers recommend the use of topical steroid creams to help soften and stretch the foreskin. This can be effective in reducing inflammation and promoting elasticity, making it easier to retract the foreskin.

3. Surgical Options: If conservative measures fail or if you experience recurrent infections, pain, or other complications, circumcision (removal of the foreskin) may be recommended. This is a common procedure and can provide a permanent solution to phimosis. However, it is understandable that you may be hesitant about surgery, and it is essential to weigh the benefits against the risks and your personal preferences.

4. Consultation with a Specialist: Since you are experiencing discomfort and have concerns about your condition, it would be beneficial to consult a urologist. They can provide a thorough examination, discuss your symptoms in detail, and help you understand the best course of action tailored to your situation.

In summary, while your condition does suggest a form of phimosis, it may not necessarily be classified as pathological if it does not cause significant issues. Conservative management and stretching exercises may be effective, but if you have concerns about complications or if your symptoms worsen, seeking professional medical advice is crucial. A urologist can help clarify your diagnosis and discuss the most appropriate treatment options based on your specific circumstances.

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