Hi Jim et al.
wonderful web site, that I've been coming back to for some years.
I'm 44, and my phimosis has progressed over 25 years or so, till I have a very very small opening.
I have a healthy heterosexual sex life, but find that pressure pulling on my foreskin is actually uncomfortable, and results in very slight tearing (i.e. the skin tears on the surface for a fraction of a millimetre-- under a high power magnifying glass, it's only the very surface that breaks, but enough to expose the nerves I suppose underneath: no blood or anything), around the tip of my penis, which then takes from a few days to a fortnight to heal, rather than any useful stretching.
Ironically when my opening is at its smallest, this effect seems most pronounced (as in its got worse as my phimosis has advanced: for simple mechanical reasons).
I decided a few (maybe 5?) years ago to do something about this, and read your fantastic web site, after lots of head scratching and googling.
I have had 4 or 5 attempts at stretching now, each time lasting quite some months (the longest nearly 6 I think), brought to an end by painful surface tearing, with long pauses in between waiting for everything to become "sturdy" and the resolve to gather to have another go!
I use Eumovate (Clobetasone) cream as being non prescription in the UK. I found "mastabation like" stretching to be useless, and after much thinking and experimentation (e.g. with 2 commercial devices a glansie: useless, and a ballon like device, again useless, for different mechanical reasons), settled upon some DIY tools.
There is absoultley no way I can insert fingers, so tools are my opnly possibility.
In particular, I made myself a set of "plugs" I supose you could call them: by taking a cotton bud (the sort one would use for cleaning ones' ears), and wrapping PTFE tape around the end. By using a vernier caliper, I can judge the size at the thickest, and have a whole set now in in increasing diameter, about .3 mm increase per tool. The end of each one tapers to nothing over the last perhaps 3--5 mm, so that as inserted, it is somewhat conelinke, and pushes the foreskin apart as it works its way in.
The smallest are 5mm or so diameter, and the cotton bud un wrapped is about 3mm or so.
When I start a "stretching program", getting the 3mm cotton bud in is a real struggle and takes quite a few days. (In fact where I am now again )
In time however, by using the cream to lube it, and gentle twisting persuation, I can get each in in turn, and on successive days, I always work back up to whatever size i'm currently on, in my 10 min morning, or 10 min evening session, as there always seems to be elastic "bounce back" from day to day.
It seems to take a week to go up .6mm or so, but each time I've done this: first time I got to about 10mm then... a tear on the inside of my foreskin near the tip: not "massive" in the sense of blood gushing or anything, but: painful esp when urinating for instance, leading to a "pause" and me feeling i should leave it alone: but... 2 weeks + later, things of course had contracted again, and on recommencing stretching, the tear opened up... so more delay...
6 months later, I started again.. same again i think 10mm max, on the second "programme"
Next time round I managed to get to 15mm which did feel an amazing acievement: I could just get my little finger in. Wow !!! although eventually I would need proabbly 30mm i think, before my foreskin would retract.
then.. Tears again. Bugger.
So.. some months went by... (you get the picture)
Anyway, I'm back to stage 1 again, and it's frustrating, how to stretch slowly enough and not create this self induced problem which seems to get me back to step one every time. It takes ages to get the stretching up, yet my body seems to take no time in retracting back down to the smallest again. the asymtery in time seems so perverse.
I'm thinking I'd do better using some kind of (DIY) tool that applies very gentle, but continual stretch, and I bought a series of "flesh tunnels" for ears from ebay for instance, but I found as they have no compliance, they were pretty useless: they either wouldn't go in, or if they did, they created no tension at all. They also weren't a nice shape, with quite "sharp" ridges, which if tightly fitting clearly cut in--altogether not good.
I'm wondering if one might be able to do something with for instance... a sequence of latex dumbbells ? (but no idea how to source such a thing), of a series of sizes, or maybe even a suitably fashioned piece of sponge material .. (though the friction I think would be too high...).. any suggestions ?
