Healthy Foreskin for Men - Treating Phimosis and Other Foreskin Problems

How to treat and prevent foreskin problems.

Treating foreskin problems like phimosis (a tight foreskin) and preventing foreskin problems is one of the most commonly searched for items on Google under the category of men's health. Within 5 minutes you will learn about the 8 most common foreskin problems - how to treat them and how to prevent them. This will save you an enormous amount of anxiety, stress, worry, embarrassment, pain, discomfort, and of course money.

No discussion about the foreskin can start properly without an understanding of what the foreskin is and what a vital role it plays in a man's health and well-being. So to begin with it is important to know that the foreskin plays several key roles. But what is the foreskin?

Given that you are looking up information about the foreskin I will assume that you understand that it is located at the end of the penis and covers the glans. It is comprised of many different types of highly specialised cells and nerve endings. It plays an important role in maintaining the healthy working conditions of the penis and plays a very important role in sexual activity. The loss of the foreskin or a problem with the foreskin can create both physical and mental health issues for a man.

The key functions of the foreskin in adult men.

1: Protection of the sensitive glans of the penis

2: Increased surface area of the penis

3: Specialised nerve endings & cells related to sexual function

4: Lubricating interface between the penile shaft and the vagina

5: Immune system activity

Protection of the sensitive glans of the penis

A healthy penis has a very soft smooth moist glans (that part at the end of the penis). We know that when a man does not have a foreskin the glans becomes keratinized, that is, the skin becomes very hard and insensitive. The glans becomes a rough and difficult to "excite" part of the man,  when the foreskin has been removed or is not functioning properly. The best way to understand the changes that can occur to the glans when the foreskin is removed, is what happens when you lose a toenail or a finger nail. That is the nail bed hardens and loses sensitivity to touch. A health nail bed is soft just like a health glans.

Increased surface area of the penis

It has been observed by some researchers and physicians that men without a foreskin have  much tighter skin around the penis during erection, and that has led to some hypothesising that circumcision may lead to a slightly shorter penis than would otherwise be the case. We have received numerous case reports from men who have undergone adult circumcision and have indicated that they have lost up to one-third of an inch or approximately 1 centimetre in length as a result of the loss of the foreskin which provides a much larger surface area of skin around the penis.

Other men report that following on from circumcision is that they have an increased incidence of tearing, cracking or redness along the penis and glans during physical activity such as exercise and during sexual activity. The most common explanation is that the remaining skin has become too tight and that increases their risk of these issues arising.

Practical case reports suggest that the extra few inches of penis skin provided by the foreskin can make a significant difference to the health of the penis and to a mans general health and well-being. Of course more systematic research is required before a final conclusion can be made.

Specialised nerve endings & cells related to sexual function

Medical scientists and pathologist have been able to identify a number of highly specialised nerve endings and specialised cells related to sexual function. It is proposed that these nerve endings help with maintaining stimulation and erection. It is commonly reported by circumcised men (being circumcised an adult)  that they find it difficult to maintain stimulation and an erection compared to previous experience with a foreskin. The loss of the foreskin results in a very significant loss of nerve endings which has been shown to significantly reduce the perception of sensitivity during sexual activity.

A lubricating interface between the penile shaft and the vagina

In 2009 we received a report from the wife of a man who had been circumcised by his surgeon to treat his phimosis. The wife was deeply concerned that the experience of sexual intercourse after the circumcision left her in pain with dryness of the vagina, bleeding on some occasions, and dissatisfaction compared to before the circumcision. 

We undertook further research and received significant data that supported the observation that the foreskin plays a vital role in providing a lubricating interface between the penis and the vagina. The loss of the foreskin during intercourse can be described as like sticking a pole in to the vagina and moving it back and forth causing abrasion. The foreskin behaves much like a cushion of skin that prevents abrasion and allows for the extremely sensitive nerve cells to send very positive and rewarding messages back to the brain. Men without a foreskin require extra personal lubricant to reduce the abrasion on their partner. We recommend to only use a lubricant formulated to add extra protection to your partner. 

Immune system activity

Scientists specialising in immunopathology have shown specialised immune cells exist in the foreskin tissue. However,  whilst they understand the role of some of these cells, other cells need further research as they are not fully understood. In the EU where men usually grow up with their foreskin compared to men in the United States, men in Europe have a much lower risk of HIV (AIDS) infection compared to men in the United States. Many scientists and clinicians in Europe consider this evidence that the foreskin immune cell functions play a protective role. In The United States with an industry that has a vested interest in maintaining circumcision rates,  they often point to  HIV rates in Africa as evidence for the need to do routine circumcision. In Africa men are routinely circumcised in many regions. Independent scientists have pointed out that there are many confounding variables in Africa regarding HIV and circumcision, these include public health limitations, poverty, poor diet, limited hygiene education, religious and cultural objections to wearing condoms, and many others. So it is not safe to rely on African data to support routine circumcision. 

