This site discusses phimosis in its specific forms of phimotic ring, frenulum breve, adhesions or skinbridges. My concern is the early prevention of phimosis. The late correction of adult phimosis was never my interest. My belief is that once the medical profession realise the need, they will develop hundreds of new methods of treatment which I cant even imagine ... Therefore treatment is purely an appendix on this site, however, because I have no specific bias, my research allowed a rare objective survey of the many posibilities.

This site offers detailed information on individual problem related treatment, often advising simple, cheap, minimal and specific surgery and time honoured solutions taken from traditional methods including partial circumcision, dorsal slit and frenular incision and tying. - (Links are given where appropriate to sites dealing with the modern solutions of preputial plasty and full-circumcision).

THE APPROPRIATE TREATMENT
OF PHIMOTIC RING


The Condition: Phimosis

The causes of phimosis are as individual and varied as the treatment

Following Dr. O.J. Clemmensen's findings, this simple practical "rule of thumb" conclusion is suggested:

1) If the subject has a primary or congenital phimosis, i.e. ever since he can remember, then there is every reason to believe that gentle stretching will mobilise the elastic capacity of the skin tissue.

2) If on the other hand he can remember the phimotic ring developing then it is most probably a secondary phimosis of a lichenoid or fibrous type, such types are atrophic (prone to degeneration), they will generally be difficult to stretch. Clobetasol Propionate and other steroids may help, but recurrent problems require surgery.


Circumcision remains largely unquestioned as the treatment for phimosis. Circumcision is the oldest routine operation. This operation is the foundation stone of surgical history and its tradition in Western medicine. However, in the modern world a full circumcision is usually performed, whereas the origional traditional operation was a partial circumcision or dorsal slit, and these are usually fully sufficient and effective treatments.

I believe Clemmensen's study is a revolutionary step in the history of the treatment of phimosis, this study establishes a scientific basis and medical indications for an individual approach to phimosis treatment, ... as is appropriate for our culture.

Diagnosis and Appropriate Treatment

Please firstly accurately diagnose the physical appearance of your condition: check under Phimosis Research that yours is the typical sort of phimotic ring. (With the "monotonous clinical appearance" of a thin strip of tight tissue which is embedded in the inner foreskin). Contact me or the forums if this is not the case.

Following Clemmensen's findings, some forms of phimotic ring will stretch, others will not.

To understand this subject, it will help to understand LSA: 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

(Clemmensen distinguishes at least 3 forms of this ring) At times a simple primary phimotic ring can degenerate to a "fibrotic" ring --- By stretching what we're doing is making elastic, and reversing this atrophic (degenerative) process.

From what I've heard a primary phimotic ring doesn't vanish, once stretched it needs stretching every couple of days ... but you'll find it gets easier to stretch, ... its on the way to regenerating ... (more from this explanation)

Therefore:
1) If the subject has a primary or congenital phimosis, i.e. ever since he can remember, then there is every reason to believe that gentle stretching will mobilise the elastic capacity of the skin tissue.

2) If on the other hand he can remember the phimotic ring developing then it is most probably a secondary phimosis of a lichenoid or fibrous type, such types are atrophic (prone to degeneration), they will generally be difficult to stretch and require surgery.

2 i) A fibrous type of ring develops often around the age of 70, but can ocurr anytime after age approx 24 yrs - stretching with betamethasone may help.

2 ii) There is the possibility of a lichenoid phimosis which we can assume is a pre stage of LSA. If there is an infection present, this will almost certainly be LSA (also called balanitis). The classical manifestation of LSA are scar like ivory coloured patches located on the glans.here, stretching with Clobetasol Propionate may help

METHODS OF TREATMENT

Stretching
Stretching is an effective treatment for primary "simple" phimosis. This must be understood as a temporary measure, however the daily stretching may become an enjoyable pastime and it becomes easier to stretch. Various methods are reported. Please see Stretching - Please note, for children stretching exercises and experiments with creams and steroids can be far more disturbing than surgery.

Steroids
The use of Kenalog, Betamethasone and Clobetasol Propionate are recently reported to have considerable success - even without stretching. - If you wish to experiment on the frontiers of skin regeneration - please see Betamethasone

SURGERY
Dorsal Slit - (non-amputative surgery)
There are at least two operations which are referred to as dorsal slits (dorsal meaning top side). The traditional dorsal slit is probably the simplest method of alleviating the restriction; modern "plastic" options are also discussed.

Circumcision and Partial Circ.
For some men full circumcision is an attractive choice of treatment. A full circumcision is also the least problematic form of treatment simply because it is easily available and doctors are familiar and experienced with a number of successful methods. For the treatment of a phimotic ring a partial circumcision (sometimes mistakenly called "loose circumcision") is all that is necessary and thus an important option. This will involve a little persuasions talent with most doctors, takes around ten stitches, and will provide a satisfying answer for most men. For variations on this theme, please see circumcision. and post. circ problems

Degree of Phimosis related to Treatment
Full Phimosis where the foreskin is fully unretractable when either flaccid or erect. - (An operation would probably entail a partial circumcision).
Partial Phimosis when erect retraction will reveal most of the glans, but the band of tight skin will hinder complete retraction. When flaccid retraction of the foreskin with this degree of phimosis will reveal the hourglass effect. - If operated to release enough loose skin a miniature dorsal slit probably suffices.
Relative Phimosis is invisible and unnoticeable when flaccid, will cause difficulties by retraction and the hourglass effect when erect. - To allow free retraction an operation requires only 4 or 5 mini Z plasty slits.

LSA
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. Cleanliness and regularly wearing the foreskin retracted are probably the simplest methods of preventing lichenoid conditions from developing in the first place.
Please see Lichen Schlerosus Index for the latest experiments and maybe success with conservative non-operative treatments - (including homeopathy)

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EXTRA NOTES
Wait and See What Happens
Øster's advice has been misinterpreted, exaggerated and widely accepted. Boys and men often report that they were advised to wait and see what happens. This most useless piece of information was even given to my father at the age of 76. - (Øster checked and educated his boys every year for 7 years - His study does not show the effects of "normal development" it shows the effects of checking and educating for 7 yrs!)

Diferent Perspectives and Individual Wishes
 Boys who are consciously aware of difficulty by retraction often want a circumcision, (and they are often dissuaded). If a boy wants a circumcision then he should certainly have it - even if his phimosis could be treated with less severe measures. On the other hand with late operations on childhood conditions where the glans has never previously been exposed, men can be extremely disturbed about the idea of losing the foreskin, simply because it is all they`ve ever seen or identified with their manhood. (more on different perspectives). and they do not realise that there is any other cure except circumcision.

A word of practical caution is also necessary about adult operations. Adult post circ. problems - I would always advise that any adult who has never previously exposed the glans, attempt stretching and then at all costs attempt to find a urologist or surgeon who will first perform minimal surgery (a dorsal slit or partial circumcision).