Foreskin Development and When Retraction Is Normal
The foreskin and the glans develop as one structure. Natural separation of the two structures occurs gradually during childhood. The age at which the foreskin becomes retractable differs for each child. It may take until the age of 17 or beyond. This is normal. Forcing the foreskin to retract may cause pain, bleeding, scarring, infection, and adhesions.
Therefore, the foreskin of a child should be retracted only by the child himself when he is ready to do so.
Most indications for circumcision in adults are for phimosis. Other men may suffer from recurrent infections of the foreskin or experience splitting and pain during intercourse. A full circumcision may not always be necessary.
Phimosis
Phimosis is a name given to the condition where the foreskin is unretractable. We must distinguish normal (physiological) unretractability from abnormal (pathological) unretractability. Physiological unretractability of the foreskin is found in nearly all new-born infants, and becomes increasingly uncommon with advancing age. It is not an indication for circumcision.
Pathological phimosis is scarring and obstruction of the opening of the foreskin. This may be found in diabetes, and in a localised skin condition called balanitis xerotica obliterans (BXO), in which the skin is thickened, white, and hard. BXO refractory to conservative treatment may require circumcision.
The medical literature contains many reports showing that some cases of phimosis can be treated effectively by topical steroid applications or by conservative surgery.
Conservative Treatments
Conservative treatments such as steroid creams or by a foreskin-saving operation known as preputioplasty. In rare instances, after all other treatments have failed, circumcision may be indicated.
Where the foreskin is merely tight but not diseased, circumcision may not be necessary, and the condition may respond to gentle stretching, which can be combined with the application of topical corticosteroid cream (e.g. betamethasone valerate 0.05%) 2-4 times daily for 1-2 months.
Short Frenulum
A short frenulum may be the cause of a foreskin not retracting behind the glans, or pulling the glans downwards as soon as retraction begins. If stretching the frenulum fails, as it usually does, it can be freed by a minor operation called a Frenuloplasty.
Ballooning of the Foreskin
You can find additional resources at:
Ballooning of the foreskin while urinating is normal in young boys. It is not an indication for circumcision. Ballooning is a temporary phenomenon that arises when the foreskin begins to separate from the glans. It speeds the process of separation and disappears when the process is complete.
Discharge Information for Patients
The Procedure
This procedure removes the foreskin from the end of the penis. It is a quick operation which is usually done on a day case basis. This means that you will be admitted and discharged on the same day as your operation.
When you have had a general anaesthetic or sedation it is important that you do not drive a car, drink alcohol or handle machinery for 24 hours post-op. You should therefore arrange for someone to collect you from the hospital.
Bathing and Hygiene
About 24 hours after surgery you may bath or shower, allowing the water to soak off the wound dressing. Avoid the use of bubble baths and scented soaps. Dry yourself carefully afterwards.
You may have oozing from the wound site for a few days. Keep penis free from urine as much as possible i.e. dab end with clean tissue paper after each time you pass urine. If the ooze from the wound changes to a yellow/green colour with or without an offensive smell, and/or the wound site becomes very red and sore and this does not resolve within 2 days, you may have a wound infection. You will need to contact your GP or specialist. If you are sent home with antibiotics take the whole course given as instructed.
Stitches and Pain Relief
The stitches are usually dissolvable over 2-3 weeks so will not require removing; check before discharge that this is the case. For a few days after the operation you may experience pain/discomfort at the wound site which may be relieved by taking prescribed/recommended painkillers.
Wearing supportive underpants and loose trousers may aid comfort. It is important to try and avoid having erections until your penile wound has healed. Avoid sex until the wound is healed and you are pain free. This may take up to three months.
You may return to work when you feel comfortable and know that you can cope with the activities that your job entails.
More Information
You can find additional resources at:
Ready to Book or Talk Things Through?
Whether you’re ready to make an appointment or simply have questions, we’re here to help. Call +44 (0) 7746 299 121, email mail@urologyconsultant.co.uk or use the contact form.