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Phimosis at 54

October 13 2008 at 2:36 AM
  (no login)

 
My age is 54.No Circumcision has been done.From last many years my foreskin was able to retract,though not very easily,and I was able to wash the under part.Now from last 1-2 months,slowly slowly I am not able to pull back my foreskin.I am not having any problem at all.I am leading a normal sex life.I am able to urinate.I fell no infaction or any irritation and no infflation.But foreskin is goining on becoming more difficult to pull back and I am not cleaning the inner side from last 40-50 days.I request you to guide me and advice me wheither I shall not worry about this as I have no problem at present or it is necessary to pull back the skin and clean the under part anyhow.Thanks.

 
    
AuthorReply
Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Discover cause

October 13 2008, 9:12 AM 

When something such as this comes out of the blue, there is cause for concern. Ordinarily, yeast is the reason. Zealous attempts at hygiene through the use of cleaning agents, such as soap, can upset the natural balance of little creatures which reside on our bodies. If you kill off the good guys, the bad ones take over. Another way it happens is throught the use of antibiotics. This may be your problem.

Usually there are signs of yeast besides the tightening. Is there any change in the texture of the end of the foreskin?

An easy way of determing the presence of yeast is to treat for it. If the problem disappears with treatment, you have found it. I suggest trying this. Treatment preparations are easily found in your local pharmacy, and they are available without prescription. Using them in absence of a yeast infection should pose no danger, so I think it's in your best interest to try it.

 
    

(no login)

Phimosis problem at 54

October 13 2008, 12:10 PM 

Thanks for your advise.I will follow this from tomorrow.Today I consulted two Doctors - one Urologist and other GP - both advised.....the same old....Circumcision.I told them that this is the last option in my mind.But they were adamant and refused to prescribe any madication.GP also told me that just one month before his son was operated under similar circumstances.

Regarding your remark on using of soap etc.,I have washed only by water without using any external substance.Yes the texture is changed a bit - it has become whitesh.In last 6 months I have not used any antibotics either.Thanks once again.

 
    
Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Possibilities of infection

October 13 2008, 1:09 PM 

Besides the use of soap and antibiotics, there are other ways yeast can get a stronghold. Diabetes is a fairly common way, for example. When sugar isn't metabolized normally, it becomes food to the yeast which then grows faster than normal. You may also become exposed through unprotected sexual activity.

Then again, it may not be yeast. The treatment will tell however, so your decision to act promptly is good. I suggest treating for at least two weeks.

 
    
George
(no login)

BXO is a possibility

October 15 2008, 3:47 AM 

If the texture of the skin has changed and become whitish, this suggests a possible diagnosis of balanitis xerotica obliterans.

Topical steroid ointment is being used to treat this condition. See

http://www.cirp.org/library/treatment/BXO/

for more information.

 
    

(no login)

Diabets ?

October 15 2008, 11:47 PM 

Hi. I'm a french man 44years old. Excuse me for my bad english writing, but it is not my birth language.

I would ask you if you had practice a diabets test ? Because I had the same problem as you 4 years ago, and foreskin tightness was due to ... diabets. Ask your doctor to test your glycemy, beacause diabet can become the foreskin and frenulum more tight.

 
    

(Login Paul_B.)

Same story

October 13 2008, 1:28 PM 

Jim has laid it out pretty clearly here. There are two basic situations for phimosis. The first one and the most common one brought here, is where the foreskin has never been able to retract. I decline to call this "phimosis" as there is no indication of a disease; it is merely a failure to encourage the foreskin to develop normally.

The second situation is what you describe here. Your foreskin used to function normally, but has tightened up. This actually is phimosis, because there is a disease present which needs to be cleared up and only then will the other things we describe about stretching, become practical.

Almost certainly, the problem is "thrush" or Candida (Albicans - a yeast). This is the commonest infestation of the genital area and causes women a good deal of trouble, even at 54! It can be provoked by a number of things and having a partner who is suffering from it is clearly one of those - if she has been treated for this, then you must use the same treatment at the same time. And in fact, as Jim says, this is the treatment you should start now and use for a few weeks (after which you should probably continue to use it intermittently, every week or two) with a view to clearing the condition and enabling you to get your foreskin back in working order.