On balance,  a reasonable evaluation of the evidence supports the assertion that the foreskin in men who lived in countries that have good public health, are well educated in personal hygiene, and have a high level of condom use, generally have a lower risk of HIV infection. Put simply, the foreskin has evolved to protect men and just  like the cold virus and influenza viruses have  evolved to work around the immune system, some viruses and bacteria have found a way to work around the protections of the foreskin. However, just as it has been found that the removal of the tonsils does not offer additional benefits to a patient (it can lead to higher risk of infection),  the removal of the foreskin also does not provide any protective benefits to men yet  comes with a high level of costs including financial, physical and mental.

So we now know that the foreskin plays many important roles in the wellbeing of the man. However, just like all systems within the human body the foreskin can sometimes develop problems. Fortunately most foreskin conditions  can be managed without the need for surgery or expensive medical intervention. Of course, like any medical condition, it is very important that a qualified doctor actually diagnose any condition of the foreskin before offering treatment options.

There are 8 common foreskin problems.

These problems include:

1: Infection

2: Inflammation

3: What is phimosis?

4: Paraphimosis

5: Tears and cracks

6: Dryness and supersensitivity

7: Excessive smegma

8: Foul odour/smell

These foreskin conditions are caused by things such as:

Genetic predisposition - some men are prone to such conditions because of their genetic makeup.

Poor Hygiene Practice - some men are not given effective and relevant foreskin hygiene training.

Harsh or overuse of chemicals - certain chemicals or laundry detergents can trigger foreskin issues.

Aggressive or unusual sexual practice - certain sexual practices or acts can increase the risk of foreskin problems.

Certain Physical Activities - activities like long distance running, cycling or gymnastics have been associated with some foreskin problems.

Mental Health issues - when the mind is not well the body suffers and foreskin problems can arise under certain mental health conditions.

Now we know the major causes for foreskin conditions let's look at each one of the 8 common foreskin conditions. Before we begin it is important to understand that diagnosis for these foreskin conditions all require:

1. Medical history and an assessment of the signs and symptoms as well as:
2. Physical Examination, and 
3. In some cases,  a swab test or blood test to check for infection or inflammatory markers.

1: Foreskin Infection

Infection of the foreskin can occur. This is usually indicated by redness, swelling, or pain and discomfort,  and rarely with leakage or oozing of liquid from a tear or some type of infectious skin anomaly.

Optimal treatment requires confirmation of the infectious entity and then either antibiotics, anti-fungal, antiviral, or combination anti-infective agents with or without a steroid. The steroid can help with reducing some inflammation, swelling, redness and may improve the efficacy of the treating agent.

Repeat or chronic infections of the foreskin can lead to other foreskin issues including phimosis, dryness, excessive smegma, foul odour, and chronic inflammation. 

2: Foreskin Inflammation

Foreskin Inflammation

Sometimes the foreskin can become red, saw, and swollen - usually this settles down after a few days or weeks. However, for some men - this redness, soreness or swelling does not settle down and can  become chronic.

For many men with an acute inflammation of the foreskin they can treat it with a foreskin cream that contains neem oil. This type of cream is often available from a larger pharmacy or chemist or can certainly be found online at reputable stores specialising in foreskin care. For example - Novoglan Cream may be prescribed as over the counter.

However,  some foreskin inflammation does not reduce and may become chronic. Some disease names that are important to know about are “lichen sclerosis et atrophicus” and “balanitis xerotica obliterans”. “lichen sclerosis et atrophicus” refers to an inflammatory condition of the skin that is chronic and mainly affects the pubic region. “balanitis xerotica obliterans” or BXo is the name given to lichen sclerosus that affects the foreskin and glans of the man.

Whilst most foreskin conditions can be managed by your general practitioner or a specialist urologist, it is becoming increasingly common  for a specialist dermatologist to manage the BXO. Whilst there are a number of treatment options the most commonly used treatment are powerful steroids that suppress the immune reaction that is causing the inflammation. Dermatologists will provide a medical treatment program with the aim of curing the man to keep the foreskin. This approach is far more beneficial to a man because the loss of the foreskin due to bxo treatment is very unfortunate and can lead to other problems down the track including but not limited to anxiety issues relating to sexual function and sensitivity.

