Adult circumcision : Are there any alternative treatments for tight foreskin in adults?

Phimosis or tight foreskin:  Are there any alternative treatments to circumcision ?

Under some circumstances, other alternative treatments may be considered to keep your foreskin but adult circumcision remains the most common treatment option to relieve your symptoms of tight foreskin. Alternatives to a circumcision include:

• Frenuloplasty – this is an operation to cut and lengthen your frenulum, which is the small tag of skin on the underside of your penis, between your foreskin and the shaft of your penis. If the frenulum is short or torn, you may have problems pulling your foreskin back. Frenuloplasty may relieve the symptoms. 

• Dorsal slit – in this procedure the foreskin is cut on the top of the foreskin to widen and loosen it, so it can be pulled back more easily. Cosmetic result showed fish mouth like appearance. 

• Prepuceplasty – this is a plastic operation called V-Y plasty or Z- plasty. This  procedure is more complicated than a circumcision. The foreskin is cut and stitched to widen it. This is not indicated in case of balanitis xerotica obliterans ( BXO). 

  Mr. Khan  can explain these treatments if they are suitable for you.

Ideal age of circumcision in children

Our audit at Thornhill Circumcision Centre, Luton, Bedforshire

incidence of complications in circumcision for 6 months olds is significantly lower when compared to 6 to 110 months old children.  We can conclude that under 6 months is the optimal age for non-therapeutic male circumcision in a community clinic using Circumplast and Plastibell devices.

Methods of Adult and older boys Circumcision

Dorsal slit method: 

The dorsal slit method for circumcision is mainly used for phimosis (tight foreskin) and paraphimosis. After a partial dorsal slit, the surgeon needs to identify the corona of the glans to cut the correct amount of foreskin.  

Sleeve method  

Freehand cutting of the skin

Forceps guided method  

Use of forceps to cut the foreskin.

Freehand method  

cutting with scissor  

Shang Ring 

disposable clamp to use  

Glue vs stitches circumcision

glue to apply to skin edges.  

Why biopsy is important in adult with balanitis xerotica obliteranes (BXO) or lichen sclerosis foreskin in phimosis (tight foreskin)

There are some association of skin cancer with BXO. In one of the series, incidence of skin cancer is reported 5.8%.  

In other series, incidence of BXO found adjacent to penile skin cancer is 33%. These findings raised a question whether BXO is pre-malignant condition. 

It is important to do biopsy of all BXO or lichen sclerosis foreskin to confirm the diagnosis and to rule out the concomitant skin cancer. Dr. Khan sends all foreskin with BXO for biopsy after the circumcision. 

Circumcision is strongly indicated if your foreskin shows signs and symptoms of BXO or lichen sclerosis which is causing tight foreskin. 

The British Association of Dermatologists has issued a guideline about MALE GENITAL (PENIS) LICHEN SCLEROSUS