Phimosis and Hypospadias: Symptoms and Treatment Options

Q: Phimosis and Hypospadias: Symptoms and Treatment Options

Hello： If the foreskin becomes tight during an erection, the doctor may recommend surgery. <br>The frenulum varies from person to person and does not require treatment in all cases. <br>Wishing you good health.

Phimosis and hypospadias issues?

Hello doctor, I have had phimosis for 27 years.
In middle school, I managed to retract it completely for the first time, but it was extremely painful and I almost couldn't push it back.
In high school, I successfully retracted it during an erection, but there was a tight ring that got stuck at the coronal sulcus.
About two to three years ago, I started experiencing cracks in the foreskin that were painful.
The doctor prescribed a steroid-like ointment for me to apply, which helped loosen the foreskin a bit.
After using two tubes, I found that retracting the foreskin during an erection was less uncomfortable, but I still feel a slight tightness.
When not erect, urination is difficult due to the small opening of the foreskin, causing me to urinate everywhere unless I pull the foreskin all the way forward, which makes it look like a condom and reduces the mess due to the smaller opening.
Additionally, during a previous examination, a doctor diagnosed me with a mild case of hypospadias, noting that there is a small opening 5mm away from the normal urethral opening, which looks like a keyhole from the front.
I am unsure if this situation is suitable for circumcision, especially since the foreskin has been affecting my urination for many years and I often feel itchy.
Also, while most people's frenulum is straight, mine appears to be curved and twisted.
Would this need correction? Thank you, doctor.

TT, 20~29 year old female. Ask Date: 2020/07/14

Dr. Du Shixi reply Urology

Hello: If the foreskin becomes tight during an erection, the doctor may recommend surgery.
The frenulum varies from person to person and does not require treatment in all cases.
Wishing you good health.

Reply Date: 2020/07/14

More Info

Phimosis and hypospadias are two distinct conditions that can affect the male genitalia, and understanding their symptoms and treatment options is crucial for managing any associated discomfort or complications.

Phimosis refers to the inability to retract the foreskin (prepuce) over the glans (head) of the penis. This condition can be physiological in infants and young boys, but if it persists into adulthood, it may lead to various complications. Symptoms of phimosis can include:
1. Pain or discomfort: This may occur during erections or sexual activity, as you have experienced. The tightness of the foreskin can create a sensation of constriction, leading to pain.

2. Difficulty with hygiene: A tight foreskin can make it challenging to clean the area properly, potentially leading to infections or inflammation.

3. Urinary issues: As you mentioned, a tight foreskin can cause difficulties in urination, leading to splashing or difficulty directing the stream.

Treatment options for phimosis include:
- Topical Steroids: As you have been prescribed a steroid cream, this can help reduce inflammation and promote the loosening of the foreskin over time.

- Gentle Stretching Exercises: Gradually stretching the foreskin can help alleviate tightness.

- Circumcision: In cases where conservative treatments fail or if there are recurrent infections or significant discomfort, circumcision may be recommended. This surgical procedure removes the foreskin entirely.

Hypospadias, on the other hand, is a congenital condition where the urethral opening is not located at the tip of the penis but rather along the underside. In your case, you mentioned a small opening located about 5mm from the normal urethral meatus, resembling a "keyhole." Symptoms of hypospadias can include:
1. Abnormal Urinary Stream: The urine may spray or flow in an unusual direction due to the misplaced urethral opening.

2. Difficulty with Sexual Function: Depending on the severity of the condition, it may affect sexual function or satisfaction.

Treatment for hypospadias typically involves surgical intervention to reposition the urethral opening to its normal location. This is usually performed in childhood, but adult cases can also be addressed surgically.

Given your symptoms of phimosis and the presence of hypospadias, it is advisable to consult a urologist. They can assess the severity of both conditions and recommend an appropriate treatment plan. In your case, circumcision may alleviate the phimosis and improve urinary function, while surgical correction of the hypospadias can address the abnormal urethral opening.

Additionally, the appearance of your frenulum (the band of tissue on the underside of the penis) being irregular may also warrant evaluation. If it is causing discomfort or contributing to the tightness of the foreskin, it may be addressed during any surgical procedure.

In summary, both phimosis and hypospadias can significantly impact quality of life, and addressing these conditions through appropriate medical intervention is essential. Consulting with a healthcare professional specializing in urology will provide you with tailored advice and treatment options based on your specific situation.

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