Most penile cancer arise out of the foreskin tissue. However, penile cancer is very very rare. The most common cause of penile cancer is one of the cancer triggering human papilloma virus species. It is hoped that with the extensive vaccination of young women and men against HPV infection that this very rare cancer will become a disease of the past.  It is very important to understand that many people who have a vested interest in promoting circumcision will use scare tactics and fear mongering to highlight the role of the foreskin in penile cancer. It needs to be repeated that the risk of developing penile cancer arising out of the foreskin is extremely rare and the offering of prophylactic foreskin removal is completely unethical and without any medical basis whatsoever.

3: Phimosis of the Foreskin

Phimosis is the inability to safely and normally retract the foreskin due to the abnormal tightening of the foreskin. Phimosis is considered to be a normal characteristic of the prepubescent boy and seems to offer a protective function. Sometimes the childhood phimosis can cause problems and these can be easily treated buy a clinician usually without the need for surgery. However, phimosis in adult men is generally considered a problem that needs to be treated. When the foreskin does not function properly it causes interference with the healthy functioning of the penis and sexual activity. It has been well established that phimosis can also cause mental health issues including anxiety, stress, anticipatory pain, depression, and relationship issues. In short, phimosis in the adult man needs to be treated and fortunately there are many medically based non surgical treatment options that will allow most men to keep their foreskin and be effectively treated.

Phimosis can be described as complicated or uncomplicated. Phimosis is graded from 0 to 6 where 0 is no phimosis and 6 is the most severe phimosis. phimosis can be complicated by inflammation, infection , tearing or cracked foreskin, excessive smegma, and Paraphimosis. it is important that these complications are treated before Treatment of the phimosis can begin.

The treatment options for phimosis include:

• foreskin stretching with a medical device designed for the treatment of phimosis
• topical steroid and finger stretching of the foreskin
• combination of a topical steroid and a medical device
• limited surgery that cuts the foreskin to relieve some of the pressure
• amputation of the foreskin using various circumcision techniques.

In 2005 and 2009 we undertook a survey of men diagnosed with phimosis. The results regarding treatment outcomes showed that 95% of surveyed men definitely wanted to keep their foreskin and would seek out treatments that allowed them to keep their foreskin. This is a very important finding and within the European Urology fraternity Clinical Urologists are now actively seeking their patients guidance on what they want as a treatment outcome. This means they no longer offer circumcision as the only or preferred treatment option. However, in many other countries including the United States, the United Kingdom, and Australia,  it is still the case that many Urologists only offer circumcision (possibly after a very limited trial of steroid without significant guidance on how to stretch the foreskin).

The Gold Standard for the treatment of uncomplicated phimosis is now the use of specialised medical devices with or without steroid. The unique patented balloon based foreskin stretching regimen is based on robust and extensive medical and scientific skin expansion processes. Foreskin cells will increase their volume thus leading to an increased circumference of the foreskin when they are placed under repeated distributed pressure. This stretching adaptation usually takes between 2 weeks up to 6 or 8 weeks. However, some men with uncomplicated phimosis may require up to 3 months of daily stretching. The benefit of this process is that in almost all cases they get to keep their foreskin which is a very important treatment outcome. Treatment times vary from person to person.

4: Paraphimosis of the Foreskin

Paraphimosis is generally considered a medical emergency whereby the foreskin of an uncircumcised man is retracted and becomes stuck along the shaft of the penis. This  results in abnormal compression of the underlying tissues and restricting blood flow and lymph tissue function. Untreated,  this can lead to gangrene and amputation of the glans penis. Quite clearly,  amputation of the glans penis is not an ideal outcome for a man and that is why it is very important that if you suspect that you or someone you know has paraphimosis then you need to get them to emergency medical care without delay.

Paraphimosis can occur spontaneously or it can occur during treatment of phimosis when a man prematurely tries to retract the foreskin before enough new foreskin tissue has grown.

Treatment of paraphimosis usually requires surgical intervention including cutting of the foreskin to release the built-up fluid and in certain circumstances the complete amputation of the foreskin, that is circumcision.

5: Tears, Cracks & Zipper Trauma of the Foreskin.

Tears, Cracks & Zipper Trauma of the Foreskin

From time to time the foreskin can become torn, cracked or traumatised. The phenomena of the zipper trauma has been identified in the medical case literature as being a phenomena that occurs when a man does not pay due attention to the closing of the zipper on a pair of pants. The foreskin usually gets caught, often through the undergarments, and is dragged into the space in between the teeth of the zipper and this causes significant trauma. In some severe cases this has resulted in full amputation of the foreskin. Generally the tissue is treated with a local anaesthetic and then released or cut from the zipper and where appropriate, stitches or more modern skin closing techniques are used to seal the wound. It is not uncommon for scar tissue to form at the site of the injury. The use of foreskin cream or other dermatologically recognised anti-scarring formulations may be of help in trying to reduce the formation of a scar.

