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Pinhole Phimosis

September 30 2008 at 6:34 AM
Alan  (no login)

 
I am sufferring from pinhole phimosis. Some years ago, I started putting cylindrical objects (e.g. Chopsticks) in the orifice. Sometimes it works, but more often, it hurts a bit (no bleeding but just feel pain) on the foreskin and as it cures itself scars are built and the hole gets smaller and smaller.

After another hurts caused several days ago, it really looks like a pinhole and it takes 5 minutes for a pee. These days, I use some cosmetic tool (not sharp but can put in the hole) to keep the hole wide enough to pee.

I believed I may have a relatively complicated case as I don't think stretching will work for me. Is it fungal infection or something? Can I just try using anti-fungal ointment with no harm?

 
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Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Fungus very likely

September 30 2008, 9:18 AM 

You'd really have to cause some damage to have the reaction you describe. The pain would probably keep you from doing it, so it's very likely something else which is preventing the hole from enlarging.

Try treating for yeast and see what happens. Yes, no harm will come from using it.

 
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Alan
(no login)

Re: Fungus very likely

September 30 2008, 10:45 AM 

Thank you for your reply.

Just to explore possibilities, I only got 'hurt' feeling (kind of little pain/heat at the opening), but my skin is soft with no crack or red spots or so. Other than fungus, could it be tiny wounds I got from stretching/enlarging?

About the cream, should I apply it when I still have that 'hurt' feeling? Should I do the exercise at the same time?

 
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Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Good questions

September 30 2008, 7:38 PM 

If something is hurting, it's a strong indication something is wrong. I think you need to treat it. The exercise can wait a while till the issue of redness and pain or heat is taken care of. Hopefully, this won't take long.

 
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Alan
(no login)

Re: Good questions

September 30 2008, 9:30 PM 

Yes, I am going to give tea tree oil ointment a try first.

For the exercise, I only insert the tool in the morning to keep a reasonable opening width. It usually gets smaller after a night's sleep.

Thanks again for your help.

 
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(Login Paul_B.)

More information to work with.

October 1 2008, 6:17 AM 

Good. The more genuine information we have to work with, the more completely we will be able to help.
  • Firstly, I really need to know where you are in life, roughly what experiences you have had (partner, children, etc) and most specifically, whether you could ever retract your foreskin fully, what happened in childhood, and so on.

  • You are saying you do not have any visible cracking or injury. I wonder therefore, why you are talking about "tiny wounds I got from stretching" and "as it cures itself scars are built"? I recognise with a fair degree of certainty, this language as the common mythology of the circumcision "fetish" sites and some commercial interests who profiteer from circumcision, and it may indeed have crept into some medical parlance even though it is entirely contrary to medical principle and ethical practice.

    There is no such thing as "invisible scarring" or "micro-tears", or at least no such thing in relation to a process of deliberate stretching. Now there actually is a disease called "Lichen Sclerosis" (which I have discussed previously in detail on this forum) which does cause progressive scarring within the skin, quite independent of trauma (such as stretching), and if you had this, you would certainly need to see a competent dermatologist (that is a skin specialist) who would arrange for you to use either the betamethasone I mention, or an even stronger topical steroid, as long as necessary to control the condition.

    Note that some dermatologists (and again, particularly in America) might show indifference to your problem and suggest you have a circumcision, but it is salutary to note that circumcision is certainly not the treatment of choice when this condition occurs in the same area in women (which it does substantially more frequently than in men). The condition is also called "Lichen Sclerosis et Atrophicus" (LSA) and in reference to the foreskin, "Balanitis Xerotica Obliterans" (BXO) which is somewhat descriptive of the condition, but quite unhelpful in general and these terms are deprecated by doctors whose knowledge is current.

    As you may see from those earlier threads, I think LS is unlikely where you have had this restriction essentially from birth, but not impossible. The use of the steroid would seem to be desirable for this degree of restriction whether or not the problem actually is LS, it is simply that with LS it is mandatory.

