Phimosis: Do You Need Surgery or Just Stretching?

Prepuce

Doctor, my foreskin can be retracted manually when not erect without any tightness, but when erect, I can only see the glans through the opening of the foreskin.
When I try to pull it down, it feels very tight, as if the opening is too small.
Do I need a circumcision, or is it sufficient to simply widen the opening?

Xiao Gui, 10~19 year old female. Ask Date: 2005/04/30

Dr. Liu Jianting reply Urology

That's right! Consult a urologist to perform the surgery for you.

Reply Date: 2005/04/30

More Info

Phimosis is a condition where the foreskin cannot be easily retracted over the glans (the head of the penis), which can lead to discomfort, hygiene issues, and in some cases, pain during erections. Your description indicates that while you can retract the foreskin when the penis is not erect, it becomes tight and difficult to pull back when erect. This suggests that you may have a form of phimosis, which can be classified as either physiological (common in young boys and often resolves naturally) or pathological (where the tightness persists into adulthood).

In your case, since you experience tightness during an erection and a sensation of constriction, it is advisable to consider your options carefully. Here are the two primary approaches to managing phimosis:
1. Conservative Treatment (Stretching):
- Stretching exercises can be effective for some individuals with mild to moderate phimosis. This involves gently pulling back the foreskin daily to gradually increase its elasticity. It is important to be gentle and not force the foreskin back, as this can cause pain or injury.
- Topical corticosteroids may also be prescribed by a healthcare provider to help reduce inflammation and promote stretching of the foreskin. This conservative approach is often recommended for those who do not experience significant pain or complications.

2. Surgical Intervention (Circumcision):
- If conservative measures do not provide relief or if the phimosis is causing significant discomfort, pain during erections, recurrent infections, or other complications, circumcision may be recommended. This surgical procedure involves the removal of the foreskin, which can eliminate the problem entirely.

- There are also less invasive surgical options, such as preputioplasty, which involves making an incision in the foreskin to widen the opening without complete removal. This can be a suitable option for those who wish to preserve the foreskin.

Considerations:
- Severity of Symptoms: If your symptoms are mild and manageable, you might want to try stretching exercises first. However, if you experience pain, recurrent infections, or significant discomfort, surgical options may be more appropriate.

- Consultation with a Specialist: It is crucial to discuss your symptoms with a urologist or healthcare provider who specializes in male genital health. They can provide a thorough examination and help you weigh the benefits and risks of each option based on your specific situation.

- Hygiene and Health: Regardless of the approach you choose, maintaining good hygiene is essential. Ensure that you clean the area properly to prevent infections, especially if the foreskin is difficult to retract.

In conclusion, while stretching may be effective for some individuals with phimosis, surgical options like circumcision or preputioplasty are available for those who require more definitive treatment. A thorough evaluation by a healthcare professional will help you determine the best course of action based on your symptoms and lifestyle.

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