Sometimes men develop tears or cracks in their foreskin as a result of chronic abrasion, dryness, chemical irritation, rough sexual activity, to name a few. Generally these tears or cracks are best treated by rest, protection of the foreskin from abrasion, chemicals and whilst not always possible, abstinence from sexual activity for a few weeks. This will provide the best opportunity for the foreskin to return to normal health. Once the tear or crack has been closed then feedback from various surveys has shown  that a foreskin cream in combination with, but used at different times,  with a foreskin oil - can significantly soften and enhance the suppleness of the foreskin if used over a period of 2 to 6 weeks. Creams and oils can seem relatively expensive, however, real world feedback from men who have suffered these conditions are a testament to the cost-effectiveness of using these creams and oils specialised for use on the foreskin to significantly reduce the impacts of the tears or cracks and also for the prevention of such occurrences in the future.

6: Dryness and supersensitivity of the Foreskin

Dryness of the foreskin will affect most men with a foreskin at some stage in their adult life. There are many reasons why dryness can occur, however, usually the dryness abates after a few days or weeks and requires no significant treatment. However, for some men the dryness can continue for an extended period of time interfering with their general wellness and does need treatment. The use of foreskin cream and foreskin oil has reported by thousands of men with the condition, as being very helpful in soothing the foreskin and returning the foreskin to a normal state. Some men also suffer from super sensitivity when their foreskin is dry and similarly the use of foreskin cream and for skin oils have been found to be beneficial in assisting men with these conditions to reducing the sensitivity back to normal and relieving the dryness.

If dryness or supersensitivity persists after the use of a foreskin cream and foreskin oil then a return to a medical practitioner is required to rule out some other conditions such as an infection or inflammatory disorder or perhaps even a neurological or neoplasia problem (which are very rare).

7: Excessive smegma of the Foreskin

What is smegma and why do we produce smegma?

Smegma is naturally occurring collection of substances that are found under the foreskin. The primary purpose of smegma is to lubricate the foreskin and to provide some protection on the inside of the foreskin and the glans. Smegma is completely normal despite the fact that it gets very bad press and is completely misunderstood by the majority of people. Basically smegma is good,  and when normal production of  smegma occurs the foreskin has its best chance of maintaining full health and normal operation. However, like other parts of the Human body, this can sometimes be dysfunctional, resulting in excessive smegma production. Excessive smegma production can interfere with the normal functioning of foreskin, increase the risk of infection and inflammation, and often results in a foul smell from the foreskin.

What to do about excessive smegma? It is very important that we do not apply excessive amounts of soap or other chemicals to the foreskin to more aggressively try and remove smegma. The best way to remove excess smegma is in the shower. Having a warm but not too hot shower where the foreskin is retracted and very gentle cleaning of the glans and gentle removal of visible smegma done daily for a week, will remove the excess smegma.

Once the excess smegma is removed it is very important that good hygiene practices regarding the foreskin are maintained. The foreskin should be retracted in the adult man during every shower and gently cleaned without any excessive rubbing or the application of chemicals.

If smegma continues to build up despite good hygiene practices it is best to refer to a clinical urologist or dermatologist who can determine if there is any abnormal factor causing this problem. In most cases good foreskin hygiene practices will result in smegma levels returning to normal.

8: Foul odour/smell

In a survey we undertook in 2009 we learnt that 4.5% of intact men had noticed a foul smell arising from their foreskin at some stage in the past five years. The foul smell is associated with the microorganisms that can grow in numbers well above normal and the breakdown of tissue and related matter releases odors that are very unpleasant. A foul smell arising from foreskin is rare, but  it is common enough that one in 20 men suffer from it at some stage within a 5 year period. Fortunately for most men the treatment is good hygiene of the foreskin. The retraction of the foreskin in a shower with warm but not excessively hot water and the gentle cleaning of the glans on a regular basis is usually sufficient to treat problem. The use of anti-infectives such as antibiotics or antifungal may be required to eliminate any colonies of unwanted microorganisms. Once resolved the situation can be prevented with the use of a foreskin cream and foreskin soap combination that has properties that can control future microorganism colonies and assist with maintaining good foreskin hygiene.

We would be grateful for any feedback and comments on this health foreskin and foreskin problems article. 

Sources:

BXO / LS http://www.irishhealth.com/askdoc.html?q=6714&qasect=10

Paraphimosis https://emedicine.medscape.com/article/442883-overview

2005 online Survey of 1648 (respondents) men about their foreskin health.

2009 online Survey of 831 (respondents) men about their foreskin health.