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 What is Phimosis?

Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. 

Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction. 

Phimosis is divided into two forms: physiologic and pathologic. Current incidence of phimosis is about 1% in 7th grade boys.

Physiologic phimosis: Children are born with tight foreskin at birth and separation occurs naturally over time. Phimosis is normal for the uncircumcised infant/child and usually resolves around 5-7 years of age, however the child may be older.

Pathologic phimosis: Phimosis that occurs due to scarring, infection or inflammation.

Forceful foreskin retraction can lead to bleeding, scarring, and psychological trauma for the child and parent. If there is ballooning of the foreskin during urination, difficulty with urination, or infection, then treatment may be warranted.

Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common for newborn boys in certain parts of the world. 

Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. In other cases, particularly in parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

Circumcision might have various health benefits, including:

• Easier hygiene. Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.
• Decreased risk of urinary tract infections. The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.
• Decreased risk of sexually transmitted infections. Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.
• Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.
• Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

The most common complications associated with circumcision are bleeding and infection. Side effects related to anesthesia are possible as well.

Rarely, circumcision might result in foreskin problems. For example:

• The foreskin might be cut too short or too long
• The foreskin might fail to heal properly
• The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair

What is a frenuloplasty? 

Frenuloplasty is the release of a fold of skin on the underside of the penis. 

What are the benefits of having a frenuloplasty?

The main benefit is to prevent pain and discomfort on intercourse. 

Key points

•   The frenulum is the band of tissue on the underside of the head of your penis, from below the urethral meatus (opening) to the inside of the foreskin
• If it is tight, it can cause pain during erection or intercourse, and it may tear, causing bleeding and discomfort
• Simple division of the frenulum under local or general anaesthetic is easily performed 
• Reduced sensation on the glans (head of the penis) may occur after the procedure 
• Circumcision may be needed if frenuloplasty does not solve your problems