I do wonder how on earth to avoid this tearing thing: and indeed, when it does happen, whether i should leave things well alone, or continue to stretch at the same size. I think I could grit my teeth, but if it prevents the tear from healing: bugger me ! or indeed if it makes it worse (which seems likely -- after all the skin locally then has lost some integrity)... then this would be totally counter productive. Thinking how long a cut say on ones knuckle takes to heal, this feels like it could be very painful for a very very long time, which I do not relish.
I'm certainly being careful, and as gentle as I can be, whilst still stretching, and indeed the reason I fashioned my set of ptfe wrapped cotton buds was so I could avoid "excessive" stretch, given their size controls the max stretch on each insertion, and also having a set of them, as opposed to increasing the amount of tape wrapped around one, meaning each time, I could work back up to the current largest, rather than assuming I could definitely get it in. I had read of people suggesting you just added a bit more tape as you go. I don't think this is the way to do it, unless perhaps with a permanently inserted device, but I can't see how to do that, as having 3 inches of stick poking out, feels about as dangerous as running whilst having a lollipop in one's mouth !
Any one else gone through a similar sequence ? And any advice ? I appreciate I've touched on lots of issues such as technicque, tools (esp ones one can leave permanently inserted for long term gentle stretching)...?
Any helpful advice/ thoughts.. ? I'm getting somewhat worn down and frustrated, although certain I want to stretch my Foreskin and not have it lopped off.
I feel I have to resolve this, as sadly when tight, this slight surface tearing happens anyway, stretching apart, leading to regular discomfort: which I would really like to get away from.
All of what you've written leaves out any attempt at discovering what has caused this. A 44 year old man should not be getting worse. Furthermore, cracks and tears should not occur. My first suspect is candida. Have you ever treated for yeast?
NoI haven't been treated for yeast. Come to that, I've never been treated for anything to do with my penis, or skin.
I have to admit, I do suffer irrational embaressment at discussing this with doctors: and have a scientific/ technical background, so certainly will take on your thoughts.
How can one know if one does have a yeast problem ? My skin doesn't crack as such: the teeny tears seem to be a result of mechanical stressed, inuduced by prolonged mastabation, or if I have a nice passionate evening of sex , but of course, I don't know if the inherent tensile strength/ elasticity of the skin is "normal" per se, but it doesn't obviously look different to other "bits" of me (I've never sufferd for ecsma or other skin conditions elsewhere on my body either).
I suspect a picture might be the way forward on this.
No time to do this till later in the week though. It may be by using macro lens, I can actually show one of these teeny tears... Is there an easy way to post a picture without causing problems?
Firstly, wondering where was your starting point, 25 years ago (now that would be age 19, wouldn't it)? Could you retract - properly - at that point?
If you have been coming to this site for years, you should know the rules. No soap or "soap by any other name" - no "products" other than unscented Zinc and Castor Oil, "Thrush" cream or the appropriate steroid.
OK, EumovateŽ/ Clobetasone cream is not suitable for this purpose; whilst it is a fluorinated steroid, it is apparently considered a "moderate" potency steroid (and so, available "over the counter") rather than the "ultra-high" potency variety required to effect weakening of the skin matrix to stretch.
The major point is the consideration of "Thrush", and the consideration related to this that at age 44, you should be tested for blood sugar level to exclude diabetes. Being sexually active (even with only one partner) represents a substantial mechanism for acquiring and re-acquiring the Candida yeast, even without symptoms other than the skin hardening and fissuring (cracking).
You do not mention treating for Candida ("Thrush") so this rather sounds like the critical factor. Initial treatment with topical cream possibly augmented by oral Fluconazole, continued with less intensity as you continue to stretch, is likely to be the "missing link".
A dilator using PTFE (TeflonŽ) tape sounds not unreasonable; I note that the more rigid "flesh tunnels" of the wrong design could be a problem. The stretcher and noting my amended suggestion to this, or at least the material used to fashion and re-fashion it, would seem to be worth pursuing as you can craft any form of the dilators from that material (without dangerous projecting parts!).
Given that you are using an effective treatment with anti-Candidal and optionally, appropriate steroid, and probably, some lubricant you really should not encounter fissuring. Zinc and Castor Oil may be an alternative as it has some anti-Candidal action in itself, and stretching should if at all possible be continued with slightly reduced pressure, even while any fissure is healing (as even a fissure represents a slight advance in dimension).