A substantial contributor to the problem, is inappropriate attempts at "cleaning" - in this situation you should never use soap, detergent or any sort of "antiseptic". The only preparation is one intended for specific treatment on the skin or in fact, intended for vaginal use.

Even more important however, is that you are tested - properly - for diabetes, which is a significant risk if you are over fifty and almost certain if you are also significantly overweight. The test is not a urine test (unless it shows positive for sugar) because it is simply not sufficiently sensitive - that may be a quick indication but you need a blood test for your glucose level - if you do not already know you have diabetes (in which case you really should have mentioned it first), then you need to see the doctor for this test.

Your story clearly points out an important feature of phimosis or a simple tight foreskin. It is often misleadingly claimed to be painful and cause some sort of difficulty with sex. As you clearly observe here, this is rarely the case, only under certain circumstances where the foreskin is pulled upon uncommonly hard which is to be honest, rather unlikely with a partner of around your age.

 
    
Dilip
(Login DD1000)

Phimosis at 54

October 15 2008, 8:47 AM 

I am really very grateful to you both for taking out your valuable time for me.I dont know how I will come out from this terrible situation without your guidance.My further points are:

1) I am not dibetic.I got my suger checked about 8 months back.I will get it tested again tomorrow.

2) I am not very over weight.My weight is 67 Kg. and height is 5 feet 6". Yes I have increased my weight by about 5 kg in last 6 months.

3) In last 6 months I have been quite lazy and not doing my walking exersise etc.I am also sitting to much on my computer.

4) I am taking regularly about 80 ml.of whisky daily from last many years.I am keeping my BP under control by medication from last 6-7 years.

Otherwise I am perfectly OK and leaving a good life - my wife has lately started compalining about my lazy lifestyle.According to her this lazy lfestyle is the reason of my problem.I also think why I allowed my foresikn to become so tight.Frankly I was not aware that this will trun out to be such a big problem.

5) My wife has never been treated for yeast infection and we are having unprotected sex from last 27 years.Ofcource from yeasterday I hve started using condom.

6) You have been advising to go for treatment of yeast infection.Now as my Doctors are not ready to help me out - without use of sessisors - I am requesting yourslves to advice me and specify which medication to be used and how.You may think I am troubling you by asking silly questions but frankly I am completely in dark about this yeast infection and about its treatment.

 
    
Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Do you have local pharmacies?

October 15 2008, 9:17 AM 

Take a walk down to the corner drug store and take a look at the shelves where women's products are sold. If your country is anything like the US, it will be loaded with a variety of preparations to treat yeast infections in women. Hint: Yeast doesn't recognize gender. The ingredients will differ, but most are effective in eradicating any infection from yeast. If you try one which doesn't work effectively, try another until you get results. It's a pretty inexpensive way to eliminate possibilities in the absence of definitive test results. If condition don't improve after treatment, then it might be advisable to seek medical tests to determine what is really going on.


 
    

(Login Paul_B.)

Treatments

October 15 2008, 2:47 PM 

Just to confirm - getting your sugar checked means your blood sugar level, generally before you eat anything in the morning. If a urine sugar is positive, then that is pretty certain for diabetes, but a negative urine sugar means nothing at all.

With a body mass index of 24, you certainly do not sound overweight, or at particular risk for diabetes for that matter. Even so, putting on weight and failing to get plenty of exercise (which is part of the cause of putting on weight) is not going to be good for your blood pressure.

I suppose 25 grams of alcohol a day is a reasonable amount - I cannot think of any particular reason why this would contribute to your problem.

Using a condom may have some advantage in determining whether yeast is a problem - if the treatment of Candida is singularly successful, then you would (simply) need to treat your wife for the yeast as well - this might amuse her somewhat, but she sounds understanding of your situation.

As for the antifungal creams, I am not sure in which country you are, but the standard ones are Clotrimazole (Lotrimin®, Canesten®, Clonea®) or Miconazole (Micatin®, Monistat®, Daktarin®), which you apply to the foreskin opening and squirt a little under the foreskin, massaging it around so it gets to every part underneath.

You could also consider a single fluconazole 150 mg (Diflucan®, Canesoral® in Australia which is actually over-the-counter) tablet, perhaps repeated after a week or two.

