[ ARC forum 2 ]

Answers! But more questions.

Written by Paul B. at 28 Jan 2002 11:25:24:

As an answer to: Just a few questions. written by Jake at 28 Jan 2002 02:56:34:

Hello Jake.

> ive got 'pinhole phimosis' judging by most of the information i have researced

Well, that's a rather graphic term. Perhaps you could explain how much of a "pinhole" it is, firstly by whether your foreskin balloons when you pee, and secondly and in reference to Jim's suggestion, with how large an object can you probe the opening, for example a biro with a smooth rounded end, a large biro with a smooth rounded end, the capped end of various felt-tip marker pens or what? The way to get these into the foreskin, either simply to try, or as he suggests, to use as a stretching device, is to pick up the tip of the foreskin on either side between fingers and stretch it forward and outward while (with your third hand! ;-) you carefully slip the cap in the opening. If you need lubricant to help it slip, olive oil would be suitable and easy to find.

> and at the moment i am unsure of what to do.

Well, I'm glad to see you realise there is no hurry in the matter. A few other questions you might answer to help clarify your situation; perhaps your actual age as a "teenager", whether this has caused you any difficulty in masturbation or in fact whether you have had any other sexual activity, and whether it causes you any discomfort?

If you read down on this forum (and you should), you will notice a few characters that are going to jump into this discussion, and they will have much to say about "urgency", discomfort, and the need to see doctors and the desirability of surgery, so it will clarify things if you can mention these matters before they start in the fray!

> I have probably had this condition for a few years now.

Have you ever not had it? Did in fact, your foreskin ever retract back over your penis head so you could see it? I suspect not, and it is unfortunate that your parents did not teach you to pull it back from an early age.

> Since then it has gradually narrowed to what i assume is pinhole phimosis and has remained this way for a while.

Well, if you can quantify it - specify the diameter of whatever object you can (sensibly) fit through the opening, not only can we get an idea of the problem, but you will have a way of judging progress, whether improvement or not.

> I have seeked a doctor ... he said that it would just go away by itself (i dont think he knew what it was),

Possible that he didn't - regrettably he is probably circumcised himself and not too knowledgeable on such things. However current teaching by paediatric surgeons is that the foreskin may even though tight, become retractable due to growth at puberty. The "catch" to this is that boys still need to actually make a point of pulling it back, need to know that this is important, and that this applies during the active growth time of the penis. If your penis is in fact fully grown, than that easy possibility becomes much less likely.

> and it hasnt gone away.

Then I'd say you definitely need to do something about it.

> I dont know how to tell my parents that this "complication" hasnt gone after this long

Well, you probably don't have to mention it, because you shouldn't need to see a doctor, though if you do use ad-hoc "dilators" to wear as we suggest, it may come to their notice by accident.

> i dont know what treatments theyd offer here in australia.

Well, there is a tendency that if you complain about it to a doctor, that they do what they know, and that's proceed to a circumcision (which would involve a referral to a General Surgeon). The thing is, most chaps who have this problem don't consider any alternatives, and circumcision is a pretty standard procedure so the doctor offers it, the patient accepts it, and it goes ahead without evaluation of relative merits.

The other alternatives are

To some extent this has always been a pragmatic approach for anyone who simply saw the problem as the skin being too tight (narrow) and set out to stretch it, and if it was only a little tight, managed it fine and thought no more of it. On the other hand, there is a tendency to see some situations as "too tight" for this to work.

What has happened however over the last fifteen years in medicine, is the realisation that slow, continuous stretching of skin can be used to achieve almost any degree of expansion needed and given that the foreskin is as it were, designed to be stretched, then even a "pinhole" phimosis can be stretched.

If you run a Google search on "Tissue Expansion", you will find many references such as this site which itself quotes a medical (research) article explaining the use of tissue expanders implanted under the skin. Fortunately, the problem of a tight foreskin can be solved by stretching devices which do not need to be put under the skin, but merely into the foreskin opening that you want stretched.

As in the article I mention, you can do this either intermittently (the article mentions a "quick stretch" as a surgeon might use during an operation, whereas you are in a position to do the stretching repeatedly over days and weeks) or by wearing the device much of the time (say, all waking hours) which will achieve quicker success with less actual time spent doing the stretching (you insert a dilator, and just leave it there - if it is hollow, you can pee without removing it).

So that is what we are recommending. There does not appear to be any device (it would have to be a set of progressive sizes) marketed for the purpose in the English-speaking world (we know of devices marketed in Japan - see elsewhere on this message board), so you generally have to figure out your own, and the three most useful ready-made plastic objects appear to be the caps from the pens I mentioned earlier, and small pill bottles and film canisters. So some ingenuity is involved.

> this topical cream? would it be available here? cost? and is it just 'over the counter' medicine?

The preferred form in my opinion is Betamethasone 0.05% ointment (Betnovate 1/2, Celestone V) or the same strength of Triamcinolone (Acetonide, as Aristocort). It is useful but you must note it does not cause the skin to stretch, it just makes it stretch more easily when you do the stretching. It requires a doctor's prescription and is covered by the NHS (one 15g tube should be plenty for this purpose, but the script allows for one repeat).

> Also just out of curisotiy i was wondering what are the stats for this condition? 1 in ?,

Don't know. You see, the foreskin nearly always looks like this at birth, so it undergoes a progressive stretching during childhood growth and the fraction of boys who cannot retract depends on age and education. Boys should be taught as soon as out of nappies, to pull it back or try to, often and if they can, to do so whenever they pee. If they are so taught, then this condition becomes rare. If however it is ignored, and they are shamed about their genitals, they may well not understand the need and desirability of doing this, and as I suspect, this is what has happened to you.

> it just seems that it is a very hard condition to find useful info on which doesnt contradict something else.

Please understand that men who were either circumcised at birth, or in adulthood because of some problem (often psychological) that they were not able to deal with otherwise, quite likely for lack of reliable information, become very keen to justify their circumcised condition as the only one possible in their circumstance, and by their way of implication, the only possible approach to any problem they deem similar. And you will meet such people on this forum. Their enthusiasm to see benefits in circumcision and to claim that the stretching process "doesn't work", at least "sometimes", leads to that contradiction that you have noticed.

> Finally; if i leave this untreated what may happen?

A good question!

Well, a properly retracting foreskin makes virtually all forms of sex (that is: masturbation, manual and/ or oral stimulation by a partner or intercourse - various) much easier and better controlled. Nevertheless, just as men manage to have what they consider an (entirely!) enjoyable sexual expression though circumcised, those with an unretractable foreskin do also. The glans (penis head) automatically adjusts its sensitivity to the (persistent) circumstance for all those sexual activities and the foreskin is obviously no bar to ejaculation and impregnating a spouse. So if you did nothing, all that would happen in its own time.

You might be more inclined to get infection or irritation under the foreskin, but if it will not retract, the things that cause these conditions are less likely to get in either, which tends to balance things out. The space under the foreskin becomes little different to the urethra (urine tube through the penis) - anything that tries to get in is washed out again.

There is a concern about penile cancer - something so uncommon you undoubtedly have never heard of someone you know, having it; unlike breast, lung, skin or prostate cancer - but largely in connection with sexually transmitted disease and other irritations of the penis head associated with poor hygiene. So this need not figure greatly in your reasoning.

And finally, you would never know the advantages of a mobile foreskin for sex!

So, how about those questions I asked to begin with?


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