I remember when 20 or so, with exterme difficulty fully retracting my foreskin when flacid, but it was one hell of a struggle, and more curiosity than anything else, and I think achieved only once maybe twice in my life.
I shall definately go and look at creams for Candida: and I've noticed that there is a bit of a vicious cycle, in that if I've got a bit carried away with stretching, inevitably there is some local inflamation: which makes it worse (as everything tightens, so indeed the internal diameter of the opening apparently is reduced for instance), and indeed the steroid cream (albeit youv'e corrected me on this), seems to settle that down over night (not that that was my motivation for doing so).
I feel in my bones i'm witnessing a sort of circular chain of events: things are very tight, so it doesn't take much mechanical "handling" and things get a little... war weary, which leads to inflamation, which leads to extra tightness, which leads to increased delicasy and "prestressing" of the skin etc, and as these teeny weeny little tears over time have healed, I suspect from my reading that each time it heals, the body's natural mechanisms lead to "the belt being tightened a little" so, the openeing has gradually decreased in size.
I've noticed one sure fire way of letting things settle down, is to refrain from sex or mastabation for a week or two: but in practise a complete lack of self control means that this only very occasionally happens, when for example I've been in bed with a temperature, and have no labido. Ironic ! I am highly sexed, so I tink some of my problem is simplhy my penis has many and frequent demands placed upon it ha ha.
I'm eternaly (intellectually) curious so understanding what has and is going on interests, me, apart from i beleive helping me understand how to resolve things !
I have to admit to being quite bad at dipping in and out of your fabulous forum: life gets in the way: so although I came across it a long time ago, it's not like I've read it non stop for some years... but is very interesting when i spend an evening looking back over postings.
Since I last looked, there has been much talk of building DIY stretchers from polymorph, and i lvoe the idea. In fact yesterday, (prior to reading your very helpful replies), i ordered up some poolymorph from ebay to experiment with.
I think I can envisage making stretchers "sprung loaded" to work at several sizes, and progressing between them in time. the very act of making them as well as being helpful, i think is going to be good fun. I shall take head of the various comments about "improving" the designs people have already played with, and i suspect it has a lot going with it, compared to what I've tried historically, all of which has "had it's draw backs"-- especially that I've had to apply apparently more force, over shortish time (e..g 10 minute stints) than I can imagine can be achieved by very gentle, but prolonged strtching these sorts of devices should be capable of.
In regard to diabetes: I have never been tested, but I also doubt it is a problem for me. There is no diabetes in my family, and I have a (reasonably) healthy BMI: I am 5'8 tall, and weigh 12 stone 10 (178 lbs) eat little fast food : no sweetened fizzy drinks, and have a salad & vegetable rich diet.
I had thought that I found somewhere on the web whilst trying to work out if there was a non prescription way of proceeding re steroids in the UK: that contrary to your advice: it could still result in skin thinning after (semi) prolonged use. I must try and google to find the links I found... do you know if there are over the counter steroid creams in the UK which could be apropriate? I just know my doctor will be of the "lets have that off" persuation: he seems to think surgery is the solution for everything... and of course, I'm not going there...!
I can't beleive I typed so much, yet apparently said so little: I'm sorry, if it appears I should have been able to answer my own questions from previous posts...
I'm very excited aout the DIY stretcher, and agree making the sprung arms go towards the base of the penis, and if anything circling it at the base, seems an excellent idea: I can imagine it could then be worn confortably for very long periods.. sadly I have little time till next week, but hey, I do have the rest of my life to get this problem sorted out, there's no immediate rush
Each time I iterate with trying different stretching equipment / techniques, at worst there is no improvement, but clearly sometimes, I can move on to a better way of proceeding, so it's all good, and the polymorph material will allow me to try differnt things to really get the hang of how to do it, and "evolve" my method.
sorry this is a bit rambling, but I can't reread your questions whilst typing this.
ty once again for your helpful thoughts and questions... it really does make a difference to know other people are going through similar things, and that doctors truly care about people. ty.
Firstly let me point out that you indeed can read the post to which you are replying; you simply have to click on the link which specifies the topic of that post in the composition page.
