Frenulum Issues: Causes, Symptoms, and Treatment Options

Q: Frenulum Issues: Causes, Symptoms, and Treatment Options

Hello： This platform cannot provide a diagnosis without a personal examination, but I can offer some personal opinions. <br>If the skin was originally not red but is now red, it is likely an inflammatory response. <br>You may try cleaning the area and then covering it back up, we

Issues related to the frenulum of the foreskin (I have already reviewed other similar responses on this website)?

Hello Dr.
Du,
The following article may be a bit long, and I appreciate your patience in reading it.

At the beginning of April, I had unprotected sexual intercourse with my girlfriend.
In mid-April, I started experiencing unusual itching and flaking in my scrotum (which I had never experienced before), so I visited a dermatologist.
The doctor diagnosed it as scrotal eczema and prescribed oral medication along with a topical steroid cream.
About a week later, the symptoms resolved.

From mid-April to early May, I masturbated twice, but starting in early May, I began to feel discomfort while urinating (slight burning sensation, frequent urination, and lower abdominal discomfort) and noticed redness and swelling in the frenulum.
On May 8, I consulted a urologist, Dr.
A, who examined my frenulum and conducted a urinalysis.
He noted slight inflammation and prescribed oral antibiotics and tetracycline ointment for the swollen frenulum.

At one point, I felt that I was recovering normally.
However, on May 22, I felt that the urination discomfort had resolved, but the frenulum still felt uncomfortable, and I experienced some pain during erections and ejaculation.
During a follow-up visit, Dr.
A informed me that the previous urine culture showed some bacteria (without specifying the type), so he prescribed another five-day course of oral antibiotics and advised me to continue using the tetracycline ointment.

In early June, after discussing with my girlfriend, I went to a medical laboratory for a full sexually transmitted infection (STI) screening and urine culture, and all results came back negative with no bacteria.
The reports are as follows, with personal information redacted:
- Report 1: https://imgur.com/mRX7F6E
- Report 2: https://imgur.com/lfDQ9UV
- Report 3: https://imgur.com/6itHeRe
On June 8, I returned to the same urology department, where Dr.
B noted that the frenulum was still uncomfortable and felt swollen.
He mentioned that I only experienced slight pain at the beginning of urination, but not during the rest of the process.
After examining the frenulum, Dr.
B said it looked fine and requested another urine culture, asking me to return the following week for the results.
He also prescribed a steroid ointment for the frenulum.
Since I was hesitant to apply too much steroid, I only used it on June 9 and 10.

By June 15, the frenulum was slightly swollen but not red.
During my follow-up with Dr.
B, he mentioned that the culture report showed some staphylococcus, so he believed there might be small, less visible wounds on the frenulum.
He prescribed a topical ointment for me to apply.
However, starting June 17, my frenulum seemed to become red and swollen again, and I am wondering if I should stop using the ointment.
Attached are photos taken on the night of June 17 after applying the ointment:
- https://imgur.com/a/4QFTVNA
- https://imgur.com/mbC59Bc
It has been nearly a month and a half since I first sought medical attention for the frenulum symptoms.
There were times when I felt recovered without any discomfort, but after a few days, the discomfort and swelling returned.
This recurring situation has made me quite frustrated, and my mood has started to decline, making me hesitant to masturbate or engage in sexual activity with my girlfriend.

In a non-erect state, my glans is fully exposed, and I can retract the foreskin to cover it.
I have never experienced any discomfort during erections, and I believe I do not have a problem with phimosis (I consulted a doctor about this in middle school, and he said circumcision was not necessary).
I always use tissue to dry the urethral opening after urination.
My application method involves drying the area after showering, using a cotton swab to apply the ointment to the frenulum while keeping the glans exposed, and then putting on underwear.

I would like to ask Dr.
Du, after reviewing my entire narrative and the provided images, do you think it is possible that the scrotal eczema has spread to the frenulum? What should I do next, or is there something wrong with the way I am applying the ointment?