  • I am concerned that you may not be stretching accurately and effectively. In general, to get a dilating instrument to pass through the opening, you need to stretch the foreskin forward (lengthwise) so that the passage is straight and the instrument will not become caught against folds inside the opening. Given that you can introduce an instrument easily all the way through the opening, you need an instrument that either opens outward, or is progressively tapered (though as there is limited depth of the space under the foreskin, this may not allow for much enlargement).

    The "Glansie" is designed for such a purpose and particularly for the degree of tightness you describe, though it becomes much less practical as the opening is enlarged to the order of 10 mm, at which point I would much favour the GFS.

  • Whatever you use as a dilator must have very smooth, blunt surfaces with no rough edges at any time. Your use of chopsticks sounds quite reasonable as they are prepared to be smooth, though they are not tapered as much as you might like and are of course, far too long.

    With such a tight opening, it clearly will take longer even when you get the manoeuvres and the medications right, so a dilator adapted more to extended or continuous wearing, such as the "flesh tunnels" discussed here previously, might be the most suitable.

  • Finally, the antifungal cream can be used liberally and there is unlikely to be harm using it at the same time as stretching, perhaps making use of its lubricant properties (though the proper "surgical" or "personal" lubricant may be better). On the other hand, if you obtain the betamethasone ointment, it should only be used in the tiniest amount sufficient to apply to the tight part of the foreskin, without leaving an excess to transfer to the glans or anywhere else. It should not be used immediately before or during stretching as that would almost certainly tend to spread it unnecessarily.
That is what comes to mind at present; do keep in touch!

 
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(Login Paul_B.)

Things which may have been missed

September 30 2008, 3:19 PM 

So, this problem has always been the case, or were you ever able to retract your foreskin? It would be illustrative if we knew your age, how long you have perceived this problem, and whether you are sexually active (since fungal problems may relate to this), and in what country you reside?

In any case, if your foreskin opening is becoming narrower, it clearly indicates some disease process. In such a situation, you do need to use an antifungal for a start. You also would benefit from the use of betamethasone ointment in addition to the antifungal. If you do a good deep read back through the forum here, you will see that we have discussed these things in detail.

If you could find a doctor who understood such matters (and most American "urologists" do not, but the NORM or NOCIRC sites offer pointers to doctors who should), it would help with the prescription of such a medication (the antifungals are of course "over-the counter") and some guidance on just how much force in using a dilator is likely to be appropriate.

If you have not been using a lubricant (standard "personal" or surgical one) to do the stretching, then this may well be difficult and traumatic, hopefully that may be the solution to your difficulties. Stretching should be only marginally painful, and correctly performed will not be the cause of scarring (on which point you may well have been misled by "information" elsewhere).

 
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Alan
(no login)

Re: Things which may have been missed

September 30 2008, 9:41 PM 

I can never retract my foreskin, and since birth the orifice has never been bigger than 1 cm in diameter.

I am now 34 and the symptom has been with me for about 8 years. I am gay and I only do hand job and oral sex. However, I am not sexually active anymore and I only do masturbation. I live in Hong Kong.

For betamethasone, I have used it for about a month several years ago, but now I would prefer a non-steroid approach.

Doctors here mostly will try to talk me into circumcision.

I use vaseline as lubricant.

Thanks for your help.

 
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(no login)

More things

October 1 2008, 3:43 PM 

OK, clearly my reply dated "October 1 2008, 6:17 AM" was submitted before yours here was actually posted, so thank you for the specific details about your situation.

One cm would have been quite a decent starting point from which to stretch to "normal", if you had that much of an opening, it would be quite easy to use the GFS device. Clearly, something happened eight years ago which has caused the present situation and I think we have to accept that the skin is diseased in some manner. This suggests to me that you will need to use the betamethasone in addition to an antifungal despite your "preference"; the situation is relatively serious.