Of course, I actually type (nearly) all my replies in the composition window of an email program which has spell checking incorporated, permitting me to jump back and forth to the whole discussion page, correct mistakes, then cut-and-paste it into the message composition window and use the "preview" function to proof read it, going back to the composition page as often as necessary. This applies to all material I post to the Web.
If you want to lodge pictures, you generally need to do so on on of the more "dubious" image sharing sites of the Web - just check out where others have done so. On the supposedly more reputable sites, ignorant people (and of them, there is no shortage) tend to "object" and have such images censored, albeit since some such sites display a random selection of recent postings on their entry pages!
Now, regarding the diabetes, given the duration of the problem and the fact that no other stigmata of diabetes have come to light over this period, this is not probable, but there is always some concern which should be looked into.
Healthy skin will stretch. Fissuring is an indication that the skin is in some way not healthy. Skin inflamed by Candida (or indeed, LS) need not crack spontaneously, but loses its elasticity and cracks on what would otherwise be minor trauma.
You fit this description. Though you started with a non-retractile foreskin, the fact that it got worse rather than better clearly describes some skin disease.
Testing for Candida is often not practical, particularly because it is actually quite common, what varies is your body's individual ability to either tolerate it, or become injured by it. Treatment therefore is the test (and is in fact, cheaper than formal testing) - if you treat for Candida and the problem is solved, then it was Candida (and as a long-term problem, may return at any time and need re-treating).
Getting the cream inside the foreskin is ridiculously easy. You roll the tip of your foreskin over the nozzle of the cream, hold it sealed, squeeze a little (not much) cream inside, remove the nozzle and hold the foreskin shut, then massage it all around inside.
I suspect "highly sexed" simply means: Male.
A little engineering "nous" makes improvements to the design of the stretcher reasonably self-explanatory. I haven't actually played with my pack of the "polymorph" yet (desk here far too occupied with paraphernalia already, mostly defective and needing to be repaired), but it certainly has the promise to make a variety of alternative tools for this purpose.
Whilst the "PI" (Prescribing Information) for the Clobetasone (apparently not the same as Clobetasol) carries "standard" warnings about the risk of skin atrophy, it appears that this is of lesser potency and as such, negligible risk as well as negligible benefit in this case, and that is why it is available over-the-counter. In a developed country, any steroid with the desired properties will require a prescription.
OK: so..one step at a time. I have some Canesten cream in my hand: (1% w/w) active ingredient clotrimazole, which I tend to apply twice daily.
I also have on my way 3 tablets of 150mg fluconazole, which although non prescription inthe UK, appears to be sold essentailly in single tablets. (in fact online 3 was the most the site would allow me to buy: and reorder within 6 months, they demand an expplanatino as to why!). What would you recomend as the regimen for it ?
I found the pharmo kinetics, via pubmed:
Fluconazole is a new triazole antifungal agent with unique pharmacokinetic properties. It can be administered orally or parenterally and achieves rapid distribution by either route, and its absorption is not affected by the presence of food. It has a plasma half-life of approximately 25-30 hr and approximately 70% of dose is excreted in the urine unchanged. There is linearity of fluconazole plasma concentrations over the dose range and the elimination rate is independent of dose. No effect has been seen on basal or ACTH-stimulated cortisol or on testosterone, estrogen, progesterone, or other steroid hormones, and there is no interaction with an oral contraceptive. No interaction with concomitantly administered cyclosporine has been documented, and there are no clinically significant differences in absorption when fluconazole is given in the presence or absence of cimetidine or food. Patients who are concomitantly receiving coumarin anticoagulants should be monitored because there is an interaction between fluconazole and such anticoagulants. Patients taking oral hypoglycemics and fluconazole should be monitored, because fluconazole has been shown to inhibit the metabolism of tolbutamide. Fluconazole has been successfully used to treat a variety of fungal infections in a variety of contexts including vaginal candidiasis; oropharyngeal candidiasis in immunocompromised patients, those with malignancies, transplant recipients, and patients with systemic sclerosis; patients with cryptococcal meningitis; and patients with fungal infections who were also treated with chemotherapy or radiation therapy. In the treatment of all of these infections with doses ranging from 50 mg to 400 mg a day of fluconazole, there has been a very low incidence of side effects (9.3%) reported, and only 1.1% of all patients were withdrawn from therapy.
