Hi, I am 48 years old and my skin does not retract at all. Since I was 25 years, during intercourse the foreskin used to tear and when it was healing the skin was becoming tighter. Now the gap has almost closed. I have started using Betnovate - C ( betamethasone & clioquinol cream) since November 14th 2009. I apply the cream everytime I go to the toilet and try to pull my foreskin down for about 10-15 seconds. (is it the correct way?). How long do you think I will have to continue for it to show some improvement.
Please advise....
regards, marc

Are you getting any results? Results are the determinant of correctness. My guess that your method could eventually produce minor results, but it would be disappointingly slow. You need to have a more concentrated effort applied to the tight ring.

I suggest that you read several of the previous threads to get a good analysis of the factors at work. Meanwhile, also do what is illustrated here:
http://pages.suddenlink.net/manual_methods/phimosis.html

Do this at least twice per day, for ten minutes each time. Create enough tension for slight discomfort to occur.

I wonder if you could also have yeast contributing to your problem. Any time the foreskin develops tears or cuts, this is to be considered. Your doctor may also suspect this, having prescribed the medicine which has an ingredient to fight mild fungal infections. However, I think he may have prescribed the wrong substance if he meant to assist your stretching attempts and if he wishes to combat yeast. Have you been using soap to wash inside the foreskin? If so, discontinue it, using only clear water.

Where are you located?

Thanks for the prompt reply.

Since I have started using the cream 6 days back, I feel a little better. Earlier I used to have a lot of trouble even to pee. Please clarify what you mean by concentrated effort? Presently I am applying the cream every time I go to the toilet (which is about 6/7 times a day) and pull the foreskin for atleast 10 - 15 sec every time.

I cannot do what is shown in the illustration as the hole is very small and hence cannot put even one finger.As of today, I will increase the time to pull the foreskin.

How long do you think it will take before I can insert 2 fingers and try to spread it? How long before I can retract the foreskin fully?

I do not have any fungal infection now although I had it a 5 - 6 months ago. Which cream would be the best to assist in stretching. I do not use any soap to wash inside the foreskin.

I am in Dubai, United Arab Emirates.

thanks, marc

How do you know the infection is gone? Is the skin supple? Any signs of fissuring? Are you using condoms during sex?

What I mean by concentrated effort is two-fold. The first relates to the degree of tension applied. Your method of retracted simply doesn't exert sufficient resistance due to the nature of the opposition. The glans is wishwashy at best, so the foreskin is not taxed. Using fingers overcomes this deficiency. The second refers to time and effort. The tension must be of sufficient force and for sufficient periods of time. Make sense?

At the moment, there is no way to predict the time you'll spend doing this. I recommend that you use extreme caution in accepting advice from physicians in that country, knowing their views on circumcision! If you place value on your foreskin, do whatever it takes to get this job done.

Here is a mild version of exercise which should get the skin loosened up a bit:



Here's a second one which you should be able to do also:



Spend ten minutes on each of these, twice per day. If you not getting some progress by the end of a week, I think you may need to consider treating for yeast. By progress I mean a loosening of the skin, not retraction. You should feel a difference in the skin.

You have a good sense of humor.

Skin is supple. No signs of fissuring. No condoms. Sex only with my wife.

Ok, I got what you meant and I am doing the way you mentioned. Already in these past 5 days since I started doing the stretching treatment, I have been able to pee without much pressure which means a positive sign.

I do not want to go in for circumcision. Ever.

Ok, will try both the exercises.

I do feel a slight loosening of the skin.
I had read somewhere that retraction can happen after 6 weeks of stretching? Is it true? What about people over 45?

regards, marc

Stretching works regardless of age. Ever see an older person gain weight? Ever hear of one whose abdomen burst?

The condom thing is about not sharing yeast. Women get these things easily and much more often than men, and they tend to donate the culture. Make sure she is also free of yeast. I'll go so far as to recommend treatment for both you. I doubt the presence of Walgreens there, but you surely have a local pharmacy which offers preparations for yeast over the counter.

Yes, retraction could happen that quickly, but it is literally in your hands.

You use English quite well, so I'm assuming you're taking advantage of a good economic opportunity. Are you British, Aussie or perhaps even American?

Now that is a relief. I was hoping you would say that.

Point noted. But so far she has not complained of it and whenever I had an infection or the forskin was torn I refrained from any sexual activity.

