Hello all,

I am a 25 y.o. intact male who has had non-retractable foreskin my whole life. I have an appointment w/ a foreskin friendly urologist next week, and he and I are going to discuss my options. I have been streaching for about 6 months and very slow, somewhat painful results, even using a steroid cream. I wish to remain intact so I am considering a preputial plasty of some sort and need oppions. here are the pictures of what I am dealing with.














I would like some suggestions, as well as any personal experiences with this issue.

thanks
kyle

Kyle, has that white ring always been there? I wonder if there might be a problem with yeast. Ask the doctor about that.

If you've already had results, my suggestion is to continue stretching. If there's a yeast problem, get it solved and things should progress faster.

How do you like the Glansie?

Yeah the white ring I have had forever, yes I am very sensitive to yeast, I basically have had to remove it from my diet, but no progress on w/ my foreskin. I am on an anti-fungal/yeast suppliment, which helps for digetsion, but it its kind of painful to strech. The glansie is ok, but like I said somewhat painful, I am not having any real progress streching. I have been working on it for almost six month and those pictures are what it has improved to. My doctor stated that because the skin never dries, it will be extremely difficult to get rid of the ring, therefore he recommended dorsal slit of some sort then continued streching. does this make since? has anyone else seen this? or gone through phimosis like this and to this degree?

That yeast has to come under control. Taking yeast alone out of the diet obviously isn't solving the problem. You have to eliminate whatever feeds it too. That means carbohydrates of all kinds. It's just a temporary thing, so you won't starve.

Get rid of all potatoes, rice, pasta, beer, wine, sodas, fruits, dairy products, and anything that has sugar in it. Also eliminate anything which if fermented, such as vinegar. You're going to be quite hungry while doing this, and you may not feel well at first. Don't give up. Carry celery sticks with you to take care of the hunger. At meal time, have fresh meat (nothing cured) and vegetables, heavy on the leafy greens.

Within a month, you should find a huge improvement. All the while, continue what your doctor prescribed for the yeast. I think you should also apply a topical treatment to that area around the white ring. Just about any over the counter yeast preparation should work. Look for them where women's personal items are displayed.

As Paul has said, the dorsal slit creates a cosmetic problem. If you can visulize a dog with floppy ears, you get the picture. Since you've live this long without retraction, what is another few weeks. Give these treatments a chance to work first.

Do you regularly take any antibiotics? This is often a cause of the yeast imbalance. You can get acidophilus supplements which help to get your system back in order. I suspect that you probably have other health issues attributable to the yeast.

As a side note, you'll become amazed at how much more clearly you can think once that yeast is controlled. It's as if a veil has been lifted.

Hi Kylie
Your excellent pictures show me that almost certainly you have BXO . (Balanitis Xerotica Obliterans ). This might be helped by treatment witb the strongest steroid creams e.g. Dermovate , but will probably have to be circumcised. I should be most ninterested to hear what your foreskin friendly surgeon said. Regards Dr Peter

I quite expected the "bogey word" to pop up here sooner or later. Such is the risk of these discussions.

"BXO" (Balanitis Xerotica Obliterans) is a deprecated (that is, obsolete) Latin term which loosely translated, means "I want to do a circumcision". Of course it must be conceded that when it was first described prior to the development of the fluorinated steroids, there was no treatment other than to cut off the affected part - and keep cutting off successively more should it progress.

The more correct term for the condition is Lichen Sclerosis which itself was previously mis-named "Lichen Sclerosis et Atrophicus". This term is more correctly descriptive of a skin condition which is correctly treated as - a skin condition - for which surgery is only indicated in the rarest of cases.

The lecture to which I alluded here previously - as my comments may be found in the page somewhere below this reply - pointed out why the older term is wrong, as the condition is not atrophy, but excess scarring - which the illustrations above do not appear to indicate, but rather "maceration" - a build-up of moist skin debris, and neither does the description of a condition present without change for most or all of Kyle's life, match (as Dr. Ball concedes).

Nevertheless, the import of all the lectures I have attended in recent years, is that Lichen Sclerosis is commonly and badly mis-treated due to the reluctance to adequately use the potent steroids in the misapprehension that there is some "danger" in using them, and that the mis-naming of the condition by the appendage of the completely incorrect term "Atrophicus" has but compounded this error.

In other words, and as so often happens in medicine, Lichen Sclerosis - as it occurs on the foreskin, and whether or not this is a factor in Kyle's case here - most often responds quite satisfactorily to steroids and thus circumcision is a most inappropriate suggestion - but only if steroids are actually used and used correctly.

