Conservative Treatments

Last Updated 12/23/2022

Alternative Treatments to Circumcision

According to NORMUK estimates, at least nine out of ten patients having circumcisions in British hospitals shouldn’t be there. Common foreskin issues can be treated conservatively and without surgery, which is significantly simpler, less expensive, and less likely to injure the patient permanently.

Unfortunately, a lot of physicians are not aware of this. Others aren’t concerned about keeping the patient’s foreskin for ethical, sentimental, or even practical reasons.

Doctors should stay current and make sure that any judgments about invasive procedures are supported by the best available research.

Therefore, it would be immoral and wrong to circumcise for therapeutic purposes when medical research has proven that other treatments are at least as effective and less invasive. [The law & ethics of male circumcision – Guidance for Doctors, BMA, March 2003]

Stretching a tight foreskin

By consistently stretching twice daily, the vast majority of tight foreskin can be sufficiently loosened in about a month.

Start by warming the penis if at all possible. Use any plain cream as a lubricant, such as baby oil, Nivea, Vaseline intensive care hand and body lotion, or Vaseline.

The foreskin should be pulled many times forward and away from the body, then it should be pulled back as far as it will go onto the glans (head of the penis), where it should be held for several minutes. Stretching will be significantly more beneficial if done while having an erection. Do this multiple times per day.

Roll the foreskin forward over the glans and thumb when stretching causes the head of the penis, known as the glans, to become visible. resulting in a bigger platform for stretching. As long as you can, hold it in this posture for a period of time, let’s say 5 minutes. You’ll want to apply the same type of mentality that you would when using a penis pump, don’t push your luck!

Repeat as many times as you have the energy and time to. Later, you’ll discover that the foreskin’s tight ring can be stretched even further by inserting two or more fingers there.

The glans is frequently uncomfortable to touch when first exposed. You can treat this by purposefully manipulating it underwater and often switching grips. It will eventually stop being so tender and return to normal sensitivity.

A short frenulum, also known as a banjo string or the tongue of skin in the midline beneath the glans, may be found to be preventing further foreskin retraction. This condition is known as a frenulum breve and can be treated with a minor procedure known as a frenuloplasty under local anesthesia.

When the foreskin becomes lax enough for paraphimosis to occur yet tight enough to make it challenging to draw back forward, take care to prevent doing so. If you don’t bring back the foreskin to cover the glans, get medical help right away.

Every time you urinate, make an effort to retract your foreskin.

Development

As one structure, the foreskin and glans grow. During childhood, there is a gradual natural separation of the two structures. Every child has a different age when the foreskin starts to retract. A 17-year-old or older age limit may apply. This is common. It’s possible to experience pain, bleeding, scarring, infection, and adhesions if you force the foreskin to retract. Thus, a child’s foreskin should only be retracted by him or her when they are ready to do so.

Steroid Creams

If after a month no noticeable improvement has been made, steroid creams should be applied next. You require Betamethasone 0.05% cream, which is available in 30 G tubes. It is offered as Diprosone in the UK. You must approach your doctor for a prescription because it is a medication that is only available by prescription.

For at least a month, the cream should be used inside and outside to the tight area of the foreskin while also stretching. It may become clear that the frenulum is preventing retraction when the foreskin thickens. This can be fixed with a quick procedure called a frenuloplasty that is carried out under local anesthesia.

Preputioplasty (Dorsal Relieving Incision)

Any tight foreskin that has not responded to stretching or steroid cream administration should be able to be treated with a preputioplasty. In this procedure, the tight ring preventing foreskin retraction is cut through in an upward and downward direction, and it is subsequently closed in a crosswise way.

The foreskin may typically be fully retracted when this has healed (2–3 weeks), and the only visual alteration is a notch that appears in the skin as it is retracted. Ascertain with your surgeon how much of the foreskin you will allow him to cut through.

Short Frenulum

A foreskin may not retract behind the glans or may pull the glans downward as soon as retraction starts if the frenulum is too short. A small procedure known as a Frenuloplasty can be used to release the frenulum if stretching it fails, as it generally does. A local anesthetic can typically be used to achieve this.

Ballooning of the Foreskin

A typical stage of growth in early childhood can include the foreskin ballooning while urinating. It does not suggest circumcision. The foreskin begins to detach from the glans, which is when ballooning, a transient phenomena, first appears.

It expedites the separation process and vanishes once it is finished. Ballooning of the foreskin can also be a symptom that you’re using a penis pump too frequently, or binging multiple sessions for a long duration. Avoid doing this, always remember that it’s a marathon and not a sprint.

Phimosis

The unretractable foreskin condition is referred to as phimosis. It’s important to distinguish between normal (physiological) and abnormal (pathological) unretractability. Nearly all newborn children have physiological foreskin unretractability, which becomes less prevalent as they get older. It does not suggest circumcision.

Scarring and occlusion of the foreskin’s aperture are symptoms of pathological phimosis. This is uncommon and can occur with diabetes, lichen sclerosus, which affects the skin locally and is also known as “balanitis xerotica obliterans” (BXO) when it affects the penis.

The skin is rough, white, and thickened with this disease. When lichen sclerosus of the foreskin is refractory (unresponsive) to conservative treatment, circumcision is an option. However, lichen slerosus outbreaks elsewhere on the penis cannot be treated or prevented by circumcision.

Numerous findings in the medical literature demonstrate that topical steroid applications or conservative surgery are successful treatments for the majority of phimosis cases.

Less than 2% of intact males have “true” phimosis, which is more accurately referred to as “preputial stenosis” because “phimosis” has acquired so many diverse definitions that it is now meaningless.

85 to 95 percent of these 2% will respond to topical steroids. If they don’t respond to this, at least 75% of them will respond to stretching done manually or with a balloon under local anesthesia. Later in life this can result in a loss of erect penis girth.

The math is straightforward: Preputial stenosis may require surgery in 7 boys out of every 10,000. It makes sense why the Canadian Paediatric Society considers circumcision to be “obsolete”! [What is ‘phimosis’?, Van Howe R, CIRP]

References

1 – What is ‘phimosis’?, Van Howe R, CIRP (further references on CIRP page)
2 – Rickwood AMK, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ 2000;321:792-793.
3 – Sivakumar B, Brown AA, Kings L. Circumcision in ‘buried penis’ – a cautionary tale. Ann R Coll Surg Engl. 2004; 86(1):35-7.

Medical professionals should also refer to the Phimosis Clinical Guidelines page and accompanying references.