Yes, I look forward to it happening as quickly as possible and go at it on a 'war footing'.

Well, I am neither of the three nationalities you have mentioned. I am an Indian.


Regards,
Marc

OK, your problems with recurrent "Thrush" (Candida) with fissuring and tearing (rather characteristic of the condition) since the age of 25, raise a strong concern about the possibility of diabetes, for which only a blood sugar test or tests can reassure (urine testing is basically useless). That would require meticulous treatment.

Another possibility is that your wife has had a recurrent problem with Candida since that time - a rather nasty state of affairs because it is also pretty difficult to manage.

Clioquinol - a close relative of Povidone-iodine or "Betadine®", a completely broad-spectrum antimicrobial - is probably reasonably effective, but the other compounds - generally imidazoles such as clotrimazole (Lotrimin®) or even the oral version, Fluconazole (Diflucan®/ Canesoral®) which can be taken weekly - may be more effective and "sticky" - they tend to stay around and penetrate the area better. Which is a point - you need to introduce the cream under the foreskin for best effect.

I am wondering about your condition prior to age 25 - your foreskin was fully retractile? I even wonder whether this was (about) the time when when you were married?

Clearly this problem has been quite chronic - though I presume that you have continued to enjoy sexual relations nevertheless; a foreskin that simply cannot be retracted at all actually causes less problems as such, because it never gets to the painful "almost" retracting point - as you observe, attempting to retract at this point is not even very effective at stretching. Progress to the point of impeding urination is however quite severe and in all regards this clearly requires fixing.

While you hold the foreskin open as Jim illustrates, you have to get another finger, your little finger tip to start, into the "funnel" you see. You may need that finger to have a spot of lubrication (perhaps saliva will do) on it but of course, you do not want the other fingers holding the opening to be slippery. The important thing is that you have your foreskin stretched forward so that there are no wrinkles on the inside to block your finger; if the finger is well manicured (smooth, short nail), it should eventually slip into the tight section and even through so that it is quite inside the foreskin and can feel the glans directly (which will not be uncomfortable if the finger is actually lubricated).

Once you get one little finger in, you then progress (in due course) by practicing getting bigger fingers in until you get to your thumb and once you can do that, two little fingers. Then you will be able to do what the "suddenlink" diagram illustrates, levering your fingers apart to achieve the full degree of stretch to an easily retractable foreskin.

The betamethasone will certainly be helpful in your case. You might need to use an alternative anti-candidal - unless contraindicated, the Fluconazole (Diflucan®/ Canesoral®) taken orally would not conflict with the present cream. Even if not visible, we have to assume that the Candida is the culprit in your condition.

Considering the confounding factors and the chronicity in your situation, we cannot really guess how long this will take you, but we do expect a result. As to older people and stretching, I had to giggle a few years ago at our dentist - not much younger than myself - sporting braces. As you get older, the bodily maintenance functions do slow to some degree, but if they ever cease entirely - well, so do you.

Incidentally, this is October 2009 (where I live), not November.

Hi, thanks for your response.

Had checked for blood sugar and got a clean chit.

Wife does not have any problem.

I am using Betnovate presently but if you can suggest any alternative/better cream I don't mind using it. Since I started stretching the foreskin, occasionaly there is a slight tear at the tip which heals quickly (possible because I am using this cream?) I do apply it under the foreskin.

Yes, my foreskin could be retracted prior to age 25 and this was the age I got married.

I never had any problem during my sexual relations though the foreskin used to tear sometimes but as it healed the skin started contracting and it had reached a point that it became difficult to even pee. Since March it has become difficult to have sex as the penis is getting bent during errection because the foreskin has become really tight. I know I have left it too long without any treatment and that is why I have come to you two 'masters' for guidance and help

I'll try out the treatment that you have mentioned. I have given myself a time frame of 6 - 8 weeks for complete retraction.


Another point I need clarification is on the number of times I can apply betamethasone cream. As of now, I apply it whenever I go to the toilet (6 - 7 times). Is there anything such thing as over use?


Sorry for the typo - it is October here too...

Regards,
Marc

Go get some now. Everything you say keeps indicating a problem with yeast. Get enough of it for both of you and treat simultaneously.

