Phimosis: When to Consider Surgical Intervention

Phimosis issue

1.
I underwent a circumcision in middle school, but I still cannot expose the glans normally and can only push it out with my hand.
2.
When I was in college, I bought some sexual wellness products for use, and I noticed that when I push the foreskin too far down, it becomes very tight and painful.
Do I need surgical intervention for this?

James, 10~19 year old female. Ask Date: 2022/04/05

Dr. Xu Wencang reply Urology

It may be necessary to schedule an outpatient evaluation.

Reply Date: 2022/04/05

More Info

Phimosis is a condition where the foreskin cannot be easily retracted over the glans (the head of the penis). It can be a source of discomfort, pain, and even complications if left untreated. In your case, it seems that despite having undergone a circumcision in middle school, you are still experiencing difficulties with retracting the foreskin, which can be concerning.

When to Consider Surgical Intervention for Phimosis
1. Persistent Symptoms: If you are experiencing ongoing discomfort or pain when attempting to retract the foreskin, especially during sexual activity or when using certain products, this is a significant indicator that surgical intervention may be necessary. Pain is a clear signal that the condition is affecting your quality of life.

2. Inability to Retract the Foreskin: If you find that you can only retract the foreskin with manual assistance and it causes pain, this suggests that the condition is more than just a minor issue. The inability to retract the foreskin can lead to hygiene problems, which may increase the risk of infections.

3. Recurrent Infections: If you have experienced recurrent infections or inflammation (balanitis) due to the inability to properly clean the area under the foreskin, this is another strong reason to consider surgical options. Chronic infections can lead to more severe complications if not addressed.

4. Impact on Sexual Activity: If the condition is affecting your sexual function or causing pain during intercourse, this is a critical factor. Sexual health is an important aspect of overall well-being, and any condition that interferes with this should be evaluated for potential surgical treatment.

5. Psychological Impact: The psychological effects of phimosis, including anxiety or embarrassment related to sexual activity, should not be overlooked. If the condition is causing significant distress, it may be worth discussing surgical options with a healthcare provider.

Surgical Options
If surgical intervention is deemed necessary, there are a few options available:
- Circumcision: This is the complete removal of the foreskin and is often considered the definitive treatment for phimosis. It is usually performed under local or general anesthesia, depending on the patient's age and the specifics of the case.

- Preputioplasty: This is a less invasive procedure where the foreskin is incised and widened without complete removal. This option may be suitable for those who wish to retain some foreskin.

Consultation with a Specialist
Given your symptoms and history, it is advisable to consult with a urologist. They can perform a thorough examination and discuss the best course of action tailored to your specific situation. They will consider factors such as the severity of your symptoms, your medical history, and your personal preferences regarding treatment.

Conclusion
In summary, if you are experiencing pain, difficulty retracting the foreskin, or any negative impact on your sexual health due to phimosis, it is important to seek medical advice. Surgical intervention may be warranted, and a urologist can provide you with the necessary information and support to make an informed decision. Remember, addressing this issue can significantly improve your quality of life and overall well-being.

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