Foreskin problems

Understanding Foreskin Problems: Causes, Signs, and Treatment

The foreskin, a protective fold of skin covering the penis in uncircumcised individuals, requires proper care to prevent potential issues later in life. Here's a comprehensive guide to foreskin problems, their causes, signs, treatment, and preventive measures.

What is the Foreskin?

The foreskin is a layered fold of skin that shields the end of the penis in uncircumcised individuals. While it requires no special care in early childhood, attention to hygiene becomes crucial as one grows older to prevent problems like swelling, infection, tightness, irritation, and dryness.

Causes of Foreskin Problems:

In young children, the foreskin is naturally attached to the penis head by the synechia membrane, which dissolves over time. Forcing it back prematurely can lead to issues. Phimosis, where the foreskin is too tight, is another cause, usually resolving between ages two and six. STIs, infections, BXO (lichen sclerosis ) or injuries can trigger problems in teenagers and adults.

Signs of Foreskin Problems:

Look out for pain during urination, itchiness, inability to retract the foreskin, pain during intercourse, redness, soreness, swelling, dryness, or split and bleeding skin. Consult our specialist Urologist if you experience these symptoms.

Treatment for Foreskin Problems:

Treatment varies based on the issue. Dryness may be managed with creams or ointments like steroid cream, while infections like balanitis can be treated with medications. In some cases, procedures may be required, such as moving back the foreskin in children with phimosis or circumcision in adults with persistent issues. Our approach with circumcision with glue is the best option.

Prevention of Foreskin Problems:

Proper care is crucial. Change underwear regularly, opt for loose underwear, avoid heavily scented hygiene products, clean the foreskin daily with warm water, and use protection during sex to reduce STI risks.

Specialists for Foreskin Problems:

A urologist, or a pediatric urologist for children, is the specialist to consult for foreskin problems. We provide these services in the London Circumcision Centre.

When to Consider Circumcision:

Circumcision is only considered when foreskin problems are severe and impact daily life, causing persistent pain or frequent urination issues. Phimosis with a scared or cracked foreskin will require circumcision.

When to Seek Medical Advice:

Call us if you experience difficulty urinating, a burning sensation, increasing pain, or inability to return the foreskin to its original position.

Understanding and addressing foreskin problems early is essential for maintaining male reproductive health. Regular hygiene practices and prompt medical attention can make a significant difference in preventing and managing foreskin-related issues.

Balanoposthitis Or Balanitis

Balanoposthitis and Balanitis for adults and Children

Balanoposthitis is an inflammatory condition that affects both the glans penis (balanitis) and prepuce (foreskin). The condition is most common in uncircumcised males and is characterized by symptoms such as penile pain, pruritus (itching), discharge, erythema (redness), rash, or inconsolable crying in children.

There are several possible causes of balanoposthitis, including poor hygiene, infections (such as candidal, bacterial, or viral infections), inflammatory skin diseases, irritants, trauma, and cancer. Poor hygiene is the most common cause of nonspecific balanoposthitis. Infections such as candidal infections are common in children. They can be associated with diaper rash, while other infectious causes include aerobic bacteria such as Staphylococcus aureus and Group A Streptococcus, anaerobic bacteria, and viruses such as human papillomavirus.

The prevalence of balanoposthitis is between 12% to 20% in males of all ages. Paediatric patients commonly present around ages 2 to 5 years, likely due to physiologic phimosis and hygiene habits. In adults, uncircumcised males with diabetes mellitus are at the highest risk, with a prevalence of around 35%. Circumcision has been shown to decrease the prevalence of inflammatory conditions of the glans penis by 68%.

According to the American Urological Association, balanitis affects up to 11% of men and can occur at any age, but it is more common in older men and those who are uncircumcised.

Pathophysiologic processes can vary widely depending on the aetiology of balanoposthitis. Most cases commence with moisture such as urine, sweat, or smegma (physiologic secretion from genital sebaceous glands) becoming trapped within the preputial space, creating a nidus for bacteria and fungi. Balanoposthitis can also be commonly provoked by irritants and allergens, causing non-specific inflammation leading to erythema and pruritis.

A thorough history and physical exam are sufficient in most cases of balanoposthitis for diagnosis and establishing a course of treatment. Your doctor may also recommend testing for sexually transmitted infections (STIs) if there is a suspicion of infection.

if you experience persistent or severe symptoms of balanitis or balanoposthitis, or as untreated cases can lead to complications such as scarring or phimosis. The diagnosis of BXO is typically made based on the appearance of the affected skin. Still, a circumcision and biopsy may be necessary to confirm the diagnosis and treatment of the phimosis.

Treatment may include hygiene improvements, topical or systemic antimicrobial agents, anti-inflammatory agents, topical steroids and circumcision in severe cases. Establishing the underlying cause of balanoposthitis is vital to guide appropriate treatment. Additionally, practising good hygiene habits and using protection during sexual activity can help prevent the development of balanitis.

Circumcision is recommended in phimosis and scaring due to BXO

Treatment options for BXO include topical and intralesional steroids, circumcision with frenuloplasty, and various surgical techniques for more severe cases.

Regular follow-up care is important to monitor changes in the affected areas that may indicate malignancy.

Sources:

1. American Urological Association. Balanitis. https://www.auanet.org/education/auauniversity/medical-student-education/conditions-education/balanitis

2. Mayo Clinic. Balanitis. https://www.mayoclinic.org/diseases-conditions/balanitis/symptoms-causes/syc-20354817

3. NHS. Balanitis. https://www.nhs.uk/conditions/balanitis/

4. Harvard Health Publishing. Balanitis. https://www.health.harvard.edu/a_to_z/balanitis-a-to-z

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.