Dear Dr G,

I am a 27-year-old uncircumcised male and I am seeking your kind advice on a penile condition called “phimosis”.

Before this, I was not aware that having an un-retractable foreskin is not normal.

This condition is not a hindrance when I engage in masturbation because the foreskin can still be pulled forward to achieve sexual stimulation.

As opposed to during penetrative sex, the penile head has to be forced through a tight band of flesh. This will force the foreskin to be pulled backwards, causing pain. I have tried pulling my foreskin backwards multiple times without success and it hurts.

Now that I am aware, I am worried that it might affect my sex life when I have a partner in the future. Also, there is concern with diseases that can fester under the foreskin that cannot be pulled back and cleaned.

Trawling the Internet for solutions has yielded 2 alternatives. The first is using DIY remedy by manually stretching the foreskin. The second is through corrective surgery: performed either on the foreskin or the complete removal of it through circumcision.

I am quite skeptical of the first method. While surgery seems like the best option, I am also very concerned of the risk involved (infection, permanent scarring, discomfort or pain), which might leave me worse from where I am now.

Coming from a conservative family, this quandary of mine is something awkward to discuss, which is why I have to put Dr. G on the spot and seek your expert opinion on this matter of my band in my pants.

Having said all of that, I guess the silver lining here is I am still single and have the time to figure things out. I would like to express my gratitude in advance for your help in this matter.

Thank you.

Regards, Greenhorn in sex

The word phimosis is derived from the Greek word “muzzle”, meaning the appearance resembling a nose or beak. In medicine, phimosis is simply defined as the inability to retract the foreskin. In a normal circumstance, the foreskin (commonly referred as the prepuce) is the skin that covers the glans penis and can be easily retracted for the ease of cleaning, masturbation and penetrative intercourse. On the other hand, phimosis is the “abnormality” appearing as a tight ring like a “rubber band” at the tip of the prepuce, preventing the full exposure of the head of the penile glans, causing tightness during erection or the ballooning of the foreskin during urination.

The fact is, we all started life with phimosis. Physiologically, the foreskin and the glans are inseparable at birth and the separation occurs naturally in boys from the age of 4. As 99% of the prepuce is completely retractable by the age of 16 years old, phimosis is generally considered pathological, when the foreskin is still un-retractable in adulthood.

The true incidence of phimosis is unknown in children and adolescence, as there is a difficulty in distinguishing developmental physiological phimosis and pathological non-retraction of the foreskin. However, the inability of an adult male to retract the foreskin, resulting in the difficulty in maintaining hygiene and normal sexual life is definitely pathological in nature. Such conditions are believed to affect around 1% of all uncircumcised men.

The severity of phimosis can be variable depending on the extent of the retraction to expose the glans. In severe cases, the tightness in the pants may result in pain on erection, risk of infections and even the foreskin being trapped behind the glans causing a medical emergency called paraphimosis. When the “band in the pants” is mild, the partial retraction of the foreskin allows men to get by, venturing into adulthood with occasional hygienic issues and limited ability in sexual performance. Imagine all the built up of the smegma trapped in the penis that had not been washed. And worse still, not knowing the “full potential” of ones manhood, when the only ability to have sex is the gentle manipulation of the penis during masturbation, to prevent the risk of tearing.

Dr. G is often shocked by “sexually naïve” men, who are too embarrassed to discuss the obstacles they face with phimosis to maintain hygiene and enjoy a normal sex life. When Dr. G is put on the spot to discuss the options of solving the issues of phimosis, he is further shocked by the degree of apprehension with circumcision, despite living with a very restricted sex life and minimal penile hygiene. When it comes to true phimosis in adult men, the conservative options of topical steroid creams and stretching is only effective in the very mild cases. Besides, other versions of surgical intervention to avoid circumcision are often insufficient to expose the glans and may be cosmetically unpleasing.

Historically, phimosis has been noted to affect fertility and even sanity. King Louis XVI of France was believed to have phimosis and this prevented him from impregnating his wife for the first seven years of marriage. Separately, Charles Guiteau who assassinated the US President, James Garfield, was also speculated to have “phimosis-induced insanity”. When I am put on the spot for my advice for the management of adult phimosis, this is my reponse.

“For the sake of vanity or sanity, go for the cut and release the “band in his pants”, only then he will realize what he has been missing for the last 27 years!”

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