Phimosis and Its Treatment Options: A Guide for Patients - Urology

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Phimosis is a condition where the foreskin cannot be easily retracted over the glans (the head of the penis). It can be classified into two types: physiological phimosis, which is common in infants and usually resolves on its own, and pathological phimosis, which occurs due to scarring or inflammation. Based on your description, it seems you may be experiencing pathological phimosis, especially since you have difficulty exposing the glans during an erection and experience pain during sexual activity.

The pain you describe when attempting to retract the foreskin, as well as the swelling you experienced after sexual intercourse, suggests that you may have a tight foreskin that can lead to complications such as paraphimosis, where the retracted foreskin cannot return to its original position, causing swelling and pain. This condition can be serious and may require immediate medical attention.

In terms of treatment options, there are several approaches:
1. Conservative Management: In some cases, gentle stretching exercises of the foreskin may help. This should be done cautiously and under the guidance of a healthcare provider to avoid causing further injury or pain.

2. Topical Steroids: Applying a topical steroid cream may help to reduce inflammation and promote the loosening of the foreskin. This treatment is often effective for mild cases of phimosis.

3. Circumcision: If conservative measures fail or if the phimosis is causing significant pain or recurrent infections, circumcision may be recommended. This surgical procedure involves the removal of the foreskin and can be performed under local or general anesthesia, depending on the specific case and the patient's preference.
4. Preputioplasty: This is a less invasive surgical option that involves widening the opening of the foreskin without complete removal. This may be suitable for some patients who wish to retain their foreskin.

Regarding your concerns about surgery, circumcision is typically an outpatient procedure, meaning you can go home the same day. The costs can vary widely depending on the healthcare facility, your insurance coverage, and the specific procedure performed. In Taiwan, if the condition is classified as phimosis rather than just a long foreskin, it may be covered by the National Health Insurance, but this is something you would need to confirm with your healthcare provider.

After circumcision, the glans will be exposed, which can lead to increased sensitivity initially. Over time, many patients find that the sensitivity decreases, and they experience improved comfort during sexual activity. The amount of foreskin removed can vary based on the surgical technique used, but typically, enough is removed to ensure that the glans is fully exposed.

It is essential to discuss your symptoms and concerns with a urologist, who can provide a thorough examination and recommend the best treatment option for your specific situation. They can also address any questions you have about the procedure, recovery, and what to expect afterward.