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Tuesday, July 3, 2007

Phimosis: The Ins and Outs of a Difficult Foreskin

Yesterday I was talking with a female colleague whose brother just had an adult circumcision due to phimosis. He was sad about the change in his sensation and frustrated that he could not choose another path to solving his problem. Unfortunately, his case (which developed in adulthood — a rare phenomenon) did not respond to some nonsurgical approaches.

What is phimosis, you might be wondering? It is the inability to retract the adult or late-adolescent foreskin of the penis because the opening is too small or adhesions (abnormal tissue attachments) have formed.

Before listing treatment approaches, it is useful to know how the foreskin functions. It is normal for the foreskin to adhere to the glans (head) of the penis at birth. It is attached with a membrane called synechia which is similar to the membrane that attaches finger nails to the nail bed. In fact, only about 4% of male babies are born with retractable foreskins. Normal bathing of the penis with water and mild soap are generally sufficient to cleanse the penis of newborn males and children.

Many people view this normal condition in children as phimosis and mistakenly attempt to force the foreskin back. This can cause harm and lead to the formation of lesions and the condition called acquired phimosis. The synechia is made up of specialized cells that will totally disappear in all but a few cases by age 17.

When puppies and kittens are born with their eyes shut, we allow nature to take its course rather than forcing their eyelids open. Foreskins develop similarly. In fact, foreskins and eyelids have a great deal in common in the protective function they serve. In cases of injuries during World War II (where some soldiers’ eyelids were destroyed by fiery explosions) the foreskins of these men were used to surgically form new eyelids for them.

In some cases, medical attention will be needed to deal with this tissue to finish what nature did not. My colleague’s brother was not one of those individuals, but before a man opts for adult circumcision he should try some gradual approaches first.

Here are the instructions: Try stretching the foreskin with fingers. Do this either in a bath or while using lubrication when the penis is flaccid (unaroused). If there is enough opening to insert the tips of the smallest finger on each hand, do so and gently stretch the opening outward. If that is not yet possible, lightly pinch the foreskin between the thumbs and index fingers at the opening and stretch it from the outside. Over time (possibly weeks or a few months) there may be enough improvement to allow the foreskin to retract sufficiently over the glans of the penis.

One can also consider minor surgical approaches. The first involves creating a slit in the foreskin when it will not stretch sufficiently. Some people do not find this solution aesthetically pleasing. Second, some plastic surgery techniques are being developed to expand the opening of the foreskin without removing it entirely. Ask physicians for information about these surgical options.

If a man wishes, of course, he may decide to have a complete circumcision, that is, the removal of the entire foreskin. While circumcision is performed on nearly 50 percent of newborn American males, in most other countries around the world it is fairly rare. I was quite happy to read recent data that indicated that California, my home state, had a circumcision rate of 21% in 2004, the most recent year for which we have data. A billboard in Florida succinctly summarized my feelings about the circumcision of newborns: a foreskin is not a birth defect.

If a man’s foreskin will not retract, it may be uncomfortable to have a full erection no matter whether his sexual partner is a woman, a man or is stimulating himself. So, regardless of one’s desires or plans regarding a sexual partner, in order to have the option of a full sexual life, I recommend that a man patiently and steadfastly tackle this problem before opting for circumcision.

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Technorati Tags: phimosis, penis, foreskin, circumcision, mens health, health and wellness

Posted by: WebMD Blogs at 2:40 pm

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