To Circumcise or Use Medication: Navigating Foreskin Issues

Circumcision or topical medication?

Hello Dr.
Hsu,
I have phimosis and a small opening.
A few days ago, I visited a urologist, who for the first time retracted my foreskin to expose the glans, which was very sensitive and uncomfortable.
The doctor suggested circumcision.
After returning home, I researched online and found that there are topical treatments that might be effective, but not guaranteed.
If I undergo circumcision, I worry that my glans will still be overly sensitive and that the smegma accumulated over the years has not been cleared (I have tried to retract it a few times, and once while soaking in water, I managed to retract it completely, but it was uncomfortable, so I wanted to revert it back, which was difficult.
I am afraid of any accidents, so I haven't dared to retract it that much since, and I still struggle to retract it).
So my current dilemma is: should I try the topical medication? (I lean towards this option, as it might allow for easier retraction and cleaning, and reduce sensitivity of the glans, then reassess the need for circumcision), or should I go ahead with the circumcision? If I do have the procedure, what if my glans still has smegma buildup and remains hypersensitive? (If surgery is performed, will I need to wait for the wound to heal before I can gradually clean the smegma?)
Additionally, if you have time, could you take a look at this blog http://tw.myblog.yahoo.com/shin460336/archive?l=f&id=1? The author strongly advocates for trying topical treatments or a gradual approach instead of immediate circumcision, claiming that this is the correct perspective.
However, doctors and educators do not seem to share this strong stance or promote it.
I hope you can provide some guidance.
Thank you.

Fei Pu, 20~29 year old female. Ask Date: 2012/08/09

Dr. Xu Weikai reply Urology

Hello, each case of phimosis is different.
In milder cases, improvement can be achieved with medication.
Using corticosteroids for treatment requires a lot of patience, as it often takes time, and many people give up halfway through.
Of course, if you feel you can commit to it, medication treatment is worth considering.
If there are any unclear points, feel free to ask again for further discussion and research.
Responses on the internet should only serve as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
This message is from Dr.
Hsu Wei-kai, Director of the Urology Department at Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2012/08/09

More Info

When it comes to the decision between circumcision and medication for managing issues related to the foreskin, such as phimosis (tight foreskin) or sensitivity of the glans (head of the penis), it is essential to weigh the benefits and drawbacks of each option carefully.
Understanding the Conditions:
Phimosis is a condition where the foreskin cannot be easily retracted over the glans. This can lead to difficulties in hygiene, discomfort, and sometimes pain during erections or sexual activity. In your case, it seems that you are experiencing both a tight foreskin and heightened sensitivity, which complicates the situation further.

Medication vs. Circumcision:
1. Topical Treatments: There are topical medications, such as corticosteroid creams, that can help in cases of phimosis. These creams work by softening the skin and may allow for easier retraction of the foreskin over time. This approach can be beneficial, especially if you are hesitant about surgery. However, it requires consistent application and patience, as results may take weeks to months.
2. Circumcision: This surgical procedure involves the removal of the foreskin and can provide a permanent solution to the issues you are facing. It eliminates the risk of phimosis and allows for easier hygiene. However, as you mentioned, there are concerns about sensitivity post-surgery. Many men report increased sensitivity initially after circumcision, but this often decreases over time as the glans becomes accustomed to exposure.
Addressing Concerns:
- Sensitivity: If you choose to undergo circumcision, it is common for the glans to be sensitive initially. Over time, the skin will adapt, and sensitivity typically decreases. It is important to discuss this concern with your urologist, who can provide insights based on your specific case.

- Hygiene and Smegma: If you opt for circumcision, you will need to wait for the surgical site to heal before you can effectively clean the area. Post-surgery, maintaining hygiene is crucial to prevent any buildup of smegma (the accumulation of dead skin cells, oils, and other secretions).

- Gradual Approach: The blog you referenced advocates for a gradual approach using topical treatments before considering surgery. This method can be effective, especially for those who are not experiencing severe symptoms. If you feel comfortable trying medication first, it may be worth a shot.
Consultation with a Specialist:
Ultimately, the decision should be made in consultation with a qualified urologist. They can assess your specific situation, including the degree of phimosis, sensitivity issues, and any other underlying conditions. They can also provide guidance on the effectiveness of topical treatments versus the benefits of circumcision.

In summary, both options have their merits and potential drawbacks. If you are leaning towards trying medication first, ensure you follow the treatment plan as directed and monitor your progress. If you find that the medication does not yield satisfactory results, circumcision remains a viable option that can provide long-term relief from your symptoms. Always prioritize open communication with your healthcare provider to make the best-informed decision for your health and comfort.

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