and I also found interestingly that :
Following oral dosing, fluconazole is almost completely absorbed within two hours. Bioavailability is not significantly affected by the absence of stomach acid. Concentrations measured in the urine, tears, and skin are approximately 10 times the plasma concentration, whereas saliva, sputum, and vaginal fluid concentrations are approximately equal to the plasma concentration, following a standard dose range of between 100 mg and 400 mg per day. The elimination half-life of fluconazole follows zero order kinetics, and only 10% of elimination is due to metabolism, the remainder being excreted in urine and sweat. Patients with impaired renal function will be at risk of overdose.
Which leads me to supose that "one a week" seems to be a bit hopeless, given its halflife, but equally 1 every 3 or 4 days would mean plasma levels would drop to 10% or so: so probably hit the sweet spot. Given it is an enzyme inhibitor, it should be effective even at relatively low levels.
the point of all my rambling ?
Wondering what your expereince is, and indeed, what sort of dosing regimen your hunch is would be most efficaceous... ?
which nicely refers to several studies with different agents, whilst the following seems to answer the explicit question I was posing: efficacy of my clobetasone butyrate vs. the "traditional" steroid, from a 2005 paper.
Whilst the method and stats look somewhat dubious [I'm afraid that seems to be the way of 80% of medical papers/ research -- but then I would say that I'm a mathematician-- although i would also quote that in fact the BMJ agreed with me a few years back...] nontheless they do at least allow one to get a little beyond "gut feel"... for lay people like me, but I'm happy to be corrected by a proper professional!
Highly potent and moderately potent topical steroids are effective in treating phimosis: a prospective randomized study.
Yang SS, Tsai YC, Wu CC, Liu SP, Wang CC.
Department of Urology, En Chu Kong Hospital, Taipei Medical University, Taiwan.
We report a prospective randomized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis.
MATERIALS AND METHODS:
A total of 70 boys 1 to 12 years old with phimosis were randomly assigned to receive topical application of either betamethasone valerate 0.06% (a highly potent steroid) or clobetasone butyrate 0.05% (a moderately potent steroid). Parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroids over the stenotic opening of the prepuce twice daily for 4 weeks, then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 0 to 5. Response to treatment was arbitrarily defined as improvement in the retractibility score of more than 2 points.
Mean treatment and followup periods were 4.3 and 19.1 weeks, respectively. The response rates in boys treated with betamethasone valerate and clobetasone butyrate were 81.3% and 77.4%, respectively (p = 0.63). Mean retractibility score decreased from 3.9 +/- 1.0 to 1.7 +/- 1.1, and 4.2 +/- 1.0 to 1.9 +/- 1.0 in the betamethasone and clobetasone groups, respectively. Both steroids were effective in all age groups. Pretreatment retractibility score did not affect treatment outcomes. No adverse effect was encountered.
Highly potent and moderately potent topical steroids are of comparable effectiveness in treating phimosis. A less potent steroid may be considered first to decrease the risk of the potential adverse effects.
Your thoughts I'd be very interested in, and happy to do some more digging...
Of one thing. Your phimosis is quite severe. And you are a dab hand with that camera (Canon EOS 7D - certainly does a good job; better than many other pictures we have seen here)!
I have to say in support of Jim's first comment at the top here that you should not be getting worse at or by the age of 44, so that something is wrong and with or without diabetes, Candida - yeast - is the hot contender, so we continue to recommend treating for that as "first line" before (though not to the exclusion of) persisting with steroid of whatever sort. What your photos - particularly the first one - do suggest, is a degree of inflammation - redness, shine, and a degree of flaking - of the opening which might be presumed to extend inside, and I definitely suggest as previously described, "injecting" an anti-Candidal cream into this area on a daily basis to start with.