"Correctly" means that the right steroid is used; the most potent available which appears at this point to be Clobetasol (DermovateŽ/ TemovateŽ/ or possibly EumovateŽ); that is is used regularly - at least daily if not twice daily and that there is no benefit in "resting" from the treatment - it is a serious disease to which one must "Give no quarter". Treatment must be continued until the disease has completely visibly settled and for some small time after at which point it may be ceased, but must be re-commenced immediately at the earliest sign of recurrence.

And of course, the steroid must be applied correctly - applied exactly to the affected area and only to the affected area. My understanding of dermatology is that for this condition (as for most conditions unless there is significant exudation), the ointment is preferable to the cream as it maximises skin penetration.

The final comment regarding "BXO" is that there is a "gotcha" regarding its diagnosis, which is by biopsy - i.e., you cut a piece out, send it to a histopathology laboratory with a request form that says "this looks like BXO" and the lab sends back a reply "Yes, it does look like Lichen Sclerosis" (or BXO, depending on the era of the pathologist). What's the "gotcha"? Well, if you didn't tell the lab that it was foreskin or vulva, and didn't mention the "magic words", the report would read "Non-specific dermatitis with evidence of chronic inflammation".

In other words, it's all a matter of interpretation - the disease is what you want it to be, usually mild and responds promptly to steroids (but may come back and require successive courses - not uncommon with many skin conditions), sometimes more severe and requiring - more intensive and more persistent steroid treatment. You might consider it to be common, in which case the vast majority settle either spontaneously or with brief treatment, or you might consider it to be relatively rare, but difficult to treat. It probably is a continuum.

Nevertheless, it does appear that to some extent, its predilection for the vulva and anus and (perhaps one-sixth as often) the penis - and much more rarely, the mouth - is related to those being persistently moist areas. There are various theories as to why this might be. It therefore does make sense that as much as circumcision, treatment with steroids and stretching so that the foreskin can be easily retracted, will alter the environment of the skin such as to reduce the likelihood of recurrence.

And while I still doubt this is in fact the nature of Kyle's problem here, it does similarly apply that if he can stretch his foreskin fully so that it retracts easily, the curious white "macerated" appearance should resolve. It's all a matter of getting over that hurdle.

Hello Kyle. Nice pics, not a bad camera that Digital Rebel XT; good flash exposure at close-ups, which is hard to do with basic cameras. Unfortunately the last shot with the self-timer managed to focus on the wardrobe doors instead of you!

Clearly you have a bit of a problem there, but not insurmountable, so I'll throw a few suggestions and questions at you, and see how we can do:

• Jim is worried about the whitish appearance - it's a good point, it may suggest some fungal growth, so his question as to how recent it is is of relevance. It may however, merely represent a buildup of skin debris - since skin is continuously growing - just like you get "wax" (cerumen) in your ears. In fact, the ear is a pretty good comparison - this narrow opening looks passably similar!
  
  Is it itchy or irritated in general?
  
  
• You evidently have obtained a "Glansie" - good move for your particular problem. Unfortunately, to my mind you have the wrong sort - the cheaper one without the "lock", which is probably the most important part, as it allows you to use it for much longer periods without fatigue. Alternatively, some rubber bands might do the job.
  
  
• Could you please explain in what way the "results" are painful? I think the "jaws" of the Glansie are far too narrow in most cases, and if you can stretch as far as you demonstrate, then you really need wider "jaws".
  
  This can be implemented by using "snubs". The sort of thing I have in mind is the little plastic handle such as used on toggle switches, these are in fact also used to protect various (sharp) surgical instruments during transport and thrown away when unpacked, but that little nugget of knowledge will probably not help you!
  
  Snubs (or "shods") are also used on surgical clamps to prevent marring of suture material whilst being held, and are in that case simple short lengths of (silicone by preference) tubing pushed over the jaws. Your local hardware shop may have some suitable tubing, perhaps that used for air hoses to fish tanks (though that may be too large). The only problem is that the cut end can be rough - you may be able to smooth it with a hot air appliance.
  
  
• Whilst both pressure and duration of stretch are important, I venture to suggest that duration is slightly more important, so I really am keen to suggest means to make longer stretching sessions both comfortable and practical.
  
