[ ARC forum 2 ]

Two steps forward, one back.

Written by Paul B. at 24 Nov 2002 03:21:45:

As an answer to: doubts and treatments available over the counter (in the UK) written by Val at 23 Nov 2002 15:03:53:

> I get the impression that when I do my stretches and have the impression that it's done something, the following time I do them it seems to me like my foreskin is even tighter than it was before I started. I don't know if this is a normal reaction

Well, performing the stretching may indeed cause a little bit of tissue oedema (swelling) as it puts stress on the tissues. The "classical" demonstration of this is to scrape a fingernail down your forearm - you get a white stripe which (if you scraped firmly, but not necessarily painfully) turns red and then becomes raised as histamine (the stuff which makes your nasal membranes swell when you have a cold or hay fever, and which you treat by taking antihistamine tablets) is released. This is called a "Wheal and flare" reaction to tissue injury.

In this case however, the injury is not substantial, and the swelling reverses in due course, even if not quite by your next "session". In other words, yes, it may be tighter afterward, but is not going to cause damage, or scarring, in case anyone proposes that (as they have in the past) - any more so than your nose is scarred from the common cold.

> because in the beginning the foreskin tends to return to its normal size and therefore tightens a little, but it certainly isn't reassuring...

I trust that once you understand the process, you will be reassured.

> Also, if anybody is interested, the hydrocortisone cream I'm using is actually available over the counter. The doctor prescribed a 30mg tube but the chemist was out of those so offered me the 15 mg tube which is actually available without prescription. The name of the product is Cortopin. I hope the fact that it is available without prescription doesn't mean it is completely useless.

Here (Australia) for example, you can get 0.5% hydrocortisone "over the counter", often combined with other agents, but 1% on script. If you were to seek more, you should use the ointment - but if you followed my previous instructions, you will realise that whatever you use, the amounts are so small if used properly, that you will not be seeking another tube.

> I'm also wondering if I should insist with my doctor to be referred to a urologist. She doesn't seem to be in the know about this type of treatment.

Please understand that a referral to a urologist, is a request for surgery. There is little about urology that is non-surgical. The urologist is not a specialist so much because he knows more about urology (though that will necessarily be the case - in specific areas), but because he is trained, authorised and equipped to practice surgery.

In terms of non-surgical treatments, a competent General Practitioner should (but indeed, there is a wide range of expertise) be able to determine and undertake most of them.

In short, a urologist is quite unlikely to be able to assist you with stretching, because few people who are referred to him expect that approach - most anticipate surgery rather than something which requires their active participation - such is the common view of "medicine".

And much the same applies at the GP level - people who know about stretching, tend not to ask doctors about it. Stretching is largely self-motivated and self-directed, through self-help groups such as NORM. As Jim (the "real" one) is prone to comment on these fora, few people go and discuss their body-building program with their doctor, unless perhaps they already know (by word of mouth) that to be his specific interest.

> Better than the other doctor ... who had never heard of the use of topical steroids for the treatment of tight foreskin and said I should bring in the articles I got off the internet.

Well, that sounds promising anyway - Did you actually show them to him?

> I'm not British and I'm always surprised at the tendency in this country to assess you at GP level instead of referring you to a specialist and, to make things worse, GPs are often reluctant to actually visit you.

Then you entirely misunderstand the nature of medical practice. A GP should refer people to specialists when he knows that the specialist able to execute treatment for the condition where he is not. This does not automatically imply that the GP is ignorant of the condition and its treatment - referral may occur on this basis, but is surprisingly (to you perhaps), not the norm.

If however, the GP knows that the specialist does not have expertise in the particular area, then referral to that specialist is inappropriate and in your case, this is true. If what you want is a circumcision, then you go to a specialist, and if you do not, you do not!

And since you mention it, when have you ever heard of a specialist coming to visit you, and however is that relevant?

> To answer your question, no, my doctor didn't actually ask to see my foreskin relying solely on the information I was giving her which seemed OK at the time,

But it does indicate on the one hand, a deviation from correct medical practice - it is not at all uncommon to find that a patient's description of the situation - however intelligent they appear and genuine their motivations - is far from accurate, and in particular that there is some absolutely critical aspect they omitted to mention as they did not see its significance. And it also implies a certain lack of diligent interest in your problem.

> considering that the nurse kept walking in and out and was making me a little unconfortable.

Well, either you were getting the most "budget" standard of medical care (as I suspect you were - there really is no reason a nurse would enter a private consulting room without invitation), or the nurse was there for a reason - an anxious doctor perhaps. If one presumes the latter, do be advised that though plenty of pornography you find on the web fantasises sexual liaisons between nurses and patients, such things are incredibly rare in practice - display of your genitals is most unlikely to be of any amusement to a nurse at all.


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