How to deal with a tight foreskin

Dear Dr Ren:

I’m in my 50s and was married for 25 years. Sex was always physically uncomfortable but there wasn’t much of it. Now I’m divorced and have come out. I thought that having the kind of sex I wanted would fix the problem, but it didn’t.

I’ve recently learned that what I have is called phimosis. The doctors suggest cutting my foreskin or removing it altogether. Yikes! What are my options here?

Too tight

Dear Too Tight,

Yours is one of a number of genital irregularities that can affect sexual functioning.

Phimosis, the tightening of and inability to retract the foreskin, generally self-corrects in toddlerhood when mom and dad teach you to pull it back when washing. If your family has a ‘hands off’ policy about genitals, the foreskin sometimes adheres to the head of the penis, losing its elastic quality.

By the age of 50, the available treatments include topical corticosteroids, manual stretching, preputial plasty and circumcision. Conservative treatments often work; use surgery as a last resort.

Research studies show that phimosis can be safely and effectively treated by applying topical steroids 80-90 percent of the time. Apply Betamethasone cream 0.05% to the exterior and interior of the tip of the foreskin 2-3 times daily and s-t-r-e-t-c-h that tender skin. This should be effective within three months.

If steroid cream does not resolve the problem, try preputial plasty, in which a dorsal (top side) incision is made through the constrictive band of the foreskin. The underlying tissue is spread to expose the fascia and the incision is closed with absorbable sutures. This procedure is simpler than circumcision and allows you to retain the foreskin.

Almost all cases of phimosis can be resolved with one or the other of these methods. The last resort is adult circumcision, a tough choice for men who are accustomed to the sensations of arousal with intact foreskin.

However, there are some advantages to getting cut. Some research suggests that the foreskin is made up of cells that readily absorb HIV and may be more vulnerable to sexually transmitted infections. The foreskin is also susceptible to tearing and ulcers that could act as entry points for HIV. But once a circumcision scar has healed, the new skin is covered with a protective lining called keratin that is less vulnerable to HIV infections and other STIs. Though this is no reason to forego safe sex protection, it does provide another layer of protection.

Another problem some men experience is Peyronie’s disease, which affects the way the penis bends. This is the hallmark of Peyronie’s; not actually a disease but a build-up of plaque caused by repeated mild traumas to the penile tissue, like a slow bruise, which generally resolves itself within a year. Stubborn cases can be corrected with injections or one of two different types of surgery.

Your doctor can inject drugs such as collagenase, calcium channel blockers or interferons directly into the plaque in your penis. These drugs break down scar tissue deposits and return the tissue-building process to normal. You’ll receive multiple injections over a period of months. The success rate of these injections varies, and you may still require surgery.

One surgical method is shortening the tissue on the unaffected side of the penis, cancelling the bending effect. Since this can shorten the penis, it is used in men who have adequate penis length and a curve of less than 45 degrees.

With a greater curve, several cuts are made in the plaque, which allows straightening. The cut plaque is then covered with a grafted vein.

Finally, for men who have trouble with erections, doctors implant a penile prosthesis to straighten and increase the rigidity of the penis.

One way or another, the crick in the dick is gone.

If you are still using your hands to hold the paper instead of protecting your privates, remember that these invasive and uncomfortable procedures are indicated only when the condition so compromises your sexual ability that the long-term benefit of improved sexual enjoyment outweighs the temporary discomfort of treatment.

Who cares if your Johnson curves a bit to the left so long as it functions well and brings you pleasure? What difference does it make if you can’t fully retract your foreskin so long as it causes you no pain? Remember that most curvatures self-correct eventually and a tight foreskin responds remarkably well to repetitive stretching (now that can be fun!).

However, if you are suffering with a situation that prevents you from fully experiencing the depth and breadth of your erotic potential, do whatever you must to correct the problem and do it now.

You mention in your letter that you have recently come out and begun to experience the type of sex you’ve always wanted, yet are hampered by your phimosis. Set this right promptly before it hinders your new sexual patterning.

Eventually, we come to avoid negative experiences and seek positive ones. Ensure that your sexual behaviour feeds a positive reward loop. Now that you have finally arrived where you want to be, Too Tight, make it glorious!