Frenulum Removal: Is It Necessary for Pain Relief?

Frenulectomy of the foreskin?

Hello, doctor.
I have a question that has been bothering me for a long time! When my penis is not erect, the foreskin covers the glans.
However, when erect, the foreskin can retract smoothly to expose the entire glans, but it cannot retract completely and remains in a wrinkled fold at the corona of the glans.
If I manually pull the foreskin back completely, it tugs on the frenulum beneath the glans, causing pain.
Additionally, during extreme arousal and full erection, I also experience slight discomfort due to the tension on the frenulum.
Are these symptoms due to phimosis? Do I need a circumcision? Since there are no issues with phimosis, hygiene, or other concerns, and the pain is solely due to the tension on the frenulum, I really do not want to undergo circumcision (I would like to keep the foreskin covering the glans to maintain its sensitivity).
In this case, is it possible to avoid circumcision and only perform a frenuloplasty?
Additionally, how much does a frenuloplasty cost out of pocket? I assume it won't be covered by insurance? Also, can this procedure be performed during the first consultation, or is it necessary to schedule a separate appointment for the surgery afterward?
I would greatly appreciate your detailed answers to my long-standing concerns.
Thank you very much.

Gui Gui, 20~29 year old female. Ask Date: 2007/10/28

Dr. Xu Weikai reply Urology

Hello, the area below the glans, known as the frenulum, is indeed a sensitive zone for males.
Due to its position or length, some individuals may experience pulling or tearing sensations during an erection.
Whether surgical removal is necessary depends on the situation during an erection, such as whether there is any curvature or pain caused by the frenulum.
The surgery is quite simple; it involves stitching the frenulum at both ends and cutting the middle section.
The sutures will naturally dissolve in about 1-2 weeks.
The cost is typically around $1000 to $2000.
You may want to visit a hospital for an examination to understand the actual condition and costs before making any decisions.
Generally, surgery requires scheduling an operating room, and it is rare to perform it on the spot.
If you have any further questions or need more details, feel free to ask for further discussion.
Sincerely, Dr.
Hsu Wei-Kai, Department of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2007/10/28

More Info

Understanding the need for frenulum removal, particularly in the context of your symptoms, is essential for addressing your concerns about pain and discomfort. Based on your description, it seems that you are experiencing discomfort due to the frenulum (the band of tissue connecting the underside of the penis to the foreskin) being taut during erection, which can lead to pain when the foreskin is retracted or when there is significant arousal.

Is Frenulum Removal Necessary?
From a medical standpoint, the symptoms you describe do not necessarily indicate that you need a circumcision (removal of the foreskin). Instead, it sounds like you may be experiencing a condition known as frenulum breve, where the frenulum is shorter than normal, causing discomfort during erections. This condition can lead to pain, especially when the foreskin is pulled back, as you have noted.

If the pain is primarily due to the tension on the frenulum and not associated with other complications like phimosis (where the foreskin cannot be retracted), then a frenuloplasty (surgical alteration of the frenulum) may be a suitable option. This procedure can relieve the tension without the need for complete circumcision, allowing you to maintain the sensitivity of the glans (the head of the penis) while alleviating the pain.

Surgical Options and Considerations
1. Frenuloplasty vs. Circumcision: As you mentioned, you prefer to avoid circumcision to maintain sensitivity. A frenuloplasty can be performed to lengthen the frenulum, which may resolve your discomfort. This procedure is typically less invasive than circumcision and can be done under local anesthesia.

2. Cost and Insurance: The cost of frenuloplasty can vary widely depending on your location and the specific healthcare provider. In many cases, this procedure may not be covered by insurance, especially if it is deemed elective. It is advisable to consult with your healthcare provider or urologist for an estimate of the costs involved.

3. Scheduling the Procedure: Generally, a frenuloplasty can be performed during the first consultation if the physician deems it appropriate and if you are ready for the procedure. However, some practitioners may prefer to schedule a separate appointment for the surgery after a thorough evaluation. It’s best to discuss this with your doctor during your visit.

Conclusion
In summary, based on your symptoms, it seems that a frenuloplasty could be a viable option to alleviate your discomfort without the need for circumcision. It is crucial to have a detailed discussion with a qualified urologist who can assess your condition and recommend the best course of action tailored to your needs. They can provide you with information regarding the procedure, costs, and scheduling, ensuring that you are well-informed and comfortable with your treatment plan.
If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized advice.

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