I have been reading through this site and notice that there have been a few posts that mention stretching when there is scarring of the foreskin.

I have seen two differnt urologists regarding my phimosis, and both have said that stretching(or a preputioplasty) would not succeed for me because of the prescence of scarring on my foreskin (which is either a 'fair' amount or mild depending on the urologist). Not being familiar with the skin of the penis other than my own I did not realise it was scarred, but apparently I have micro fissures evidenced by a grouping of white dots around the opening of the foreskin. I also have a tougher whitened ring around the opening itself (although this is not as thick as most of the pictures I have seen showing a phimotic ring). Although I have never been able to retract my foreskin, even when flacid, I seem to have got tighter over the last few years and thought may have been another effect of the scarring. I have no idea what has caused this, one urologist suggested yeast infections but I have never had any noticible discomfort or signs of infection, although the last urologist I saw also thought I was showing some signs of BXO on the glans.

Up to finding this site I had assumed, based on their advice, that it was not posible to stretch scarred tissue, at least in any way that would permanently allow me to have a functioning foreskin. A few of the posts on this site appear to contradict this. Would any of the contributors to this site be able to throw some light on the situation? Does anyone know or have had experience of anyone who has successfully stretched a scarred and phimotic foreskin until it became fully functional?

If it is possible, is a steriod cream considered vital to the process, or does it just help speed things along? Does the process of stretching take longer when there is scarring? Finally I had been wary of doing the stretching exercises before I had my consultations as I was concerned about causing scarring and making things worse. Presumably I now have nothing to lose, but should I be especially cautious in any way to minimise the risk of further damage?

I have been given a provisional date for circumcision in about a month's time, but I am seeing my GP on Wednesday to confirm. I am minded to do what I can in a month and cancel if I see any signs of improvement, but if I may need steroid cream I understand I will need a prescription from my GP, so I would be grateful for any advice anyone can give before I tell my GP I am going against the advice of both urologists he referred me too!

These guys you're seeing are really good salesmen, aren't they? Having seen the price stickers on the windows of some of the new model luxury cars, it certainly makes sense!

If one doctor suggested BXO, wny didn't he prescribe a proper preparation? Circumcision is no longer the first line of defense for this situation. It can be treated successfully.

The little fissures indeed could have been caused by yeast. Have you ever been on antibiotics? One possible side effect of them is that the defense against yeast is lost.

Now, about scar stretching, consider this: Many babies are circumcised within their first few days of life. At that tender age, their little penises are generally about 1 cm in diameter. A scar is created at the place where the two severed edges grow together. By the time the boy becomes a man, his penis will have grown to a diameter of more than 2.5 cm. Upon erection, it grows even more. During the time he was maturing, the scar grew too. The alternative to that growth would be a constriction at the juncture, would it not? Have you ever seen that? No, because the scar grew with the gentle tension it encountered during growth of the penile shaft.

What about scars from appendectomies done during childhood. Do they grow along with the rest of the abdomen?

The doctor is using scare tactics on you. If you run into him again, ask him about what I've told you.

I highly recommend that you cancel the appointment. Your GP should be able to prescribe the necessary medicine to help you.

Thanks for the reply, Jim. I'm not sure that these guys are just after my (insurance company's)money (surely duty of care comes before this, right?)- the second one even suggested I have it done where I live to save me having to travel the 200 miles to see him. However I have read elsewhere that if you go to a surgeon for an opinion he's naturally going to be inclined to recommend surgery - its just what they know. Even my GP (who didn't even know there were alternatives to circumcision for phimosis) said that an urologist will stick to a tried and tested technique they know well rather than risk recommending something that they are unfamiliar with.

As for the BXO comment, I have no idea why treatment wasn't mentioned - maybe he assumed that a circumcision was a foregone conclusion. There was no mention of whether this contributed to the phiomsis or not (in fact he says its on the aperture of the glans - so not foreskin related at all???).

I had an accident three years ago that resulted in a severe infection to a leg wound, which nearly cost me my leg. I must have been on some fairly heavy antibiotics for this (although they operated too) - could this have weakened my defences against yeast? I would have to say that I don't ever recall seeing any of the signs of a yeast infection - itchy or sore skin, redness of the skin, swelling etc - so I can't say whether I have definately had this or not.

You make a good point regarding scar tissue on other areas of the body stretching. However as you have used children as examples they would have stretched over years of growth - would it be fair to say that I should expect any stretching I undertake to take somewhat longer than usual because of the scarring?

What is you were to have an appendectomy now, or some other surgery which required a cut on your abdomen. Let's say that you then starting gaining girth. What do you suppose would happen to that scar? Point understood?

My guess is that the antibiotics had an effect upon your ability to keep yeast at bay. Symptons can vary, so it's not surprising that visible signs didn't appear.

I still believe that you are better off with a foreskin, and that you should do whatever you can to save it. Stretching will work if there is no yeast problem affecting the flexibility of the tissue.

Physician are sometimes quite reluctant to veer from their path of training--no doubt about that. Unfortunately, many are never trained about the value of the foreskin, so whenever the least little problem pops up, they consider it dispensible. Well, they're wrong. It's there for a reason and a good one. Yes, you can function without it, just as you could have functioned without your leg, but aren't you glad you still have the leg?

Please read deeply into the "forum" here. I for one have answered all of these questions before, many times. I am out of time today and would have to search for previous material to put together a didactic response. In general, I echo Jim's comments.

If you have had this for a lifetime (how long?), then setting a month as a trial period to "see results" is short-changing yourself. I suggest you decide now - do you want to be circumcised, if so why, as you have not explained how this would benefit you, or do you want to work on your foreskin so that it can function normally?

