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12 June 2006
Penis Problems: Phimosis
by Paul A.

On a recent episode of House a Korean man walks into the emergency ward with a hat in front of his crotch. When he removes the hat we see a large bloody stain. It turns out that the man's new bride totally freaked when she saw that he was uncircumcised (South Korea is one of the few remaining countries where infant circumcision is routine). So, eager to commence with the post-nuptials he decided to take the do-it-yourself ethos to a whole new level and perform an impromptu circumcision right then and there with a box-cutter. Presumably his new wife found this LESS upsetting than a foreskin. I didn't finish watching the episode but it got me to wondering; if I had not been circumcised at birth what are the chances I'd have had one as an adult?

Unlike with infant circumcision, no one seems to have gone to the trouble of compiling statistical data on adult circumcision, but with a quick glance at medical websites it's clear that there exists a sizeable medical sub-industry in adult foreskin excision. Guys out there are freely choosing to hive off chunks of their dicks. What the hell for? Well, according to a couple of studies the overwhelming rationale for adult circumcision (75 80 percent) is medical necessity. Now whether removing the foreskin is actually necessary depends on what the medical necessity is. It turns out that the foremost "necessity" is phimosis.

Phimosis, which affects about 1 percent of males, is a condition in which the opening of the foreskin is too small to allow it to roll-back over the erect glans (head of the penis). There is a popular misconception that phimosis refers to any condition where the foreskin doesn't retract but in infancy, and sometimes as late as the onset of puberty, the foreskin naturally adheres to the glans much as a fingernail adheres to the flesh beneath it. Put simply, it doesn't roll back because it's not ready to. In the 19th century many boys were circumcised to "cure" them of what was actually a perfectly natural condition. But when adolescence hits and you're getting an erection every thirty seconds, if the foreskin can't roll back then you've got a problem. The central difficulty is that as the glans becomes engorged it expands against the stricture of the foreskin squeezing the glans and causing pain for both parts.

I've read of cases where the distortion of the glans is such that the pee-hole ends up at a right-angle to the penis. Obviously you don't want to go through life associating sex with pain and ejaculating sideways. In such cases circumcision is definitely the lesser of two evils, but is total excision of the foreskin necessary? Well, that depends on what type of phimosis you have. In most cases, the foreskin opening (inferior preputial ring, for you technical types) can be stretched over time using the following simple exercise described on the NORM (National Organization for Restoration of Foreskins) website.

Use baby oil, Vaseline intensive care hand and body lotion, Nivea or any bland cream as a lubricant. Pull the foreskin forward away from the body several times then pull it back and hold it in the stretched position for several minutes twice daily. When the hole is large enough insert your thumb, or smaller finger if necessary, into the foreskin and grip the glans ( the head of the penis) between finger and thumb. Roll the foreskin over the thumb until the tight ring is white with stretching. Hold it in this position as long as you can at a time - say 5 minutes. Repeat as often as you have the time and enthusiasm for. If later you find there is room for two or more fingers then use them.

Now if it were me, I'd lose "enthusiasm" real quick. In such cases - and if your foreskin is very tight - NORM recommends the use of a specially designed tool called a Glansie to stretch foreskin openings. The simple Glansie ST sells online for $80 bucks. A hands-free model (Glansie DX) sells for $100 (well worth the extra $20 I would guess), and for the two of them together you pay $130; though why anybody would need two is beyond me.

Now keep in mind that NORM is all about restoring foreskins. That means foreskins are real important to them and anything is better than hacking one off. You may not be quite so attached to yours, but it's probably worth paying the $100 just in case. Hell, for an extra $30 you can get one for a friend.

The situation is different if one suffers from BXO phimosis. BXO (balanitis xerotica obliterans, for you technical types) is a skin disease that affects both men and women. In men, it's manifested by a ring of hardened tissue with a whitish color at the tip of the foreskin. It is this hardening of the tissue that prevents retraction of the foreskin and also prevents stretching as a means to overcome it.

BXO can be serious. It can cause urethral constriction and a resulting retention of urine which has its own gaggle of complications. It can also lead to the growth of malignant tumors although this is rare. Bottom line: it must be dealt with. The traditional remedy, of course, is circumcision and it's likely the one the doctor will recommend. But if you treasure your foreskin there are alternatives. Doctors and researchers have been throwing everything imaginable at the problem. Corticosteroids, testosterone propionate, clobetasol propionate, and tacrolimus are just a few of the topical ointments that I've never heard of that have proven effective in treating BXO in clinical trials. More recently, laser surgeons have been successful in vaporizing the BXO lesions with carbon dioxide lasers. Chances are though, if your doctor doesn't have a CO2 laser in his office, you'll be going under the knife.

The same goes for a related condition called paraphimosis. This is where the foreskin is able to retract, but is too tight to roll back down when the fun is over. If left too long like this the glans can swell up causing the foreskin to be trapped. Infection sometimes follows and the tissues become inflamed making the situation even worse. But circumcision is not necessarily required as a treatment for this condition. Doctors will sometimes treat the swelling first by compressing the penis with tight bandages and then pulling the foreskin back over it. Another method is to make a small cut in the prepuce to loosen it sufficiently to pull it back down. Neither makes for a good end to a hot date and if it happens on a regular basis you're gonna want to make a date with a surgeon.

Recurrent infections are another reason why men get circumcised (10 percent). I know a man who had himself circumcised at thirteen because he just "couldn't take it any more." But a further 10 to 15 percent get circumcised for no medical reason at all. Why anybody would hive off one half of the erogenous tissue on their penis - just for the hell of it - is a subject for another week.

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