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Foreskin Problems The commonest problem is that of a tight foreskin. The skin becomes scarred and tight, this means that initially intercourse becomes difficult with the possibility of the foreskin becoming stuck below the glans (or head of the penis). As the scarring becomes more severe it can become impossible to retract the foreskin at all. This has two serious consequences. First, it is vital that the skin under the foreskin is kept clean, it is well documented that if this cannot be done then the chance of developing penile cancer is increased. Second, if penile cancer does develop it is most commonly under the foreskin. This is a disease which is highly treatable if discovered early, if the foreskin cannot be retracted penile cancer will only be detected in its later stages. Solution The answer to this problem is a circumcision. This is the removal of the foreskin. The operation takes 20 minutes to perform. It has an unfair reputation in adulthood, it is not really more painful a procedure in adulthood than in childhood. It can usually be performed as a day case and whilst the patient is asleep I inject some local anaesthetic to make the journey home painless. The patient can usually return to work after two weeks but obviously this time period will be shorter for those with a desk job and longer for professional jockeys. Immediately after the procedure the penis will look neat without any tissue swelling. After the first couple of days the penis tends to swell slightly and look rather untidy, this is entirely normal and settles a couple of days later. The stitches are all dissolvable saving you an embarrising trip to the local GP practice for the removal of the stitches. Frenular Problems The frenulum is a small piece of tissue which lies on the underside of the penis, it is the join between the foreskin and the skin of the shaft. This tissue can become torn during lovemaking, resulting in bleeding at first and scar formation later. This scar tissue can be painful during lovemaking. The best treatment is a circumcision, some patients may be suitable hwoever for a lesser procedure called a frenuloplasty, which aims to lengthen the frenulum whilst leaving the foreskin. Should this procedure fail however a circumcision would be needed.
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