Obviously you have been checked for diabetes with a blood test?

Hi Paul. I had searched the forum prior to my posting, and was aware of the advice being offered. However I had not seen any comments from anyone with scarring to say that stretching had worked for them, how they achieved it and how long it took.

The reason I am looking for 'success cases' is that both urologists I saw said that stretching works best for younger men (I am 40 by the way) or where there is no scarring present. They have both said that in cases they have treated stretching a scarred foreskin at best had a marginal effect and their patients had eventually elected for circumcision anyway. I have also found some medical papers on the net that advise conservative treatments instead of circumcision, but even thay state that a scarred foreskin is an absolute indication for circumcision. So although I don't doubt your advice is well intentioned, it would be good to hear of cases where it has worked to counter the apparently unanminous verdict that, in the long run, it doesn't work!

Yes I have had phimosis all my life, although I think it has become a bit tighter over the years. I have in any case put my 'appointment' on indefinate hold until I can get a clearer idea of what my options might be. I don't particularly want to be circumcised, but my position is that I have been advised that it is the only option that is likely to work for me (other than do nothing, continue to avoid intercourse because of the pain and risk any hygiene issues as I can't retract even when flaccid). Being circumcised and being able to have sex again is the treatment I am being offered, but being able to 'cure' my phimosis and have a properly functioning foreskin is obviously preferable. What I don't want to do though is spend six months, a year, whatever embarking on an exercise that will ultimately prove futile and end up in me having to be circumcised anyway.

Finally, I have had blood tests and don't have diabetes, although not as part of the phimosis consultations. Interestingly, only the first urologist asked about this.

You can no longer say that circumcision was the only advice. Paul and I agree that it's a last resort, and only as a copout for most guys.

Why are you so hestitant to get started? Laughingly, I'm thinking that you're probably a teacher or an engineer, because they're the only people I've ever run across with such doubts. The real possibility of proof is actually in your own hands, not in someone else's testimony. We've given you advice that we know will work, so all you have to do is to do it. I think it you were to search back on this site, you would be able to find a case in which someone stretched very obvious scar tissue.

There are sometime obstacles, and that's why we ask the questions we do, to help you find answers and to help you direct your local physicians in getting you what you need. I personally think a patient should be part of every decision, and if you're not, you need to go shopping for a doctor who is open to your input. My personal physician actually welcomes my ideas and my questions, and he offers many options.

The hygiene question is really overplayed. If you're not a smoker and you're not playing around, there is little risk for serious disease. If you're still producing smegma, simply do your best at rinsing it out with clear water.

My recommendation is to try what we've outlined. It takes at the most perhaps ten minutes a day, time that you really do have. I think you're going to find success pretty quickly, and once you do, it isn't going to take all that long to get it done.

By the way, forty is really pretty young! You can do this.

Hi Mark,

This is Gary from the phimosis and psoriasis thread. My problem was not the classic phimosis I have read about but narrowing caused primarily from scaring as a result of small tears from the psoriasis.

I have found it easier to retract the foreskin in the last day or two, a lot less discomfort. I have stretched at least twice a day for ten minuets and am also pulling the foreskin back over the glans each time I pee.

Although I still have a long way to go, I hope this goes some way to providing the testimony you are looking for. Keep up with the regime Jim and Paul have recommended, I’m sure you will see results, just give it time and be diligent.

Stay positive, Stay intact.

Gary

PS. As for the age issue. I turn 50 in May. You’re just a youngster.

Right, let's build up a context here. You are 40, you have never been able to retract your foreskin, but you perceive it to be "tighter" in recent years (how do you assess this?).

You have seen two "urologists" who both think that your foreskin is scarred, though you are not aware of any episodes of infection that would result in scarring. You do however note a relatively thickened and whitish ring around your foreskin which appears to be the cause of the tightness. You also refer to "white dots" which you yourself appear not to have noticed, but which have been suggested to indicate "micro fissures" - but you have apparently not seen such a thing. The out-of-date term "BXO" has been cited as a means to scare you.

Why do you think that stretching would cause scarring?

You refer to having a GP but seeing "urologists" and having medical insurance, however the GP has to confirm arrangements for a circumcision. I am rather puzzled as to from what country you hail - but it uses Imperial measurements.

You now divulge a new problem - pain on intercourse, but do not elaborate. You mention "hygiene issues" as a "risk", but it seems, have not actually experienced any (which does not surprise me - if you cannot retract your foreskin, then unless you make an effort to introduce foreign materials, there is no reason it should cause problems).

I have indeed previously explained that the treatment for Lichen Sclerosis in either sex is primarily the use of appropriate steroids. If one wishes to confirm a diagnosis, this is done by means of a (punch) biopsy. (Funny - I actually recall performing a punch biopsy on a fellow's glans once - but not for LS and the lesion which was completely removed in the process turned out to be harmless! )

Stretching scars? Wow! There is perhaps not a whole industry, but a significant number of special areas in this including the use of pressure suits and silicone pads, physiotherapists stretching scars after operations such as joint replacement, keloid treatment with intralesional steroid injection. And they don't only do this on children.

Interesting point - a number of people actually have surgery to "refashion" scars after major surgery. Why? Because the scar stretched! "Tissue expansion", albeit most of the time performed on intact skin (except for the scar where the expander is inserted) is now a standard procedure for plastic (reconstructive) surgery, and as you have observed in the posts here, is now being applied to the correction of phimosis. At worst you might have to obtain a GFS device.

Well, in summary if you have scarring on your foreskin, as suggested by the "urologist" opinions and your observation of it contracting, then it will be a slower process to stretch and you would definitely benefit from the use of the appropriate steroid, as used to treat Lichen Sclerosis.