Hello Al. Thanks for accepting the invitation. Although you will
get some intelligent responses (such as Geoff B's recent one) on "ARC"/ "Parsimony", you may on the other hand find it very confusing and disturbing.
Right - to start with, there are two situations where you get a tight foreskin. One is where it has never worked "properly" - pulled back easily and reasonably fully; and in such cases the primary advice, is to persistently stretch it.
Yours is however, clearly the second situation - you were
fine, but something happened. Clearly some disease process is at work. Geoff is most likely correct in that the simplest cause is yeast infection with Candida species, or possibly another fungus. A pretty specific indication of this - is an itch
, and some degree of redness. Did you notice such?
It is certainly reasonable to try the Clotrimazole cream in the first instance which will hopefully at least settle down any irritation present. If it does so, it will then
be appropriate to proceed with with some stretching - and I commend you to read a few of the threads here to follow the various ideas we suggest. But I specifically point out - your particular problem is
distinct insofar as you have some reason for the tightness, and that problem must
be brought under control before any
improvement will be possible.
If Clotrimazole does not seem to be working, a reasonable next step would be to try Fluconazole (Diflucan®) which I believe you will find now available "over the counter" as a single tablet whose effects should last for at least a week, and might reasonably be expected to "shake" a Candidal problem. Incidentally - you might care to explain just how long ago this problem started, and whether your wife happens to be troubled by yeast infections?
Actually, having said all this, I really think you need to see a doctor about it, but we feel from experience, that you need to be very cautious as to what (s)he suggests. It is only too common, particularly
in the USA, for a doctor to suggest circumcision, or referral to a "Urologist" - who would in turn, almost certainly recommend circumcision.
There is much clear ignorance
on this subject, particularly as it involves discussion of sexual functioning, about which many doctors feel very uncomfortable, and as a result, frequently abandon their usual deductive processes! What you have, is not a "urological" problem, but a skin disorder, and for that, you need to see a dermatologist
. Even then, you may (particularly in the USA) have to stress that you want diagnosis and treatment, not removal.
One thing the doctor must do before all else, is to arrange a blood test for diabetes. Unfortunately, being in your 40s as you imply, there is a significant risk that you could be developing diabetes, resulting in glucose excretion in the urine, which favours infestation with Candida ("Thrush"). If that were to prove the case, than you would firstly
need prompt and effective management of the diabetes before you could hope to control the fungal infection, recurrence of which would always be a continuing risk - but of course, the diabetes itself would be the bigger problem!
Note that a blood
test - fasting glucose level followed if any doubt arises, by a Glucose Tolerance Test - and not a simple urine test, is required to screen for diabetes.
Next, you would expect the doctor to actually examine your foreskin, to assess what sort of problem (s)he could determine. If fungal infection was evident, then certainly an effective treatment for this would be started, and either then or subsequently, a suitable steroid ointment would be appropriate to address the actual skin tightness.
I will summarise what you will find in other threads here - Hydrocortisone and Mometasone (Novasone®, Elocon®) are inappropriate and a doctor suggesting them for this condition is demonstrating ignorance of the situation. While I am not sure about methylprednisolone (Advantan®) in this regard, the most appropriate steroid ointments (note - ointment rather than cream) are betamethasone (Antroquoril®, Betnovate®, Diprosone®, Eleuphrat®) or triamcinolone (Aristocort®, Kenacort®).
The specific effect of these latter is that not only do they settle down inflammation, but they suppress the process of scarring and soften the skin matrix, making it practical to stretch it progressively (and if the condition is quite recent, then quite rapidly) back to the normal or desired laxity.
Why is there a shortage of information on "phymosis"? Possibly due to the wrong spelling!
But it is certainly poorly dealt with in medical literature - and practice - being pretty much an excuse for circumcision.
But enough for now, let's see what you can do with all this? Do keep in touch.