Ok, will get Lotrimin and start the treatment today itself.
thanks, marc

Well now, I have to suspect that "Thrush" has been the root problem here. The problem is that it can persist "sub-clinically" - it is there, but you can't see it and most of the time it produces no symptoms, except that it may be chronically irritating the foreskin and preventing it from fully healing and stretching. The problem with this scenario is that if one partner has a problem and treats it, the other partner still has it and when sexual relationships are resumed, back it comes even though it is not readily noticed.

As a matter of definition, both partners should always be treated together if only one partner has symptoms - and it clearly does not matter which is which. However, "Thrush" is not a strictly sexually-transmitted disease - it is a contaminant of the environment and is acid-tolerant to some degree, present for example on citrus fruit when this "goes off" with a whitish area of softening. Consequently, it is present in food and can survive the stomach, passing all the way through the bowel and therefore contaminating the anal area from which it can affect the genitals, particularly easily in women. So regrettably, even when you do treat both partners, it has a tendency to return (and after all, where does one suppose it came from in the first place?).

Nasty, eh?

That's why I tend to suggest the Fluconazole (Diflucan®/ Canesoral®) taken orally (albeit somewhat more expensive than other preparations) which tends to knock out the Candida not only on the genitals, but also in the bowel, removing the "reservoir" for re-infection. And it necessarily permeates the full skin thickness and all the "nooks and crannies" which is otherwise difficult with creams.

Now, although I am not overly concerned about how often you would be using the Betnovate, I would rather you used it very sparingly on the tight part only, but use the anti-fungal part (cream such as clotrimazole/ Lotrimin®) much more generally and fully under the foreskin - or use the Fluconazole.

I am rather surprised that the tightness of the foreskin might actually bend your erection - presumably downward - as this might suggest more general involvement of the skin of the penis which should normally stretch easily. The manoeuvre which Jim first illustrates should be appropriate here nevertheless.

Piggy-backing on these thoughts, I beleive it is highly important to control the diet until the yeast is under control. Eliminate as many carbohydrates from the diet as possible. This would especially include bread made with yeast, but also include beer and wine. Push vegetables, preferably steamed and without sauces thickened with flour. All meats are good except those cured. Eggs are good. Fruits can be a problem, especially if dried. Stay away from peanuts. Eliminate milk, tea and all carbonated beverages. Yes, I said tea. Drink lots of filtered water.

You'll swear you're going to starve while doing this, but your mind will clear up and your energy level will soar. Carry around a baggie full of celery stick to munch on and fill the tummy. The greatest benefit is clearing out the yeast which has gained a foothold.

I was a vegetarian and a teetotaler for almost 6 years (2000 - 2006). I have a few drinks once in a way. I drink about 2 - 3 lit. of water every day.

Thank you both for your advices. I will revert back in a couple of weeks to let you'll know my progress.

Regards,
Marc

You seem to have glossed over the hair shirt and flagellation.
One might think that you (Jim) have it in for the processed food industry - which seems to speak for a huge part of the "modern" diet.

Let's see - avoiding milk tends to suggest also butter, cheese, yoghurt, custard, junket (all the processed variants). Yeast would preclude my beloved vitamin booster - Vegemite® which I eat with my avocado "butter" on pita bread. And why peanuts (which I seem to recall are monounsaturates just like olive oil)?

The reason for such a stark diet is to starve the yeast. Milk is on the list because of the sugars. Butter is actually permissable, and yogurt would be also to a degree because of the bacterial cultures which bebuild the proper mix in the digestive tract. Peanuts are out because they can be contaminated with yeast. Keep in mind that this is a temporary measure necessary for perhaps a month while the yeast is dying off.

I will be using Lotrimin for external treatment and Fluconazole(Diflucan/ Canesoral)to be taken orally. Are there any side effects or reactions? What would be the dosage? How long should I continue?

regards, marc

Dosage of the fluconazole is 150 mg weekly for a few weeks at most. It has various bad, but inconclusive and rare side-effects mentioned, but the only common ones appear to be headache and/ or nausea (mind you, dummy pills may have equal side effects). Clotrimazole cream once or twice daily (more liberally, and at different time to the Betnovate). Avoid soap anywhere near the affected area.

That's about all.

Jim & Paul,

Thank you guys for all the advices. Since I started stretching the foreskin its become easier to pee which means that there has been an improvement.
Will revert back in about 2 weeks time when I am sure I should have some good news.

thanks once again, regards, marc.