 
    
Dilip
(Login DD1000)

Phimosis at 54

October 17 2008, 7:43 AM 

Thanks for sending Brand names.I am from India and there is no problem in getting any Brand name medicine from USA Pharma companies as all are having Indian collaborations.
Today I got my sugar and urine tested for Diabetes.All was perfect.No sugar problem at all.Frankly I am not feeling any problem at all in my penis also - except of course foreskin tightness is there.Otherwise there are absolutely no symptoms of Yeast infection - no itching,no irritation,no iflamation.
Now I am going to a pharmacy to get one of the creams advised by you.Getting one without Doctors card is not a problem.I will remain always thankful to you all.Regards.

 
    
Paul B.
(Login Paul_B.)

Looking ahead.

October 18 2008, 2:11 AM 

Certainly, use of an anti-fungal/ anti-Candidal drug is the way to go at this point. The salient point about Candida infestation is that it is most of the time, asymptomatic; that is to say that because the yeast is so commonly present in foodstuffs (sweet and sour fruits and vegetables in particular), it is quite frequently present in the digestive system and secondarily to this, there are many people who have a significant growth of this yeast in the genital area but without significant symptoms, much of the time. It is only when it becomes predominant amongst the many bacteria which inhabit the area and can tend to penetrate the skin surface, that it becomes visible and/ or produces irritation or evident inflammation (redness, soreness).

That is why definitive treatment involves treatment of the partner as well. Jim will also suggest that a high carbohydrate (sugar and starch) and sweet diet (even in the absence of diabetes) favours Candidal growth - I am personally not aware of strict controlled trial evidence of this, but it has some merit that you may benefit from dietary restriction. If measures including the use of anti-Candidal medication and such dietary alteration then prove to be helpful (over some weeks) in reversing the phimosis, it is clearly appropriate to follow that line of treatment and also include your spouse.

I do wish however, to cover the possible scenario where anti-Candidal treatment does not resolve the situation. The next step (in addition to the anti-Candida medication,) and regardless of the actual diagnosis, is the use of high-potency steroid ointment (such as betamethasone 0.1%), precisely and regularly applied to the area of tightness in the foreskin.

This generally will require a doctor's prescription.

So far, it seems you have fared badly on competent medical advice. What you have is a skin disease, but the urologist clearly has no competence in this area. He undoubtedly does have a competence in the performance of mutilative surgery such as might (frequently) without question be needed in the case of a malignancy (cancer), and applies it to your completely different situation in the spirit of "When the only tool you own is a hammer, every problem begins to resemble a nail".

Your GP appears to be of similar ilk. It is particularly sad to see that his own son has borne the brunt of his ignorance. If the son is of an age such as to have had some sexual experience and since studies which have been made of the actual consequences, such as Masood's report indicate that much of the time there is not even substantial improvement of the symptoms for which circumcision has been offered, then should he (the son) in the fullness of time come not only to realise that he has lost sexual function but also fortuitously learn (as one might from encountering this forum here) that the procedure was simply never necessary in the first place he may well "put two and two together" and become very resentful of being treated in such a cursory fashion.

It is then possible if the anti-Candidal treatment is not effective, that you are suffering from a skin disease called "Lichen Sclerosis" and should be managed on this account by a competent dermatologist (that is, skin specialist). When affecting the foreskin, this condition has been called "Balanitis Xerotica Obliterans" or "BXO", but this term is deprecated in up-to-date dermatological practice as whilst it does plausibly describe this particular manifestation of the disease, it implies the deception that this is specific to the foreskin and therefore something of interest to urologists. This inappropriately tends to divert attention from the knowledge base pertaining to the much more common presentation of Lichen Sclerosis affecting women's genitalia where "circumcision" (which is to say, vulvectomy) is sensibly considered as the management of very last resort and where the treatment with ultra-potent steroids is extremely well known and understood.

In fact, the older name for this condition as "Lichen Sclerosis et Atrophicus" is also deprecated as it is simply wrong - the disease does not involve a process of atrophy (thinning of the skin) but rather the opposite, infiltration by scar tissue. While atrophy of the skin particularly when they are used on the face is a concern relevant to treatment with (potent) topical (applied to the skin) steroids for other conditions, in Lichen Sclerosis this effect in suppressing proliferation of scar tissue, is the very one absolutely essential to the effectiveness of the treatment.