I suspect that in Hong Kong, betamethasone 0.1% ointment is in fact, procurable without a doctor's prescription. The fact that the doctors there will mostly try to talk you into circumcision indicates more their lack of knowledge of alternatives, than any deliberate malevolent design, though they may of course, profit from performing surgery. I presume that in that culture, they are more sympathetic to your desire to have a normal foreskin, than in America where ritual circumcision is so common.

"Hand jobs" and oral sex would seem to be relatively unlikely to introduce Candida ("thrush") to your foreskin, than vaginal intercourse, while solo masturbation has a pretty negligible risk unless of course, you practice anal manipulation as part of masturbation in which case it is a huge risk. The anus is the prime source of contamination with Candida in both sexes, simply because Candida is a contaminant of food and can actually proliferate in the bowel. Obviously anal intercourse, irrespective of the partner's sex, is "asking for trouble" from Candida infection.

Vaseline is fine as a lubricant for this purpose - and is also the base for the betamethasone ointment in any case.

 
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Alan
(no login)

Re: More things

October 2 2008, 7:34 AM 

betamethasone 0.1% needs doctor's prescription here, not decided yet..For antifungal, I am using 3% Tea Tree Oil ointment as a start.

Today's update:
One point on the skin around the orifice hurts a bit when I put in my stretching tool (kinda cosmetic tool) until it gets stuck. Aiming to make a bigger hole, I tried to put in more..The orifice becomes a bit bigger now, however, when I pee just now, it seems to have 1 to 2 "wound" points and they cause more pain. No bleeding found.

Am I still in a state of "infection" or "inflammation"? I have had a little white discharges a few days ago (after a night's sleep), but not now.

 
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Jim
(Premier Login jimsplacetofixthings)
Forum Owner

OK

October 2 2008, 12:44 PM 


The tea tree oil is anti-fungal, anti-viral and anti-bacterial, so it should take care of any infection. One problem is that it can irritate delicate tissue. The glans and the inner lining of the foreskin are composed of mucosa, which could react unfavorably to the oil. Has this happened yet?

What consistency was the discharge? Was it watery, creamy or flaky?

 
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Alan
(no login)

Re: OK

October 2 2008, 5:29 PM 

My ointment is 70% aloe vera and 3% Tea Tree Oil. With 3% only, I think it doesn't react in any visible way as I didn't find any.

The discharge is just white and watery. As opposed to what I may think of a fungal infection should be, there aren't any flakes found for me.

So, I am not so sure about my condition here..

My symptom is the skin around my orifice gets hurt easily (usually start at any one point) as I insert a tool for stretching 1 to 2 times a daym with vaseline as lubricant.

When it gets hurt, and if I continue to do the exercise, I get something like an infection (pain at point of hurt when urine passes thro', occasional white discharge and no bleeding). After it recovers, the orifice gets smaller. If I am in good luck, I can then stretch it again to a size before the hurt.

Is it more like a fungal infection or I am just working to hard on it? If it is the former, I think it should not be a serious infection since I don't have a thrush or flakes or itchy. For the latter, heard from you guys that the skin should be quite elastic enough..(or because mine is no more since I have scars?)

 
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(Login Paul_B.)

Defining the actual problem

October 2 2008, 2:56 PM 

Frankly, I'm not so keen on the Tea-tree oil as an effective antifungal and I certainly couldn't guarantee that it would not cause irritation and inflammation in itself. I would prefer to see you using a known pharmaceutical such as clotrimazole, miconazole or even fluconazole by mouth.

And your description of a "white discharge" definitely suggests that the overall problem is a fungal infestation. Now, if you have fungus (Candida; "Thrush") hiding under the foreskin, then the obvious problem is - how are you going to get at it? Well, you have two options, one is the oral fluconazole (Diflucan; Canesoral) and the other is to get one of the other creams into the space under the foreskin.

