Concerns About Tight Circumcision Sutures: Healing and Treatment Options

Two months after circumcision, the sutured area still feels tight, and the surrounding skin is prone to cracking?

Previously, I underwent a circumcision due to a tight foreskin opening that was prone to tearing.
During my last follow-up appointment one month post-surgery, the wound had healed, but the sutured area felt slightly tight and was indented.
The urologist mentioned this was normal and would gradually loosen over time.
However, now that it has been two months since the surgery, the tightness has not improved.
Recently, I noticed that during sexual activity (which was of moderate intensity and adequately lubricated), the tightness at the sutured area seemed to cause a small section of the foreskin, located about 1-2 millimeters below the outer-facing part (relative to the scrotum), to tear, resulting in one or two small horizontal cuts about half a centimeter long that are not easily visible.
These cuts can be mistaken for microvascular injuries, but they appear a brighter red, and sometimes there is a mild stinging sensation when pressed.
I am concerned that repeated tearing may worsen the situation, so I have stopped sexual activity and have been applying a moisturizing repair lotion recommended by a dermatologist after showering (which I have used on my entire body, including the foreskin, for many years without adverse reactions).
After 10 days, I checked and saw no wounds, so I resumed sexual activity, but after two encounters, the aforementioned wounds reappeared, and the sutured area seems to have become slightly tighter and more indented (though I am unsure if this is just my perception).
Therefore, I would like to ask:
1.
Can applying a topical treatment like Lidocaine help to improve the tightness of the sutured area? Is applying it once a day sufficient? Will it cause the skin to thin, making it more prone to tearing? If so, are there other medications or types of skincare products that would be more suitable?
2.
Is it true that the tightness of the sutured area can gradually loosen as the urologist suggested? It has been two months without improvement, and I am feeling somewhat pessimistic about this.
I would like to hear your opinion as a dermatology specialist.

3.
If the tightness of the sutured area and the wound continues to slowly worsen, could it potentially lead to a situation similar to incarcerated phimosis, resulting in poor blood circulation and penile necrosis? If so, could surgery be performed to use skin from another area to graft over the sutured area and the surrounding foreskin?
Thank you for your guidance on these questions!

Nìmíng, 20~29 year old female. Ask Date: 2023/10/16

Dr. Wu Yuxin reply Dermatology

Because you are only using descriptions, it is difficult to accurately assess the actual situation.
However, it is certain that applying Linderon is not recommended.
Other issues may require a physical examination to provide you with better advice.

Reply Date: 2023/10/16

More Info

It sounds like you have some valid concerns regarding the healing process after your circumcision surgery, particularly with the tightness of the sutures and the potential for injury during sexual activity. Let's address your questions one by one.

1. Can topical treatments like hydrocortisone help loosen the tight suture area?
While hydrocortisone cream is often used to reduce inflammation and itching, it is not typically recommended for use on surgical wounds or sutures, especially in sensitive areas like the penis. The concern is that while it may help with inflammation, it could also thin the skin over time, potentially making it more susceptible to tearing or injury. Instead, a more suitable option might be a gentle moisturizer or a silicone gel, which can help hydrate the skin and improve elasticity without the risk of thinning. Applying such products once or twice daily is generally sufficient, but you should consult with your healthcare provider for specific recommendations tailored to your situation.

2. Will the tightness of the suture area eventually loosen as the healing progresses?
It is common for surgical sites to feel tight or constricted during the healing process. However, if two months have passed and you are still experiencing significant tightness, it may not be resolving as expected. While some degree of loosening can occur as the tissue heals and remodels, persistent tightness could indicate scarring or other complications. If you are concerned about the lack of improvement, it would be wise to follow up with your urologist or a dermatologist specializing in this area for a thorough evaluation.

3. Could continued tightness lead to complications like strangulation or necrosis?
Yes, if the tightness continues to worsen, there is a risk of developing complications similar to phimosis, where the skin cannot retract properly, potentially leading to issues with blood flow and tissue health. If you notice any signs of compromised circulation, such as discoloration, severe pain, or swelling, it is crucial to seek medical attention immediately. In some cases, surgical intervention may be necessary to relieve the tightness, which could involve a revision of the circumcision or other procedures to improve the condition of the skin.

In summary, while some tightness can be expected post-surgery, ongoing issues should not be ignored. It is essential to maintain open communication with your healthcare providers, who can offer tailored advice and interventions based on your specific situation. If you feel that your concerns are not being adequately addressed, seeking a second opinion from another urologist or a specialist in dermatology may provide you with additional insights and treatment options.

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