Phimosis: When to Consider Circumcision for Relief

Q: Phimosis: When to Consider Circumcision for Relief

Hello： If your condition can remain non-inflammatory, surgery may not be necessary. <br>However, if you experience inflammation 2-3 times a year, surgery might need to be considered, as frequent inflammation can lead to scarring and skin hardening. <br>When discussing circumcisio

Phimosis

I would like to ask the doctor about my condition of phimosis.
When I am not erect, my foreskin covers the glans, but I can manually retract it.
However, the skin is quite long and needs to be folded back about 3-4 times behind the glans.
As shown in the images online, the foreskin is protruding.
When I am erect, the glans can be exposed without any issues, but there is excess skin that folds back behind the glans, causing some discomfort.
Additionally, I feel that there is a strong odor of urine because I am hesitant to expose the glans when urinating in public restrooms, which are often dirty.
Sometimes, after washing my hands, residual urine drips out with the foreskin, making my underwear damp.
I clean the area daily while showering, but I am cautious about retracting it too often due to tightness and concerns about blood circulation.
About a year ago, I consulted a urologist (Doctor A) regarding a small red spot on the glans, which seemed like balanitis.
The doctor said that I could retract the foreskin without needing a circumcision, and that the red spot was due to poor hygiene, which could improve with proper cleaning.
A few weeks ago, after being hospitalized and unable to shower, I noticed that the foreskin and glans felt uncomfortable, as if they were covered in urine, and the red spot from balanitis had not disappeared.
I then saw another urologist (Doctor B) at the same clinic.
During the examination, he noted that my foreskin was protruding when not erect and stated that I had both phimosis and a long foreskin, recommending circumcision to prevent urine accumulation and inflammation.
He did help me retract the foreskin and confirmed that it could be retracted without issue, but mentioned that the excess foreskin around the coronal sulcus was problematic.
He prescribed medication for the balanitis, and after a few days of application, the red spot gradually faded.
I have researched online and found varying opinions from different doctors.
Should I consider my own situation? I would like to ask the doctor for their opinion on whether to proceed with circumcision or not.
I have heard that the recommended length for circumcision is to expose half of the glans when not erect and to fully expose it when erect, but it seems that typically both the flaccid and erect states should show the glans.

A Ren, 20~29 year old female. Ask Date: 2018/01/24

Dr. Du Shixi reply Urology

Hello: If your condition can remain non-inflammatory, surgery may not be necessary.
However, if you experience inflammation 2-3 times a year, surgery might need to be considered, as frequent inflammation can lead to scarring and skin hardening.
When discussing circumcision with your doctor, you can request to preserve more tissue, but since your issue is related to inflammation, leaving too much foreskin may retain moisture, which is not ideal.
Wishing you good health.

Reply Date: 2018/01/24

More Info

Phimosis, or the inability to retract the foreskin fully over the glans (head of the penis), can be a source of discomfort and hygiene issues for many men. In your case, it seems that you are experiencing a combination of phimosis and possibly some degree of balanitis (inflammation of the glans), which can lead to concerns about hygiene and odor, particularly when the foreskin is long and difficult to manage.

When considering whether to undergo circumcision for phimosis, several factors should be taken into account. First, it is essential to understand the symptoms and complications associated with phimosis. If the foreskin is too tight, it can lead to pain during erections, difficulty cleaning the area, and an increased risk of infections, such as balanitis or urinary tract infections. The fact that you have experienced discomfort and have concerns about hygiene suggests that this might be a significant issue for you.

You mentioned that you can manually retract the foreskin but find it cumbersome and uncomfortable. This is a common experience for men with phimosis, especially when the foreskin is long and folds over itself. The presence of a strong odor and the feeling of moisture can indicate that bacteria may be accumulating under the foreskin, which can lead to further irritation and inflammation.

In terms of treatment options, there are generally two paths: conservative management or surgical intervention. Conservative management may include topical treatments, such as corticosteroids, to help loosen the foreskin, along with proper hygiene practices. However, if these methods do not provide relief or if the phimosis is causing significant discomfort or hygiene issues, circumcision may be recommended.

Circumcision is a surgical procedure that removes the foreskin, which can alleviate the problems associated with phimosis. It is important to discuss with your urologist the specifics of the procedure, including the expected outcomes and any potential risks. You mentioned that one doctor suggested circumcision while another felt it was unnecessary, which highlights the variability in medical opinions regarding this condition. Ultimately, the decision should be based on your symptoms, lifestyle, and personal preferences.

Regarding the specifics of the circumcision procedure, the typical recommendation is that the foreskin should be removed to the point where the glans is fully exposed both when flaccid and erect. This ensures that there is no excess skin that could fold back over the glans, which could lead to similar issues in the future. It is also crucial to have a thorough discussion with your healthcare provider about the length of foreskin to be removed, as this can vary based on individual anatomy and preference.

In conclusion, it is advisable to have an open and honest discussion with your urologist about your symptoms, concerns, and the potential benefits and risks of circumcision. If you feel that your quality of life is being affected by phimosis, and conservative measures have not been effective, circumcision may be a suitable option for you. Remember that the decision should ultimately be made based on your comfort level and the professional guidance of your healthcare provider.

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