Managing Painful Tear Around the Foreskin: When to Consider Circumcision

Tear of the foreskin opening?

Hello doctor, I have a problem with phimosis.
When I'm not erect, I can retract the foreskin behind the glans, but when I am erect, only a small part of the glans is exposed at the opening of the foreskin.
I have been trying to retract the foreskin during erections, and although it has been painful, I have noticed significant improvement in the retraction, as I can now expose some of the glans.
However, recently, after retracting the foreskin during an erection, I have experienced pain whether I am erect or not.
Upon closer inspection, I noticed two to three areas of torn skin around the opening of the foreskin, resembling cracked skin.
As a result, it is painful to pull back the foreskin for cleaning the glans after showering or using the restroom, and it seems that the foreskin can no longer continue to loosen or expand.
I would like to ask the doctor how to address this issue.
Should I continue to try to retract it, or is it time to consider a circumcision?

Lü, 20~29 year old female. Ask Date: 2019/05/16

Dr. Li Xinyi reply Urology

A simple dorsal slit of the foreskin may be sufficient.
Your situation seems to be covered by health insurance, so it is advisable to consult a urologist for an examination and discuss it with the physician.

Reply Date: 2019/05/16

More Info

Managing painful conditions related to the foreskin, particularly in cases of phimosis or tight foreskin, can be challenging and may require careful consideration of treatment options. In your situation, it seems that you are experiencing significant discomfort due to tearing and cracking of the skin around the foreskin, which is likely exacerbated by attempts to retract it during an erection.
Firstly, it is important to understand that the foreskin is designed to protect the glans (the head of the penis) and maintain moisture. When the foreskin is too tight, it can lead to painful conditions, including tearing, inflammation, and even infections. The pain you are experiencing, especially during retraction, indicates that the skin is likely irritated or damaged, which can further complicate the situation.

In terms of management, there are a few approaches you can consider:
1. Gentle Care and Hygiene: It is crucial to maintain proper hygiene without causing further irritation. When cleaning, be gentle and avoid pulling the foreskin too forcefully. You may want to use mild, unscented soap and warm water to clean the area, ensuring that you rinse thoroughly.

2. Topical Treatments: Over-the-counter topical creams or ointments, such as hydrocortisone cream, may help reduce inflammation and promote healing of the torn skin. However, it is essential to consult with a healthcare provider before applying any medication to ensure it is appropriate for your situation.

3. Gradual Stretching: While you have been attempting to stretch the foreskin, it is important to do so gently and gradually. If the pain persists or worsens, it may be advisable to stop this practice temporarily to allow the skin to heal.

4. Consultation with a Specialist: Given the ongoing pain and the presence of tears, it would be wise to consult a urologist. They can assess the severity of your condition and determine whether conservative management is sufficient or if surgical intervention, such as circumcision, is necessary.

5. Circumcision Consideration: Circumcision is often recommended for individuals with severe phimosis or recurrent infections. It can provide a permanent solution to the problems associated with a tight foreskin. If the pain and tearing continue despite conservative measures, circumcision may be the best option to prevent future complications and improve your quality of life.

In conclusion, while it is commendable that you are trying to manage the condition on your own, the presence of pain and tearing suggests that professional medical advice is warranted. A urologist can provide a thorough evaluation and discuss the best course of action, whether that involves conservative management or surgical options. Remember, addressing these issues early can prevent further complications and improve your overall well-being.

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