Phimosis and Hidden Penis: Surgery or Weight Loss?

Q: Phimosis and Hidden Penis: Surgery or Weight Loss?

Hello： 1) Hidden penis requires a specialized surgical procedure, not just a routine circumcision. <br>The hidden penis can be visually assessed, as the actual penis (not the foreskin) is mostly buried in the fatty tissue. <br>2) Not everyone with phimosis requires surgery; the k

Questions about the foreskin?

I have a condition of phimosis, where the foreskin is long and covers the glans when not erect (I can manually retract it, but it is quite long and requires several folds behind the glans).
When erect, about two-thirds of the glans is exposed, but I still need to pull the skin back to the coronal sulcus, and there is still a ring of skin that I’m unsure if it’s too long and causing discomfort.
Sometimes, when I retract the foreskin to urinate, I still feel a sensation of needing to urinate, which leads to damp underwear.
I previously had balanitis, and the doctor prescribed topical medication.
The doctor mentioned that circumcision is optional, and I should just maintain proper hygiene.
I am 181 cm tall and weigh 68 kg, which is considered a normal body type, but I have some abdominal fat.
The doctor said this could be classified as a hidden penis.
I hope to lose fat.
1.
I would like to ask the doctor: I read online that a hidden penis may require surgery, but the doctor suggested weight loss.
Do I need surgery, or can the hidden penis be assessed visually by the doctor after weight loss?

2.
Regarding the long foreskin, sometimes when I retract it or do not retract it while urinating, the foreskin tends to retract slightly, causing moisture.
Will this long-term condition increase the risk of inflammation or infection? Is circumcision recommended, or is it not advisable to circumcise in cases of a hidden penis? Should I consult another specialist, or is it sufficient to focus on weight loss? (I visited a well-known clinic in Taipei.)
3.
I am quite interested in circumcision, but I am concerned about having keloid tendencies (I previously injured my hand on a cabinet corner, resulting in a deep wound that I neglected and did not treat; now I have a slight scar that is not very raised, less than 0.1 cm, but the surface is smooth.
A dermatologist mentioned that I have keloid tendencies).
Given this, is circumcision advisable? The dermatologist only did a brief examination without further tests.
Should I seek a more detailed evaluation from a dermatologist before proceeding with circumcision? Thank you for your assistance.

RYAI, 20~29 year old female. Ask Date: 2019/07/05

Dr. Du Shixi reply Urology

Hello: 1) Hidden penis requires a specialized surgical procedure, not just a routine circumcision.
The hidden penis can be visually assessed, as the actual penis (not the foreskin) is mostly buried in the fatty tissue.
2) Not everyone with phimosis requires surgery; the key is to maintain proper hygiene and dryness.
Not everyone experiences inflammation; it depends on individual hygiene habits.
If one works in a warm and humid environment, they may be more prone to inflammation.
3) Individuals with keloid tendencies should avoid surgery as it may be difficult to manage if complications arise.
There is generally no need for special medical attention; just be careful to avoid injury.
Wishing you good health.

Reply Date: 2019/07/05

More Info

Phimosis and hidden penis are conditions that can significantly affect an individual's quality of life, both physically and psychologically. Understanding these conditions and the potential treatment options is crucial for making informed decisions about one's health.

Understanding Phimosis
Phimosis is a condition where the foreskin cannot be fully retracted over the glans (the head of the penis). This can lead to discomfort, hygiene issues, and potential complications such as infections or inflammation. In your case, it seems that you can manually retract the foreskin, but it requires effort, and there are concerns about hygiene and potential irritation.

Hidden Penis
The term "hidden penis" refers to a condition where the penis appears smaller or is partially concealed due to excess fat in the pubic area or other anatomical factors. This can be exacerbated by weight gain, which may lead to a more pronounced appearance of the condition. In your case, the presence of some abdominal fat could be contributing to the hidden penis phenomenon.

Treatment Options
1. Surgery vs. Weight Loss:
- Surgery: Circumcision is a common surgical option for phimosis, especially if it leads to recurrent infections or significant discomfort. However, if your doctor has indicated that surgery is not strictly necessary and that maintaining good hygiene may suffice, it may be worth considering non-surgical options first.

- Weight Loss: Losing weight can potentially improve the appearance of a hidden penis by reducing the fat pad around the pubic area, which may make the penis appear longer and more prominent. This approach is often recommended before considering surgical options, especially if you are otherwise healthy.

2. Hygiene Concerns:
- Long-term issues with phimosis, such as difficulty urinating or maintaining cleanliness, can indeed lead to infections or inflammation. If you are experiencing persistent issues with moisture or irritation, it may be advisable to discuss circumcision with a urologist, as they can provide a more tailored recommendation based on your specific situation.

3. Keloid Concerns:
- If you have a history of keloid formation (hypertrophic scarring), this is an important factor to consider before undergoing any surgical procedure. Keloids can develop after any skin injury, including surgical incisions. It would be prudent to consult with a dermatologist or a plastic surgeon who specializes in scar management to assess your risk and discuss potential surgical techniques that minimize scarring.

Recommendations
- Consult a Urologist: Given your concerns about phimosis and hidden penis, a consultation with a urologist is advisable. They can provide a thorough examination and discuss the best course of action, whether that involves surgery, weight loss, or other management strategies.

- Weight Management: If you are considering weight loss, a structured plan involving diet and exercise can be beneficial. Not only can this help with the appearance of the hidden penis, but it can also improve overall health.

- Monitor Symptoms: Keep track of any symptoms related to phimosis, such as pain, difficulty urinating, or recurrent infections. If these symptoms worsen, it may necessitate a more immediate intervention.

In conclusion, while surgery is an option for phimosis, it may not be the only solution. Weight loss could potentially alleviate some of the concerns related to a hidden penis. It is essential to have open discussions with healthcare professionals to determine the best approach tailored to your needs and circumstances.

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