CHUAN, 20~29 year old female. Ask Date: 2020/06/18

Dr. Du Shixi reply Urology

Hello: This platform cannot provide a diagnosis without a personal examination, but I can offer some personal opinions.
If the skin was originally not red but is now red, it is likely an inflammatory response.
You may try cleaning the area and then covering it back up, wearing looser underwear, avoiding the use of soap or body wash, rinsing with clean water, and drying thoroughly.
It is also advisable not to use alcohol-based disinfectants.
Ensure that your diet and sleep are normal, and practice safe sex by using condoms.
Avoid being too vigorous during any DIY activities.
Eczema is inherently a skin issue, and similar skin areas may also be affected.
It is difficult to ascertain whether there is a risk of transmission.
Wishing you good health.

Reply Date: 2020/06/18

More Info

Understanding issues related to the frenulum, particularly in the context of your symptoms and experiences, requires a comprehensive approach that considers potential causes, symptoms, and treatment options. Based on your detailed account, it seems you have been experiencing a series of discomforts related to the frenulum, which may be linked to previous skin conditions and possibly an infection.

Causes of Frenulum Issues
1. Infections: The symptoms you describe, such as redness, swelling, and discomfort, could indicate an infection. The presence of bacteria, as noted in your urine culture, suggests that there may be an underlying infection that needs to be addressed. Common bacterial infections in this area can lead to inflammation and discomfort.

2. Dermatitis or Eczema: Your initial diagnosis of scrotal eczema could have contributed to the sensitivity and irritation of the frenulum. Eczema can cause skin to become inflamed, itchy, and flaky, which may extend to the frenulum area if not properly managed.

3. Irritation from Products: The use of topical medications, especially corticosteroids, can sometimes lead to skin thinning or irritation if used excessively. It's crucial to follow your doctor's instructions regarding the application of these medications.

4. Mechanical Irritation: Activities such as masturbation or sexual intercourse can sometimes lead to mechanical irritation of the frenulum, especially if there is any underlying inflammation or sensitivity.

Symptoms
The symptoms you are experiencing, including:
- Redness and swelling of the frenulum
- Discomfort during urination
- Pain during erections or ejaculation
- Flaking or peeling skin
These symptoms can be indicative of several conditions, including infections, dermatitis, or even a reaction to medications.

Treatment Options
1. Follow-Up with Healthcare Providers: It is essential to maintain open communication with your urologist or dermatologist. Given the persistence of your symptoms, a follow-up appointment is warranted. They may consider further diagnostic tests or a referral to a specialist if necessary.

2. Topical Treatments: Continue using the prescribed topical treatments as directed. If you experience worsening symptoms with a particular medication, inform your doctor. They may suggest alternative treatments or adjust the dosage.

3. Hygiene Practices: Ensure proper hygiene in the genital area. Gently clean the area with mild soap and water, and avoid harsh chemicals or irritants. After washing, pat the area dry rather than rubbing it.

4. Avoid Irritants: If you suspect that certain products (such as soaps, lotions, or even laundry detergents) may be causing irritation, consider switching to hypoallergenic options.

5. Monitor Symptoms: Keep a record of your symptoms, noting any changes or patterns. This information can be valuable for your healthcare provider in determining the best course of action.

6. Consider a Second Opinion: If your symptoms persist despite treatment, seeking a second opinion from another urologist or dermatologist may provide new insights or treatment options.

Emotional Well-Being
It’s understandable that dealing with ongoing discomfort can lead to feelings of frustration and anxiety. It’s important to address not only the physical symptoms but also the emotional impact they may have on your life. Consider discussing your feelings with a mental health professional, especially if you find that your mood is affected by your physical health issues.

Conclusion
In summary, your symptoms related to the frenulum could stem from a combination of factors, including infections, dermatitis, and irritation. It’s crucial to continue working closely with your healthcare providers to monitor your condition and adjust treatment as necessary. By maintaining good hygiene, following prescribed treatments, and addressing any emotional concerns, you can work towards alleviating your symptoms and improving your overall well-being.

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