While I certainly hope that your condition can be resolved more simply, I thought it best to outline well in advance what you will need to know in order to proceed if it happens you are not so fortunate, and as an immediate reference for any others for whom the anti-Candidal treatment has apparently failed.

 
    
Dilip
(Login DD1000)

Phimosis at 54

October 19 2008, 12:34 PM 

Sir from today I have started applying Clorimazole Ceeam I.P.(Canesten) under and around foreskin.I have also taken one tablet of Forcan-150.
However before starting this medication,today I saw many small red rashes on my hand and palm.These may be due to some allergy.There is itching in these rashes.I hope this is nothing to do with my main problem.
Thankyou vey much for analysing my problem from all angles.No Doctor here will take so much pains and that too without any self advantage.I am really pleasantly surprised and grateful to both of you.



 
    
Dilip
(Login DD1000)

Phimosis at 54

October 22 2008, 9:17 AM 

I am applying Clotrimazole Cream I.P. (Canesten) under and around foreskin though not deeply as foreskin has become tight.I have also taken one tablet of Fluconazole (Forcan-150). There is,however, no improvement whatsoever.There is no pain,inflammation or itching either.I am continuing with this treatment.Thanks.

 
    
Jim
(Premier Login jimsplacetofixthings)
Forum Owner

Patience

October 23 2008, 7:41 AM 

You've been at this three days. Give it some time.

 
    

(Login Paul_B.)

Reasonable expectations

October 23 2008, 2:21 PM 

I thought I had posted an earlier reply here, but must have blundered in the process. I cannot see any clear connection between a recent rash on the hands, and your foreskin problem, but you certainly need to consider irritants in laundry detergents or any other "product" you might be using on your body.

It is certainly the case that skin conditions take a while to treat, since the skin has to re-grow in order to repair whatever defect is caused by injury or irritation, which takes a week or two. If there is a degree of scarring involved, it takes longer for that to settle down (but the stretching becomes part of that process).

In general, you should use the antifungal for a week or two before you start to implement the stretching. How successful that then is will give some clues as to the need to continue the antifungal treatment - at least intermittently.

 
    

(Login DD1000)

Re: Reasonable expectations

October 28 2008, 11:58 PM 

Dear Sirs:

Hi. Finding no improvement by using Clotrimazole Cream,as advised
by you, I thought to consult a Dermatologist.He gave a long list
of medication - both for my tight foreskin and rashes.I am using
this treatment from last 4 days. Rashes are under control
but my foreskin problem remains the same.For wasing of my bhands and body,on advise of Doctor I am using only Hidrate Glycerin Soap Bar.

Treatment being given is as follows:

1) Cefprozil Antibotic tablet 500 mg(Zemetril) - twice daily.
2) Loratadine tablets USP - once daily
3) Terbinafine in Betacyclodextrin Tablets(Tyza)- once daily
4) Alcometasone Dipropionate Cream USP 0.05%(Aclomet
Cream)-twice
daily for forskin
5) Sertaconazole Nitrate Cream 2% (Onabet)-twice daily for
Forskin
6) Nodifloxacin Cream 1% - twice daily for Raches
7) Mometasone Furoate Cream- once daily for Rashes
8) Zincovit Tablets - once daily- vitamin,zinc,etc

First one is for 7 days and rest for 15 days use.I am waiting for
the outcome. Regards.


 
    
Paul B.
(Login Paul_B.)

Wow!

October 29 2008, 4:42 AM 

This appears to me to be the most amazing piece of "shotgun therapy" that I have encountered in a while. It seems to consist of one oral antibiotic, one topical antibiotic, one oral antifungal, one topical antifungal, an (oral) antihistamine, two different steroid creams and a Zinc and vitamin supplement. Well, the Zinc is probably a good idea anyway.

I am a little bit concerned about the prescription of Alclometasone(sic.) for a tight foreskin - I could be wrong and am not at all familiar with the medication, but the available web references seem to suggest it is exactly the wrong steroid for this purpose.

That is to say, it is specifically noted to be a weak steroid on a par with hydrocortisone, which will probably not help much with stretching your foreskin. Nevertheless, if you are using these medications, I daresay we will see what happens. I do mention that you may want to use those for application to the foreskin well beyond the 15 days as part of a stretching program.

 
    
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