Free advice for tight foreskin and tight frenulum

Phimosis is a term used for tight foreskin. Phimosis is when you cannot pull the foreskin back to see the tip of the penis. In some cases, the skin may fold back when the penis is relaxed but is unable to withdraw when the penis is erect. When the foreskin is tight, there is minor trauma to the foreskin during each erection and sexual activity. This generates to loss of elastic fibres due to scarring. In adults, sexually transmitted infections or other infections such as balanitis can be associated with phimosis.

Adult Circumcision is an operation that matches men’s cosmetic and functional requirements. Tightness of the foreskin can be due to BXO or Lichen Sclerosis.

Cracks on the foreskin

Cracked foreskin presents with mild burning, itching, swelling and red patches, and with tight foreskin (phimosis)

Cracks or fissures on the foreskin may be due to Inflammatory conditions of the foreskin (called posthitis) or head of the penis (balanitis) or both (balanoposthitis). These cracks could be painful and associated with fungal or bacterial infection, scarring conditions called lichen sclerosus (BXO), and tight foreskin (phimosis and Paraphimosis).

Fungal infections are usually responsible, most commonly involving the yeast called Candida albicans, which is associated with a bacterial infection. Foreskin yeast infection is generally called “candidiasis” or “thrush” and is not common in healthy individuals but in cancer, immunocompromised, and diabetic individuals.

Bacterial infections, especially Streptococcus organisms, are the second most common cause of balanitis. The sexual health clinic needs to exclude sexually transmitted infections (STIs). The most common STIs are Chlamydia trachomatis, genital mycoplasmas, and Neisseria gonorrhoeae. These can produce cracks and red foreskin.

Poor hygiene due to a tight foreskin can cause cracks on the foreskin and irritant balanitis.

Diabetic patients with uncircumcised men have a high (35%) prevalence of balanitis, which gives them cracks to the foreskin. Among men with an acquired tight foreskin, 26% had a history of diabetes. Tight foreskin (phimosis) in men with diabetes increases the risk of infection of the foreskin and glans.

Balanitis xerotica obliterans (BXO) is a chronic, progressive, and sclerosing inflammatory foreskin disease of unknown cause. BXO will produce scars and cracks.

Treatment of the cracks is medical (antifungal, antibiotics and steroids) and surgical (dorsal slit, preputioplasty or circumcision). Control of sugar in diabetes patients is critical to managing the above treatment.

If cracks of freoskin are associated with tight foreskin (phimosis)

The treatment of phimosis depends on several factors, including age and the degree of tightness. Here are the available options:

1. Steroid Cream or Ointment: These reduce inflammation and improve foreskin elasticity.

2. Stretching Exercises: Beneficial, especially in the early stages of Phimosis.

 3. Stretching Rings (Phimostretch): Devices that aid gentle foreskin stretching.

If cracks of freoskin are associated with diseased freoskin (BXO)

We provide circumcision, dorsal slit or preputioplasty at our centre
Please get in touch with us for professional and expert advice by calling the mobile number below to the doctor directly.

Please call us at +447527314081 to discuss this further and get advice from our specialist team.

• Dr Nkwam: Consultant Urologist

• Dr Sanndher: Consultant Urologist

• Dr Khan: Paediatric Surgeon/Urologist

• Dr Safdar: Experienced Surgeon

London Circumcision Centre, Leyton and South Woodford Clinics, London

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