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.

Cuts or tears of foreskin

Cuts and Tears in the Foreskin: Causes, Treatment and When to See a Doctor

The foreskin in men is delicate and prone to minor cuts or tears during sexual activities. While these cuts usually heal within a week, knowing their cause, how to care for them, and when to seek specialist urologist advice are essential. Possible causes of foreskin cuts or tears include rough sex, tight foreskin, diabetic complications, skin lesions like lichen sclerosis (BXO), STDs, and fungal infections. Treatment options include simple care, medications, controlling underlying conditions, and surgery, e.g. circumcision or preputioplasty in some cases.

This blog will explore the potential causes of foreskin cuts or tears, treatment options, and when to see a specialist.

Causes of Foreskin Cuts or Tears

Rough Sex

Friction during sexual activity can cause minor tears. While these minor cuts usually heal within a week, it is essential to know how to care for them in case you have some medical conditions.

Tight Foreskin

A condition called phimosis can make it difficult to retract the foreskin over the head of the penis, leading to tearing during retraction.

Diabetic Complications

Poorly controlled diabetes can decrease blood flow and slow healing, making the foreskin more susceptible to cuts and infections. The repeated infection will require prompt treatment, and tight freoskin will require circumcision in diabetes.

Skin Lesions

Eczema, Balanitis Xerotica Obliterans (BXO) or other skin conditions on the foreskin can cause cuts or tears.

Balanitis

Balanitis is an infection and swelling of the foreskin and the tip of the penis (called the glans penis). Balanoposthitis is called a more severe infection of the head of the penis along with the foreskin.

Sexually Transmitted Diseases (STDs)

Certain STDs can cause sores or ulcers on the penis, including the foreskin.

Fungal Infections

Yeast infections can irritate and inflame the foreskin, making it more prone to tearing.

Treatment Options

Simple Care

For minor cuts, gentle cleansing with warm water and a saline solution, followed by applying petroleum jelly or lubricant, can promote healing.

Medical treatment

Depending on the cause, your doctor might prescribe:

• Antifungal creams for fungal infections.

• Antibiotic creams to prevent bacterial infections.

• Steroid creams to reduce inflammation in early BXO

Controlling Underlying Conditions

If diabetes or an STD is the culprit, managing those conditions can help prevent future cuts and promote healing.

Surgical Options

In some cases, surgery might be necessary. Here are some potential procedures:

• The Dorsal Slit

A small incision was made on the upper side of the foreskin to relieve tightness and prevent future tearing.

• Preputioplasty

Preputioplasty repositions the foreskin to allow for easier retraction and reduce the risk of tears.

• Circumcision

Complete or partial removal of the foreskin.

• Biopsy

Sometimes, a small tissue sample might be taken to rule out more serious conditions or BXO.

Post-Operative Care:

Following surgery, your doctor will provide specific instructions on wound care, pain management, and follow-up appointments after circumcision or other procedures. This might include using steroid creams to reduce inflammation in BXO and monitoring for signs of recurrence of BXO on different parts of the penis.

When to See a Urologist

See our specialist if you experience any of the following:

*  Severe pain or bleeding

*  Signs of infection, such as redness, swelling, pus, or fever

*  Difficulty urinating

*  The cut doesn't heal within a week

*  The foreskin is exceptionally tight

*  You suspect an STD

Conclusion

Most foreskin cuts heal with simple care. However, seeking medical attention is crucial if you experience any concerning symptoms. Early diagnosis and treatment can prevent complications and ensure a speedy recovery.

Disclaimer

This blog is for informational purposes only and should not be a substitute for professional medical advice. Always consult with our consultant urologist for diagnosis and treatment.

Aftercare Instructions for Glue Circumcision

How do I look after a circumcision treated with skin glue?

Skin glue is a special medical adhesive gel that is applied to the circumcision wound edges. It can be used on its own or with stitches. It takes only 3-5 minutes to dry and set, forming a thin layer over the wound. It forms a waterproof coating over your circumcision wound. Glue circumcision is the best method. 

How does skin glue work on circumcision wounds?

The inner and outer foreskin have edges that can be easily joined together with medical liquid glue using a special technique. 

