As an answer to: Husband Problem written by W at 04 Jun 2005 15:34:29:
Hi W,
Gosh I am sorry to hear of your husbands ill health, indeed he has been unlucky. It is difficult to be precise about your husbands condition since it is obviously more complex than most of the accounts we hear. However you appear to have come to your own conclusion that your husband has been wrongly diagnosed with the condition Non-Specific Urethritis (NSU).
The most important indicator to the nature of your husbands condition is whether or not it has developed over time or whether he has had the problem since birth. Your suggestion that he may have a short frenulum (Frenulum Breve) is only likely to be correct if he has had problems with ripping and bleeding during sex for most of his adult life. I cannot determine from your description whether the ripping and bleeding is coming from the frenulum or not. Consider this description of the frenulum to try to determine this, 'The frenulum is similar to the joining ridge under the tongue, a small sheet of skin underneath the glans which joins the glans to the foreskin' So it is a thin piece of skin attached to the V shaped groove on the underside of the glans. Does this sound like the area he experiences bleeding? I am not aware of frenulum breve developing over time and that is why I say that it is unlikely to be frenulum breve if he has not experienced the symptoms for most of his adult life. It would also surprise me that a short frenulum was not identified at an earlier stage given your husbands previous medical history and close contact with a Urologist for many years.
It would appear to me from your description that your husband does indeed have a phimotic ring and phimosis is characterised by the presence of a phimotic ring (i.e. 'a thin contour of tough skin tissue which branches out from underneath the penis and curves round over the front of the inner foreskin, like a noose') Additionally 'the phimotic ring is by nature less elastic and expands relatively less than the rest of the foreskin, so any difficulty with retraction when flaccid is magnified when erect' .
Assuming that your husband does have phimosis, the usual treatment for the condition when present from birth is stretching with steroids for a temporary relief of the symptoms or a partial circumcision for permanent relief. However it sounds likely that your husband is suffering from some type of infection which is causing a phimotic ring to develop around his foreskin. Most commonly phimosis which develops later in life is either caused through a degeneration of the elasticity of the foreskin simply due to old age or as I believe in your husbands case it is caused by Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus et Atrophicus (LSA). BXO or LSA is characterised by 'The glans demonstrating sclerogenous ivory colored patches located perimeatally'. Does your husband have any ivory coloured patches located anywhere on his penis?
Basically BXO or LSA often results in the development of a secondary phimotic ring. Unfortunately 'Infections develop easily in the humid almost subtropical preputial zones and require dry surroundings to heal. The only safe recommendation if an infection has developed is to recommend a full circumcision'. I suggest that maybe this is why your husbands Urologist has recommended this course of action. The likely reason that the antibiotics have not helped is that 'LSA is not an infection in the viral sense, it is an immune reaction'.
To understand LSA more consider this passage, 'lichen sclerosus atrophicus... Lichen means some sort of mixture between fungi and algae, sclerosus means scarring, atrophic means degenerative, --- it seems simple phimotic rings stretch, but when they are connected with "degenerative fungal scarrings" (LSA) they don't'.
Interestingly and possibly relevant to your husbands previous Urethra Stricture, 'Most strictures of the external urethral meatus are associated with BXO or LSA' (See https://www.london-urology.co.uk/penile%20problems.htm ). It may be the case that your husbands Urethra Stricture was not around the meatus and entirely unrelated but it is an interesting link between the two.
The only part of your description which makes me momentarily doubt my opinion is the bleeding during sex. I am assuming therefore that the reduced elasticity of the skin surrounding your husbands penis caused by the infection is resulting in cracking and bleeding during intercourse. However it should be noted that diagnosis of BXO or LSA is by the presence of white patches as discussed above.
If my suggestion is wrong and your husbands Urologist informs him the the circumcision is to treat frenulum breve then I must advise you that a circumcision is the wrong treatment of that condition. A much more appropriate option is available to treat a short frenulum known as a frenuloplasty (see https://www.male-initiation.net/frenulum_treatment.html#start ). Your husband should be encouraged to press this issue with his Urologist. Additionally it will be of benefit to discuss the reasons for your husband allegedly requiring a circumcision with his Urologist on your next visit to the hospital. It may be the case that your Husbands urologist already considers that your husband is suffering with BXO but did not want to worry him with the specifics of the condition.
I hope this helps, if you have any more questions you would like to ask feel free to E-mail again and in the meantime keep checking out the forum.
