Foreskin got you down? Common Foreskin Ailments for Men at Any Age
While most people have heard of circumcision, a common surgery to remove a young boy’s foreskin, few are aware that foreskin-related problems may and cause problems throughout a man’s entire life. Depending on the specific foreskin condition, treatments include everything from topical creams, oral medications, such as antibiotics and steroids, as well as stretching exercises and, finally surgery. This editorial highlights some of the more common foreskin ailments that can bring a man down at any age.
What You Need to Know about Foreskin Health and Management
Common Reasons Parents Choose Circumcision
Approximately 50% of boys receive a neonatal circumcision in the first few months of life based on their parents’ personal and/or religious preferences. To be clear, these are not medically indicated circumcisions, and the popularity fluctuates slightly from year-to-year. For those boys who manage to keep their foreskin, conditions may develop subsequently that will require medical attention. This is one of the arguments supporting neonatal circumcision. While the pros and cons have been debated for years, there is no overwhelming benefit justifying neonatal circumcision as routine amongst any pediatric working group, society, institution, or authority.
In early years, the most common issue known as phimosis, occurs if the opening of the foreskin is to narrow. This leads to irritation and urinary symptoms and when more severe can result in ballooning of the foreskin and cause both foreskin infections (posthitis) or urinary tract infection. The initial treatment is to perform gentle stretching exercises with the child at bath time and use some topical steroid cream to loosen the foreskin. If this method fails and/or if the skin starts to harden and scar down, a circumcision may be required. It is important to know that the foreskin does not need to be fully retractile for proper voiding. It just needs to be open enough to allow the urine to pass freely.
Foreskin Retraction and Possible Medical Issues for Boys
Fully retractile foreskins may be considered ideal for sexually active males but the most important reason to be able to retract the foreskin is to allow the urine to be expelled without any hinderance. Every year, as boys age into teenagers, more of them can fully retract their foreskin. There is no age at which point a boy must be able to retract the foreskin fully. However, by 18 years of age, 90% or more men can fully retract.
Sometimes, when a boy retracts his foreskin for the first time it gets stuck behind the coronal sulcus (base of the glans penis) and an emergency occurs known as paraphimosis. The stuck foreskin traps blood in the penis leading to significant swelling of the glans and further strangulation by the snug foreskin. This creates a vicious cycle prevents preventing the foreskin from being manually reduced back into its normal anatomical position. Some paraphimoses can be reduced manually under local anaesthetic or conscious sedation by a doctor and the rest will need a surgical intervention either an urgent circumcision or dorsal slit to decompress the situation. Therefore, some good advice for boys with snug foreskins, is to remind them to reduce their foreskin immediately following their first few full retractions.
Sex and Foreskin Medical Issues in Adult Men
During adulthood, most foreskin issues relate to irritation and inflammation occurring because of sexual activity. There may be other factors at play including poor female lubrication or a snug foreskin. If severe and long term, this condition known as preputial irritation, can progress from small foreskin abrasions to visible skin cracks, bleeding and eventually a thickened scarring fibrosis also known as balanitis xerotica obliterans (BXO). Lubricants and temporary abstinence are the initial treatment options for these men.
The lubricants (e.g. Uberlube, KY Jelly Personal, or Timm Medical Lubricating Gel) allow the foreskin skin to slide better over the glans and also over the vaginal introitus, and abstinence will allow the abrasions to heal.
Some adult men notice their foreskin is specifically tight at the underside at the point called the frenulum. This part, located at the 6 o’clock position, acts like a small anchor for the foreskin. In these men it is too tight and may not only crack or tear but also cause a downward deflection of the glans. For these men, a frenuloplasty surgery can release the frenulum or they may opt for a circumcision.
Foreskin Scaring in Elderly Men
Finally, in elderly men, the foreskin may scar down due to an aging process that is poorly understood although probably has to do with a hormonal phenomenon occurring in the penis. This results in a phimosis and can reduce urinary flow and the ability of these men to void properly. Like the phimosis seen in young boys, it may require a circumcision to allow voiding or to facilitate the insertion of a catheter. While some elderly men are surprised to learn that they need a circumcision as octogenarians, most seem to have a good sense of humour about it, often saying – “Doc, I waited 80 years to have this operation!”
About Dr. George Vrabec, MD FRCSC (Urol.)
Dr. George Vrabec, MD FRCSC (Urol.) is a Urologist and Surgeon with over 20 years of medical experience, currently practicing at Abbotsford Regional Hospital and Cancer Centre in Abbotsford, Canada. He completed his bachelor of arts at the University of Pennsylvania and medical school and urology residency at the University of British Columbia and then went on to do a one year fellowship in Austria focusing on Minimally Invasive Surgery.