Will glue get separated during the erection of the penis? 

No, glue is strong enough to stay on the skin during your erection in our unique technique of glue circumcision.

Why is the skin glue used in circumcision?

This will give a waterproof seal, less pain, less risk of infection, and better results than stitches. 

Can glue be used to redo or revise circumcision?

Yes, redoing or revision circumcision with glue gives the best outcome of the previous scar. Glue revision circumcision is the best method.

How long does glue stay on the circumcision wound?

The glue usually comes off itself within 5-15 days 

Will I feel pain after glue circumcision?
For the first few days, you may feel pain and use simple pain relief medication. Take simple over-the-counter painkillers for a few days. Glue circumcision is less painful than circumcision with stitches only. The head of the penis (glans) remains very sensitive after circumcision; you can apply a small amount of Vaseline or olive oil only to the glans penis. Sensitivity may last many weeks or months.

How do I care for a circumcision treated with skin glue?

Please follow the aftercare advice from Dr Khan

• Wash your hand before you touch/change the bandage 

• Only wear tight underwear with the head of the penis upwards toward the belly button. 

• Avoid soiling the bandage with urine

• Do not touch the glue for four days 

• Keep the circumcision wound dry for the first four days

• Keep the bandage for four days and take showers after four days. Afterwards, change the bandage daily for seven days after applying Fucidin cream only on the stitches

• No bath for 15 days to prevent soaking the wound

• Wrap the circumcision wound with cling film if you would like to take a shower for four days. 

• If the circumcision site gets wet, pat it dry. Don't rub the glue site, and do not apply cream or an antiseptic solution to it.

• If the wound edges join together securely and the glue is still in place after 15 days, you can remove it in the shower.

• Apply bio-oil on the wound for 2-3 months after four weeks to decrease the scarring.

What are things to avoid during the healing of the circumcision with glue?

• Do not scratch, rub, or pick at the glue; doing so may loosen the film before the wound fully recovers.

• Do not soak or scrub your wound for 15 days.

• Do not swim until the adhesive film (glue) has fallen off naturally

• Do not apply liquid, ointment medications, or any other product to the wound while the glue is in place. It could loosen the glue film before the wound is fully healed

• Do not do any heavy lifting, gym or exercise for two weeks

• Do not do any sexual activities for 4-6 weeks

How long will swelling or bruising settle down? 

The shaft of the penis will have swelling for 4-6 weeks, and bruising of the glans and shaft of the penis will settle within four weeks. 

How long frenulum is will heal? 

If you have frenuloplasty with glue circumcision, we put a few stitches covered by glue at the frenulum, which will take longer (about four weeks) to heal. Apply Fucidin cream after changing the bandage. The frenulum area will heal later than the circumcision site.

When should I get help from the Doctor?

Most circumcision wounds are sealed with skin glue and heal normally with excellent results. You should get medical help from our specialist doctors if: 

• Your wound gaps open or start to bleed

• You think your wound may be infected

What are the symptoms of wound infection?

• The circumcision wound looks redder or swollen

• The pain in the wound gets worse after three days

• Discharge of pus or blood comes from the circumcision wound

• You have a fever of 38C (100.4F) or more 

• Wound edges get separated by bleeding

Please get in touch with our doctors for medical advice if you have any questions.

Written by a patient at Leyton Clinic, London, February 2020

“I got circumcised by Dr Khan using the glue method and I can only praise both the surgeon and the technique. He was extremely friendly and approachable. I had a long list of question before the procedure which he happily answered over the phone. Booking an appointment was very easy and hassle-free. On the day of the operation, Dr Khan asked me about all my wishes and preferences and gave me personalised suggestions. The operation itself was virtually completely painless. I kept talking to Dr Khan and his lovely nursing assistant throughout the procedure. Having followed his post-operative care plan to the letter, my recovery was very quick and uneventful. I only needed to take simple over-the-counter painkillers (paracetamol and ibuprofen) for 2 days. The pain was completely gone after that. The swelling settled in about a week. As I'm writing this review, I am only 4 weeks post-op and it feels like I have been circumcised forever. The glue method achieved an excellent cosmetic result. I cannot recommend Dr Khan highly enough.”

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