phimosis treatment options (besides chopping pieces off!)

May 6, 2007 7:09 AM

I'd like to know a bit more about treatments of phimosis before I talk to my doctor about it.

Given that circumcision is totally out of the question, how well do the various treatment options work? I'm just a tad worried that the best treatment option might not be the one my doctor pushes (not that I'm the type to argue with doctors). I'd love to hear personal or anecdotal experience relating to how well certain procedures worked and how comfortable or uncomfortable they were. Email [e-mail] if you don't want to comment here. I'm in San Diego by the way, and my insurance is for Kaiser. Thanks!

posted by anonymous to health & fitness (4 comments total)

A friend of mine has phimosis, and he's gone with the gentle stretching option. Lots of vitamin E oil and cortisone cream. It takes a while--he's been doing it for almost a year, and can only now fully retract his foreskin when erect--and you really need to be doing it every day, but it does work.

Don't have any (second-hand) experience with any of the other treatment options, but good on ya for not letting them slice things off.

Bear in mind, of course, that if one treatment doesn't seem to be working you can always go with another.
posted by dirtynumbangelboy at 7:37 AM on May 6, 2007

IDHAPM: I don't have a penis myself.

As far as I know, there are three treatment options for phimosis: cortisone cream, a small incision in the foreskin and circumcision.

The cortisone cream apparently works best with younger boys or men whose foreskin is only a little too tight. a friend felt apprehensive about circumcision and decided to try this route first. The doctor clearly stated that the likelihood of succes was very slim in his case and that in his opinion a circumcision would be a better approach. However, he perfectly understood a friend's predicament and prescribed the ointment without pressuring him into any of the other treatments.

Alas, the cream didn't work. (Although he only tried for 6 months, not a full year, and I think the doctor said to give it 3 or 4 months.) On the plus side, the level of comfort: not uncomfortable at all.


a friend then underwent the incision-making surgery in which a small incision is made in the foreskin which widens the diameter of the foreskin opening. The operation itself was a routine procedure, a friend went to the hospital in the morning and was home in the afternoon.

Level of comfort: quite uncomfortable and painful for the first two days, just uncomfortable and a bit painful the next two days and only uncomfortable the next two days.
a friend had to walk in a slightly different manner, as to not to make it hurt. He walked a tad funny the first few days, but I don't think anybody noticed except for me. (And he had a cover story of a sprained back or something else ready just in case.)

The night and day after the procedure were the most painful, but hurray for painkillers. The most annoying thing apparently was finding a comfortable sleeping position. The most painful was changing the bandages, as it bled a lot, so at the end of the day sometimes part of the bandage had gotten stuck in the dried blood on his penis. (Sorry for that visual image.)
Also, his penis didn't look very nice, but you would have supected that, I suppose. The stitches, the swelling, the blood, the dried blood, the bruises,...not a pretty sight, so brace yourself for that.


Unfortunately, after everything had healed, it appeared that the problem still persisted. Circumcision was now the only option. a friend was especially afraid of the sensitivity of the head of the penis and the friction of his underwear. Again, a routine procedure, in in the morning, out in the afternoon. It bled and it was painful, but surprisingly enough, less painful as the incision procedure. Maybe he was more accustomed to it after having had the first procedure or it really did hurt less, I have no idea. Again, it bled a lot and it looked awful, but just as after the incision procedure, the first painful days were followed with just uncomfortable days. Amazingly, the sensitivity to friction disappeared much more quickly than he had anticipated, about a week after the surgery (I'm guessing, I don't remember clearly.) Of course, it looked even worse than after the incision surgery, but again, that was to be expected.


A few things to keep in mind:

As I've written this story above, it looks like it was all a very smooth process. Do not be mistaken, it was not. The first step, talking about the problem, took a lot of a friend. I can understand how men with phimosis might be afraid to talk about their problem, have a fear of rejection or feel like not being a man etc., but it really is not as big a deal as you might think. I've never loved a friend less for it, how frustrating the situation might have been at times and apparently, it's a very common problem and doctors are quite used to it. So congratulations for your courage to speak about your problem!

Secondly, this whole process took time. It took time to talk to a doctor for the first time about his phimosis and it took time to make a decision. It took time to start the first treatment and it took even more time to start the second treatment. As you can imagine, it took yet even more time to make an appointment for the circumcision. Of course, I would have preferred a quicker solution, but I can understand the hesitation about treating phimosis. I can understand the thought of having a surgeon cutting a piece of your penis is not pleasant. So don't feel bad if it takes some time to talk to your doctor or to make a decision.

If you choose the least invasive treatment, keep in mind that it might not work. The frustration this brings is not to be underestimated and you'll have to motivate yourself to try something else. That's why I would recommend you to try the cream and if that doesn't work, directly take the circumcision route. The incision hurts the same or even more, and is not a guaranteed succes. After you've been trough the pain and disappointment of the incision method having failed, it will take you a lot of will power to undergo surgery yet again.
(If circumcision really and truly is not an option, hopefully the cream or incision will work. Your doctor can judge the likelihood of succes best.)

But the most important of all: at all times, keep your goal in mind. Whatever you decide, the outcome will eventually be a great sex life, and that's quite a good motivator.

Good luck! (And my apologies for the length of this post.)
posted by lioness at 7:17 PM on May 6, 2007

Well, I'll come out as the poster here, as someone who emailed me wanted to share some info:

Email 1:

I did some research after being told point blank that circ. was the
only
option. Here is one of the articles that I found. It talks about the
use of
corticosteroids (in this case betamethasone) as a treatment.

It is not that expensive (At least where i am) and might be worth a
shot.

http://www.cirp.org/library/treatment/phimosis/milanovic/

I would take this article and others you can find (try searching for
"phimosis" and ("steroid" OR "cortisone" OR "corticosteroid" OR
"hydrocortisone" OR "betamethasone") to the MD. This doesn't seem to be
a
known approach and this might help convince them to at least prescribe
something for you.

good luck!

email 2:

Whoops, almost forgot:

1) Maybe you could be kind enough to post this answer on MetaFilter so
that
others can see my response and perhaps comment on it.

2) After I tried it, things improved, but honestly it is hard to say if
it
was the cream or if it was the regular "manipulation". Things aren't
perfect
but they are significantly improved




So I guess some doctors aren't aware that there are other options to circumcision, but I guess creams aren't exactly miraculous.
posted by Citizen Premier at 8:32 PM on May 6, 2007

I've also heard about some sort of bell-shaped device thing that you slide under your foreskin, and stretches from the inside. I can't remember where I saw it, though.
posted by dirtynumbangelboy at 4:19 AM on May 7, 2007