There's the point: I am concerned about exactly what it is you are doing with your "cosmetic instrument" (and indeed, just what sort of instrument it is - I have been presuming that it might be something that resembles the "Glansie"). As things stand, you should have a space under your foreskin, between the glans and the inner part of the foreskin; this space should extend all around the glans (except for the fr├Žnulum underneath) and should extend to the back of the glans - the "corona" or ridge that defines the extent of the glans.

We refer on this forum to the "balloon test" in which you hold the foreskin opening shut as you pee, so that this space inflates into a nice round balloon which then conceals the glans entirely. If you are having difficulty peeing at a normal rate, then this is what should be happening every time you pee and I am surprised that you have not mentioned it. If it is not happening, then either your foreskin is completely adherent to your glans, which would indicate quite severe and chronic inflammation (and indeed, make the stretching process far more difficult; beyond what we could hope to assist you with simply through advice here,) or else you are confused as to which part of your penis is which, and actually have a meatal stenosis rather than a narrow foreskin.

Given that your foreskin is pronouncedly "ballooning" whenever you pee, and in proportion to the difficulty that you have peeing, then it will demonstrate to you that there is such a space under the foreskin and whenever you introduce an instrument, it should pass through the narrow part and into that space with no difficulty or discomfort whatsoever. If you have an instrument like the "Glansie", it can then be gently opened out to provide the appropriate stretch to the tight foreskin.

If you have a tapered instrument (with more taper than the chopsticks), then it should be able to be passed just into the space under the foreskin as I say with no difficulty, and then passed further in to provide the stretching, as far as the distance between the front of the glans and the back (the corona) allows. Clearly, to do this requires an instrument with a particular taper behind the tip; they exist but I cannot find a reference to such.

In any case, I mentioned before that in order to get the instrument to pass through the tight part of the foreskin, you need to stretch the foreskin forward as you insert it. Similarly, to get the antifungal creams into the space under the foreskin, you have to place the nozzle of the tube of cream against the tip of the foreskin, then hold the foreskin over the nozzle so that it makes a seal, then gently squeeze a bit of the cream through the foreskin opening into the space underneath. Once you have a little of the cream inside, you can massage it around so that it spreads all through that space.

 
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Alan
(no login)

Re: Defining the actual problem

October 3 2008, 6:45 PM 

Since the clotrimazole and miconazole are sold under doctor's prescription here, I am using tea tree oil ointment as a starting point. I can only find tolnaftate over the counter, will it work?

My cosmetic instructment is a kind of taper. For my case, my foreskin opening is only 1mm!! The tool is needle shaped (but no shape) and I can put in for about 1 cm. I applied the ointment on the outside of the hole and use the tool to get some inside.

For ballooning, yes, I have several inflammation/infection before and my glan adheres with the foreskin. When I pee, only the part near the tip swells a bit.

More on my symptom, the foreskin is actually a bit swellen (thicker) near the opening. When I just pee, it still hurts. Before bed, I got a little (1~2 drops) watery transparent discharge with a bad smell.

 
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(Login Paul_B.)

Limitations

October 5 2008, 5:53 AM 

It does sounds as if you are in a very difficult situation there. Tolnaftate is a somewhat weaker antifungal to my mind - but may well be effective (I just took a look at it on my software - there are five or six listings for products using it; sometimes in combination - it is claimed to be quite unlikely to cause a sensitisation reaction).

I fear I have little more to offer; I have described as well as I can the technique of "injecting" some of a suitable antifungal cream under the foreskin and massaging it around. You clearly have a particularly chronic (longstanding) inflammation which will take some time to treat.

I have to say that it sounds as if you would be best served by a doctor with competence in this particular area but I have no idea how you would go about finding one. Clearly, you would need to avoid being referred to any doctor with the title of a "urologist" - it is a skin specialist or dermatologist that you need unless you can find a "generalist" ("GP" or "family physician") who takes a serious interest in your concern. Circumcision is somewhat farcical, as it would involve stripping any adhesions you may have developed to the glans, so in effect it would involve even more damage.

 
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