  
• You mention "steroid cream", but as you might observe from reading back on this forum, that does not mean much. Only Betamethasone and Triamcinolone or I think, Clobetasol are really useful for this purpose, while if you have been using Hydrocortisone or Mometasone (EloconŽ/ NovasoneŽ), then you have essentially been wasting your time. The very effect that is classed as "dangerous" in respect to long-term use of the first three I mention, is the very effect that is essential to treat this problem - though there is some risk that these preparations may render you more susceptible to "Thrush" (Candidal) or other fungal infections - so you may need to use an anti-fungal in addition.
  
  
• Finally, if you are indeed to see a "foreskin friendly urologist" in the near future, then you may measure just how "friendly" he is against his attention to all these details in preference to surgery. The problem with "preputioplasty" is that it is unlikely to be sufficient on its own and simultaneously deliver a good cosmetic result - you would need to apply the same stretching techniques (not the Glansie) afterward, as part of the healing process.

I have not mentioned the use of a "dilator" to be worn throughout the day (and night). This is another consideration about which it would be interesting to see what the urologist thinks!

ok here are some additional details to the issue. I understand the candida diet most likely better than anyone, I live it. I am slightly allergic (more accurately intollerant) to most forms of wheat, therefore all yeast is a direct hit to my immune system...basically makeing my gut a breeding ground for yeast. apparently my foreskin also. I have never thought to get a female yeast product will this help?the steroid cream i have is mometasone furoate usp 0.1%, I am open to continued streaching but the white band is the painful area...basically when i streach it fatigues and becomes irritated then shrinks in responce, not what i am looking for. I spoke with the doctor about a dorsal slit he said no to that but reccommends a procedure to remove the white band and open the area and stich it back togeather to form a uniform circular opening, which he said i will have to streach once what he is calling the white area (scar tissue) is removed. please keep the suggestions comming
thanks

Interesting comments there. Intolerance to wheat is generally a manifestation of Coeliac disease (also known as gluten-sensitive enteropathy or coeliac sprue) which actually is a real allergy; that is, an activation of the immune system. It has in itself, little to do with yeast however.

A "female yeast product" would be quite appropriate for use with the steroid cream, and insofar as what is troubling you may have a Candidal component, may help anyway, but a product offered for general use containing clotrimazole (CanestenŽ or LotriminŽ), or the oral once-a-week fluconazole (DiflucanŽ) is just as appropriate as the vaginal creams.

Betamethasone 0.05% is appropriate for the purpose of facilitating stretching, the ointment version is generally preferable to the cream as it is less likely to migrate after application, penetrates the skin better and tends to reduce maceration (chafing) of the skin.

You apply it twice a day, get a tiny bit from the tube on the tip of your finger, and apply it only to the part that is tight while you put it on the stretch. That is the only bit that needs to stretch, so it is the only bit you want the cream or ointment to go on. If it feels distinctly "greasy" afterward, you have put on too much, and increased the risk of it getting on other areas on which you did not want it. It's not really dangerous, but whatever problems it might (theoretically) cause, are directly related to the amount you use.

The matter of how "dangerous" these medications are was dealt with in a lecture which I attended just a few weeks ago. People tend to become confused about the difference between "atrophy" and the development of scar tissue - these are completely opposite processes. If the problem in this case were caused by scarring of the problem area, which may or may not be the case insofar as you describe it as present from childhood, then this is absolutely not "atrophy", which is cited as a potential side-effect of the steroid.

You want the skin to soften and loosen so you can stretch it. This is the effect of the steroid; in this circumstance it is not a "side-effect", it is the therapeutic goal. It is why you want to use Betamethasone or Triamcinolone or Clobetasol, and why Hydrocortisone or Mometasone are relatively useless as they are specifically intended to be "safe" and not do this (significantly). I mention this as I wish to refer other people to this discussion in regard to the "safety" scare.

Moving on to surgical options.

A dorsal slit is (very) effective in enabling you to retract your foreskin, and is absolutely functional - unfortunately is does not produce a good cosmetic effect in many cases due to the asymmetry. That said, I suggest that your specialist's suggestion is also inappropriate as it conceptualises "removing the scar tissue". One has to ask on the one hand - is it actually scar tissue? If not, then why remove it? Secondly, if it is scar tissue, then what makes one think that removing it, which requires the borders of the area removed to heal - that is to form scar tissue - will not re-create the same scar tissue? Of course, you would have to stretch it after all, unless a grossly excessive amount is removed, which is to say, a true circumcision!

Since what you want, is to provide more length around the opening, the correct procedure is what is called a "plasty", which is an almost universal principle in Plastic and Reconstructive surgery (not to be confused with Cosmetic surgery, though that of course will use similar techniques where needed).

