A white, inflammatory scaring condition called BXO can also develop in congenital tight foreskin in adults.

The Association Between Phimosis and Balanitis Xerotica Obliterans (BXO) 

Phimosis, a condition characterised by the tightening of the foreskin, leading to difficulty in retracting it over the head of the penis, can appear at birth (congenital) or later in adult life (acquired). This blog also discussed the correlation between acquired tight foreskin and balanitis xerotica obliterans (BXO), also known as lichen sclerosus et atrophicus, a chronic inflammatory condition primarily affecting the genital area. 

Correlation Analysis of Phimosis and BXO: Notably, the association between acquired phimosis and BXO is more pronounced than congenital phimosis. BXO is identified as the primary causative factor for acquired phimosis in both adults and children. The inflammatory nature of BXO triggers scarring and constriction of the foreskin, consequently resulting in diseased and acquired phimosis. While the relationship between congenital phimosis and BXO is less explicit, BXO can also be present in cases of congenital phimosis. 

Significance and Treatment Modalities: The heightened risk of BXO linked to acquired phimosis underscores the critical importance of timely diagnosis and effective management. Early intervention for BXO is paramount in averting complications such as extensive scarring and urethral stricture. 

Treatment approaches vary based on severity and aetiology. In milder instances of acquired phimosis, topical corticosteroids and non-surgical interventions may be required. Surgical intervention, particularly circumcision, may be warranted in severe cases of phimosis or BXO, particularly when they pose significant discomfort, impede hygiene, or disrupt sexual function. 

Recent Study on BXO and Phimosis: A contemporary study sought to enhance our understanding of the correlation between BXO and phimosis. Histological analysis of tissue samples from 120 subjects who underwent circumcision for phimosis was conducted. Findings revealed a substantial presence of BXO, with 45.1% of subjects with congenital phimosis and 62.3% with acquired phimosis manifesting BXO. This data strongly indicates a robust association between BXO and acquired phimosis. 

Key message: The study distinctly underscores a robust correlation between BXO and acquired phimosis. Notably, the type of phimosis (congenital or acquired) emerged as the pivotal factor linked to BXO development in this investigation. Nevertheless, further research is warranted to validate and fortify these observations. 

Consultation with our Urological Specialist: Individuals faced with challenges retracting the foreskin are advised to seek consultation with our consultant urologists for precise diagnosis and tailored treatment options. 

Note: This blog is intended solely to serve an informative function and should not be taken as medical professional advice. For specific concerns, it is imperative to use the expertise of our consultant urologists.

When will circumcision be needed for tight foreskin (phimosis) in adults or older men?

Male circumcision is rarely discussed, leading to insufficient information about foreskin conditions. This causes many conditions to go unnoticed, worsening one's health. One such condition is phimosis, where the foreskin is too tight to retract. Sometimes, it can fold back when the penis is relaxed but not when erect. This tightness causes minor damage during erections and sexual activity, leading to scarring. In adults, phimosis can be associated with infections like balanitis or sexually transmitted diseases.

Facts:

- Physiological phimosis in children often improves with age. The foreskin attachment breaks down, releasing a white material called smegma pearls. Most boys have a fully retractable foreskin by ages 10-12.

- Pathological phimosis is a medical condition caused by disease or scarring (BXO). It's important to distinguish it from a natural tight foreskin (physiological phimosis) as treatments differ.

Paraphimosis occurs when the foreskin gets stuck behind the penis head due to a tight ring. It requires immediate treatment, such as pulling the foreskin forward or preputioplasty to preserve it.

Causes:

- Skin conditions like BXO, Lichen planus, or Eczema.

- Infections: Circumcised men have lower rates of sexually transmitted infections, including syphilis, chancroid, and genital herpes (HSV-2).

- Scarring: BXO can cause severe scarring and phimosis.

- Potential cancer: There's a long-known link between un-circumcised men and penile cancer, especially in cases of phimosis history.

Non-surgical treatment:

Treatment for phimosis depends on age and severity. Options include:

- Steroid creams or ointments.

- Stretching exercises in early stages.

- Antifungal or antibiotic medications.

However, stretching scarred foreskin may cause more tearing and scarring. Scientific evidence is lacking for its effectiveness. Phimosis creams have had limited success in recent reports. Mild phimosis symptoms in adults can be managed by using condoms and lubricants during sexual activity.

Mild tight foreskin caused by fungal infection can be treated with antifungal medications and steroid cream. Adults with high blood glucose levels (diabetes mellitus) and phimosis may require circumcision due to recurring fungal infection or possible BXO. Tight foreskin (phimosis) in diabetic patients often requires circumcision and biopsy of the foreskin.

Surgical treatments:

- Frenuloplasty: A procedure that releases the frenulum, a small fold of tissue. It allows the foreskin to detach from the penis head.

- Preputioplasty: A procedure that expands the foreskin by an incision in front, enabling full retraction.

- Partial circumcision: Leaving part of the foreskin covering the penis head. It has long-term complications.

- Full circumcision: The standard surgical option with glue or stitches for tight foreskin, particularly for BXO phimosis, traumatic injury, or penile cancer.

If sexual activity is painful or uncomfortable due to phimosis, urgent treatment is needed. Home treatment includes daily cleansing, controlled stretching exercises, and clearing smegma. Infections with tight foreskin (balanitis) require antibiotic or antifungal treatment. It's essential to get examined for sexually transmitted diseases by a GUM clinic or a doctor.

In summary, there are various alternatives to full circumcision, such as medications, creams, frenuloplasty, preputioplasty, or a combination. These options should be discussed with a specialist or urologist. Full circumcision without any medical problems should be seriously considered as it is irreversible surgery.

PS: This information is for guidance only. This is not a replacement for professional medical advice. Please call Dr Khan for video consultation £150 advice at +447527314081 without any obligation.

Should you circumcise your newborn son? under Tricare Overseas Program (TOP) in the UK

Circumcision in newborn is very common in USA (58%).

Ideal age of newborn circumcision is 3 days to 6 weeks.

Male infant circumcision is far more common in the United States than it is in most developed countries.

The paediatric urologists agree that parents should consider the medical benefits and risks of circumcision in the context of religious, social and cultural preferences.

We offer newborn circumcision under the USA Tricare Overseas Programme in the UK for 48th Medical Group - RAF Lakenheath Brandon IP27 9PN

Please contact us as soon as the baby is born. We have 27 years experience Paediatric Urologist, 24 hours telephone support, CQC registered clinic, and Excellent patients’ experience

Care Quality Commission has given "Good" rating to London Circumcision Centre in all five domains

This service is rated as

Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

CQC carried out an announced comprehensive inspection at the London Circumcision Centre. This inspection was conducted as part of CQC inspection programme of independent health providers.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC key findings of our clinic were:

• The service had systems in place which kept patients safe. These included checks on patients attending the service and risk assessments conducted to ensure staff and patients were safe whilst attending the centre.

• Staff at the service had the skills and knowledge to provide effective care.

• Feedback on the provider and service revealed high levels of patient satisfaction.

• Provision of services at the clinic considered patient demand and included timely access appointments which included face-to-face, telephone and video consultations.

• There was a focus on innovative, learning and improvement.

Good Ratings for London Circumcision Centre

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Good Ratings for London Circumcision Centre -

CQC inspected and Rated Good