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.
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.