Applied to your problem, that would be to make not one "dorsal" slit, but six, evenly spaced around the tight opening (because the opening you demonstrate is actually, reasonably symmetrical), which are then sutured over around the circumference. The result is a little like the "Christmas party hat" - a zig-zag edge whose total length is much longer than the original edge and while it includes parts of the original border and its supposed "scar tissue", the other parts will however be easier to stretch (and indeed, you need to stretch whatever path is taken).

Incidentally, were you to have this done (and that should still be a very distant consideration), you would also be using the steroid during healing as it often is to prevent recurrent scarring.

Now you (or your specialist) might object that this "zig-zag" edge could be a cosmetic concern. But it isn't. When your foreskin is forward, most would be covered; it becomes part of the "frilly tip", while when retracted, just as that "frilly tip" smooths out, so would the "zig-zag" edge (though as you might note if you happen to have been following the foreskin "fetish" sites, it might take a while). This procedure specifically lengthens the circumference of the opening, far more effectively than the "partial circumcision" you have described.

ok, so i purchased some lotrimin ultra, and i have the betamethasone cream and i have been streching twice a day and i must say i am seeing some progress. I am experiencing minor tearing its not overly painful or uncomfortable so i have just continued. but i need to know how to use the lotrimin. should i use the betamethesone and the lotimin at the same time or apply one then 3 hours later the other both twice a day? so for example

8am streach
9am steroid (just after streaching and showering what ever)
12 noon lotrimin
6pm steroid
9pm lotrimin
10 streach

does this schedule work well?

or should it be altered?

thanks

If the Lotrimin and the betamethasone are both creams then they are pretty miscible, and it matters little in which order you use them.

I generally recommend when using betamethasone ointment, to make sure the antifungal (such as Lotrimin) has been rubbed in and disappears before using the ointment - as ever, sparingly, that is, in the minimum amount. The reason for this is that the ointment will "seal in" the other, while if you used it first, it might seal it out!

It occurs to me however, that if you can put them on separately, that is more consistent with my comments about using the betamethasone sparingly and making sure it does not get anywhere but the exact spot where its effect is desired. The purpose of the Lotrimin however, is to clear the whole area (under the foreskin) of any Candida, so you can be more generous in its use; one way is to squirt a little through the foreskin opening (by not pulling the foreskin tightly back) and then to "massage" it around under the foreskin (which might arguably lead to other occurrences ).

As always, we emphasise that it is the non-violent but persistent stretching, that is the main factor - but you have been doing that awhile.

Your comment about "minor tearing" concerns me a little - this is not a desired effect and I would tend to advise to "take it easy" but not by any means stop the stretching. I presume you mean the skin develops little cracks ("fissures") rather than tears. You certainly do not want this to happen to the extent that it is either painful, or bleeds, but it does indicate that since healthy skin does not tear at all easily, there may well be a chronic fungal problem which the combined treatment will in most cases resolve.

I am actually not particularly familiar with "Lotrimin UltraŽ" - it is a slightly different drug from the clotrimazole that I associate with the brand "LotriminŽ", but it sounds quite appropriate.

All in all, it does sound that you are "getting there" and that schedule is just fine - do be patient, and thanks for the continuing feedback. I shall be particularly interested to hear when you can see the tip of your penis.

Hi Kyle... read your post and am in a similar situation.. here is my history

I am a 24 yr old uncircumsised male from India and measure 5" when erect. My foreskin used to not retract at all over my glans as I had never tried to attemp it. I was having no problem masturbating or having sexual intercouse with my girlfriend since the past two years... used to get very confused when I used to see pics of retracted penis on the internet (used to assume they are circumsised. However when I researched over the internet I realised that I suffered from phimosis. I then started some streching exercises.

After these exersises I could pull my foreskin a little behind.. but this led to a new problem. Once when my girlfriend was riding me (I dont pull my foreskin behind before putting on a condom) my foreskin came down and got stuck there. My glan felt so sensitive that we had to stop right away.. also the foreskin got stuck behind the glan and felt very tight.

Now I practice manually retracting and manage to pull the skin back over the glan.. its much better now and less sensitive.. infact I can now masturbate in this position but the foreskin still feels pretty tight behind the glans.

I am still looking for advice.. donot even wanna think of getting circumsised.

Pl let me know if you would want to me to share my penis pics in its various stages (from unretractible to fully retracted after streching) if that can help them get a clearer pic of my condition and advice.. and to compare their case with mine.

P.S if you can pls tell me how to load my pics in the query itself the wayu you have done it .. I do not know how to do that
Regards
Kumaar