Dear Dr. G,

I am a thirty-three-year old man and have been married for three years.

I was diagnosed with diabetes about a year ago and have recently have been having problems in bed.

Six months ago, I began to realised that my foreskin had become very tight and difficult to pull back for cleaning.

I even noticed some unsightly cracks on my manhood – the penis become red, itchy and also smelly.

I went to the doctor again, he told me this was related to my diabetic condition. Apparently the skin can become too tight, cracks and is infected with fungus.

The doctor advised me to have a circumcision or the foreskin could become stuck if I pull it back forcefully.

I was shocked! Having this done at the age of thirty, isn’t it ridiculous?

But true enough, about three weeks ago I was having sex and the forced retraction of my foreskin left me with a deep cut and skin stuck below the glans.

My wife rushed me to the hospital and the nurse had to help me to put my manhood back as it should be.

With a bruised manhood and ego, could Dr G please tell me what is wrong with my penis?

Why am I still getting an infected, itchy penis despite good diabetic control?

Do I have no other choice but to get the cut?

Yours truly,
Bruised Bruce

The condition you described sounds like balanitis, which is characterised by the inflammation of the glans penis. When the foreskin is also affected, the condition is termed balanoposthitis. The term balanistis, apparently, is derived from Greek word “balanos” which means “acorn”. Which does kind of describe the condition quite graphically!

Balanitis or balanoposthitis is common condition believed to affect 3% of all uncircumcised men. In a recent clinic survey, balanitis constituted 11% of adult male urology outpatients. The inflammation is usually caused by build-up of smegma in cases of poor hygiene. This can be further complicated by bacterial, viral or fungal infections. Recurrent episodes of balanitis eventually cause scarring of the penile opening. The reduced elasticity of scar tissue on the foreskin then leads to pathological tightening, often referred to as phimosis.

Fissuring or the cracking of the foreskin is a phenomenon well recognised amongst diabetic men. The infections, scarring, tightening and cracking is believed to be a biochemical process that is the hallmark of excess sugar. According to studies, the accumulation of AGEs (Advanced Glycation End products) causes continuous biochemical stress to the normal skin. This is further exacerbated by repeated acts of retraction from washing and sexual intercourse. Furthermore, poor hygiene with the accumulation of smegma will promote a vicious cycle of candida overgrowth.

Most men with infected foreskins and tight fissures will find it impossible to keep the glans clean, let alone have sex. Any forceful attempt to retract the tight foreskin is often a recipe for disaster. Paraphimosis occurs when the tight retracted skin constrict the glans. This is an emergency situation as the glans could be deprived of oxygen and at risk of ischemia and turning gangrenous.

Martial arts master Bruce Lee once said; “Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind!”

When it comes to the manhood of diabetic men, the same principle regarding stiff wood applies. So for diabetic men with a cracked manhood resisting the inevitable snip due to a bruised ego, Dr G on the spot says; “the stiffest trunk is never easily cracked when properly trimmed. Then, the curse of the wilting willow will be gone with the wind!”

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