Common Urological Concerns: A Guide to Foreskin Issues

Q: Common Urological Concerns: A Guide to Foreskin Issues

Hello： <br>1. <br>My penis, whether erect or not, has the foreskin covering the urethral opening. <br>When the penis is not erect, the foreskin can be easily retracted to the coronal sulcus without pain; however, when erect, the foreskin becomes tightly constricted at the coronal

Inquiry Consultation

Hello Dr.
Du, I have a few questions for you:
Q1.
My foreskin covers the urethral opening regardless of whether my penis is erect or not.
When my penis is not erect, I can easily retract the foreskin to the coronal sulcus without any pain; however, when erect, the foreskin becomes tightly constricted at the coronal sulcus and causes pain.
Based on my description, would you consider this condition to be phimosis or simply a long foreskin?
Q2.
What is the recommended frequency for properly retracting the foreskin for cleaning? Should it be done several times a day, once a day, or every few days?
Q3.
When I urinate without retracting the foreskin, the urine flows in a straight stream.
However, if I retract the foreskin to expose the glans, sometimes the urine stream splits into two directions, although this is less likely to happen if the volume of urine is larger.
Is this situation normal or abnormal?
Q4.
When I retract the foreskin to the coronal sulcus, I cannot directly see the connection point between the frenulum and the glans on the "right side" because it appears to be a small indentation.
However, on the left side, I can see the connection point clearly.
I have observed that urine does not exit from this small indentation (so it should not be a case of hypospadias), and I believe this indentation has been present for some time.
In your opinion, what could this small indentation on the "right side" of the frenulum indicate? (e.g., a tear at the connection point, a depressed scar, or a normal mucosal fold)
Q5.
Following up on the previous question, since this small indentation is neither painful nor itchy and does not affect my daily life, I am only concerned about the possibility of dirt (such as smegma) accumulating in it, making it difficult to clean.
What would you recommend I do about this? (e.g., seek immediate medical attention or continue to observe it)
Thank you, Dr.
Du.

Axiang, 40~49 year old female. Ask Date: 2022/10/07

Dr. Du Shixi reply Urology

Hello:
1.
My penis, whether erect or not, has the foreskin covering the urethral opening.
When the penis is not erect, the foreskin can be easily retracted to the coronal sulcus without pain; however, when erect, the foreskin becomes tightly constricted at the coronal sulcus and is accompanied by pain.
Dr.
Du, does my situation qualify as "phimosis" or "excessive foreskin"? -- Both.
2.
Dr.
Du, what is the recommended frequency for completely retracting the foreskin for cleaning? (For example: several times a day, once a day, or every few days) -- 1-2 times.
3.
When I urinate, I do not retract the foreskin, so the urine flows in a straight line.
However, if I retract the foreskin to expose the glans, sometimes the urine stream bifurcates, but if the urine volume is larger, it is less likely to bifurcate.
Dr.
Du, is this situation normal or abnormal? -- Normal.
4.
When I retract the foreskin to the coronal sulcus, I cannot directly see the connection point between the frenulum and the glans on the "right side" when I pull it apart; it resembles a small indentation.
On the left side, I can see the connection point directly.
Upon my observation, urine does not exit from this small indentation (therefore it should not be a hypospadias), and I recall that this small indentation has been present for some time.
Dr.
Du, in your opinion, what could this small indentation on the "right side" of the frenulum and glans connection indicate? (For example: a tear at the connection point, a depressed scar, or a normal mucosal fold) -- Please seek medical attention; it may be adhesions.
5.
Following up on the previous question, since this small indentation is not painful or itchy and does not significantly affect my daily life, I am only concerned about dirt (such as smegma) accumulating in this small indentation, making it difficult to clean.
Dr.
Du, how should I handle this situation? (For example: seek immediate medical attention or continue to observe) -- Seek medical attention.
Wishing you good health.

Reply Date: 2022/10/07

More Info

Hello! Thank you for your detailed questions regarding foreskin issues. Let's address each of your concerns systematically.

Q1: Phimosis vs. Excessive Foreskin
Based on your description, it seems you may be experiencing a condition known as phimosis, particularly when the foreskin is unable to retract fully over the glans (head of the penis) during an erection, causing tightness and pain. In contrast, excessive foreskin typically refers to a situation where the foreskin is longer than usual but does not necessarily cause pain or difficulty in retraction. Since you mentioned that the foreskin can retract easily when not erect but becomes tight and painful when erect, this suggests phimosis rather than just excessive foreskin.

Q2: Frequency of Cleaning Under the Foreskin
The frequency of cleaning under the foreskin can vary based on personal hygiene practices and individual circumstances. Generally, it is advisable to clean the area daily. This can help prevent the buildup of smegma, a substance that can accumulate under the foreskin, which may lead to irritation or infection. If you are able to retract the foreskin without pain, doing so during your daily shower or bath is recommended.

Q3: Urination Patterns
Your observation regarding the urine stream is quite common. When the foreskin is not retracted, the urine may flow in a straight line due to the constriction of the urethra. When the foreskin is retracted, the urine stream may split or bifurcate, especially if the urethral opening is slightly constricted or if there is a change in pressure. This is generally considered normal, especially if the urine flow is strong and consistent when the bladder is full.

Q4: The Small Indentation
The small indentation you described on the right side of the frenulum (the band of tissue connecting the foreskin to the glans) could be a normal anatomical variation, such as a natural fold or a minor scar. It is not uncommon for individuals to have slight asymmetries in this area. If there is no pain, discharge, or other symptoms, it is likely not a cause for concern. However, if you notice any changes or if it becomes painful, it would be wise to consult a healthcare professional.

Q5: Managing the Small Indentation
Since the small indentation does not cause you discomfort and does not seem to affect your daily life, it may be best to continue monitoring it. Regular cleaning during your hygiene routine should suffice to prevent any buildup of debris. If you notice any changes, such as increased irritation, pain, or discharge, it would be prudent to seek medical advice.

Conclusion
In summary, it appears that you may be dealing with phimosis, which can cause discomfort during erections. Maintaining good hygiene by cleaning under the foreskin daily is important. The variations in your urination patterns and the small indentation seem to be within normal limits, but ongoing observation is key. If you have any concerns or if symptoms worsen, please consult a healthcare provider for a thorough evaluation and personalized advice.

If you have further questions or need clarification on any points, feel free to ask!

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