BEFORE PUBERTY
Among young children, the main psychological difficulties which the congenital conditions present, is from phimosis resulting in a longer infection (often due to urinary problems) before having an operation. The nature of such disturbances appears to be a conscious one of early embarrassment with possibly a resultant lack of self esteem. Two men had intense memories of disturbing episodes in their childhood, which they thought had been caused by phimosis. The subject requires a deeper study, it is beyond the scope of this essay.

PUBERTY RITUALS
In Europe today, many operations occur once puberty has started. A number of cases have come to my attention. Most of the problems arise simply because boys masturbate, and the rubbing action of a phimosis repeatedly passing over the coronal ridge of the glans, causes soreness, which may subsequently develop into inflammations or infections.
Two men described how due to this process, an infection became so obvious that they were forced to tell their parents. Two more reports without any infection, are of masturbating painfully for five and nine years. One adolescent with adhesions reported consciously avoiding pain, until he was eighteen. All these latter cases experienced pain, or the proximity of pain for several years before they felt confident enough to be able to approach a doctor, or to persuade him to operate.
When it is left to the boy alone to discover by the conscious pain of his first active erections, it means that a considerable percentage of boys who are not routinely circumcised or checked, are going to have a fully distorted first impression of sex and manhood. An absurdly mismanaged and senseless puberty ritual.

THE PERSONAL TABOO
A great number of people have asked me "Why did it take you so long to discover?" To summarise an answer, it is normal and healthy for an individual to avoid pain and difficulty, and people develop habits. From an analytical point of view, this lack of awareness is probably stimulated by uncomfortable experiences previous to puberty, a learned experience of difficulty at puberty, this being reinforced after puberty.

ORIGINS
There are hundreds of different degrees and combinations of these three conditions, some are possibly psychologically harmless, while others are more dangerous. It seems that the imminence of pain from adhesions always leads to their discovery at puberty. The frenulum breve and phimosis are often discovered later. It may be an exaggeration, but one surgeon tells us "men between 20 and 30 years old" - with a frenulum breve or phimosis - "always complain that the operation was neglected in childhood"13 .
In my own case, at the age of eleven when I retracted the foreskin on the erect penis, it sprang forward again, it was uncomfortable, pointless and (when unlubricated) it was painful. I did not question this, I thought this was normal. At the age of twenty eight, after consulting literature on circumcision, I checked myself, I had forgotten the unlubricated sensation of pain at puberty, and on this occasion the foreskin retracted without any pain or difficulty, (and naturally sprang forward again). The idea that my condition was a normal and healthy one, was thus confirmed.
Men with an extreme phimosis apparently never notice any sensation of pain or difficulty, they simply find retraction impossible. In many cases, the individual is not consciously aware of any inability to retract the foreskin, it is simply not desirable.