I do feel that you are in a quite different category to the Yang study (of children) which as you observe was not placebo-controlled but presumes the earlier study; that if steroids are so clearly superior to no steroids, we only have to compare steroids. What is actually being compared (in that earlier study), is steroids plus some degree of stretching, versus circumcising instead. The Yang study should have compared two steroids - with stretching, albeit relatively half-hearted - against the same application technique with Sorbolene cream (or even - an anti-Candidal!) in which case it might have been found that all approaches were similarly effective or even that an anti-Candidal was better!
My point is that you need to use the anti-Candidal as a "baseline", you may then proceed with the moderately-potent steroid as well as long as you are also effectively stretching which at this point could best use a hand-crafted "plug" or dilator of calibrated size designed to be used for extended periods.
April 16 2012, 4:25 PM
I shall go and do some homework!
Holding the 7d, and balancing the light with my teeth .. I'm sure you get the idea the difficulty was not getting camera shake whilst laughing... lol
One has to keep a sense of perspective.
ty for your kind words about possessing a fine medical example. lol
Right... fun with cream and tablets for the next week or two. Any thoughts on the frequency I should down the anti-fungal tablets ? I'm quite happy to go for belt and braces whilst working out what's going on...
All part of life's discovery!
I shall keep in touch and let you know how it all goes...
ty... it really does help so much to be able to bounce ideas with thoughtful knowledgeable people-- especially ones with a good sense of humour.
The particular advantage of fluconazole is that it gets everywhere and penetrates skin as well as coming out in secretions and excretions. The brief "flash" of the antibiotic in urine, semen, pre-ejaculatory fluid and vaginal secretions will tend to clear superficial Candida, but its persistence in the skin itself makes that inhospitable for the organism to persist in the surface skin and mucous membranes.
Once weekly administration is thus adequate for this degree of Candidiasis, though more frequent administration - on prescription - is used for more serious (and potentially life-threatening) infestations in immunocompromised (particularly AIDS) persons.
I agree systemic treatment has got to be superior: I have some tablets winging their way: in the meantime however I have started with the cream.
As a matter of interest, although I see by a "slip of the tongue" you referd to its antibiotic effect (when it clearly is anything but, given it is an antifungal, and its method of action by being a specific enzyme inhibitor makes it 100% irrelevant to bacteria) -- it made me think, can these problems be created by bacterial infection, and if so, how would one know? Is it just that in practise it's yeast (or at least fungal in a broader sense) 99.9% of the time, hence your (and indeed clearly many other Doctors') empiric emphasis on anti fungal preparations ?
Just curious... ?
BTW the head of my little friend doesn't seem so angry today, but I find it hard to beleive the anti fungal cream can have done anything so swiftly given its only been 24 hours, but who cares, feeling less angry is only good . In your experiences (Jim et al), can one see reduction in soreness that swiftly ? I thought from my googling genital fungal infections were relativley slow to clear up, apart from vaginal thrush ...? Anyway, I'm certainly not about to stop treating for a fungal infection, as cleary I want to rule out any possibility of a yeast infection screwing up "the main feature", but as always I'm curious to understand what I'm experiencing.
No "slip of the tongue" at all, my use of the word "antibiotic" was deliberate and calculated. An "anti-biotic" is a substance that is toxic ("anti") to living organisms ("biotics"), and yeasts are indeed, living organisms. Many or most antibiotics function by inhibition of specific enzyme systems, but different orders of bacteria, mycoplasms (Google the exact spelling) and fungi have different enzyme systems. Penicillins for example, suppress the synthesis of bacterial cell walls, but organisms which do not depend on a cell wall (animals and mycoplasms) are completely unaffected.
The tetracycline antibiotics are toxic not only to bacteria, but also to koalas (and some other animals). But they are still antibiotics.
The only arguable point is in regard to viruses, which are technically, not living organisms (as they cannot grow and reproduce) but "faulty" genetic data which infect actual living organisms - eerily identical in concept to computer viruses.
Let me assure you most vigorously that vaginal "thrush" does not clear up in a day or two. Nevertheless, some improvement may well be visible in a day or so. We will see - I trust you will keep us posted.
I'm almost wondering, if you teased me with your use of antibiotic, to see if I would rise to the implied semantic tease ?
I didn't know about mycoplasma - which was very very interesting to read about.
I certainly knew about the penicillin / gram positive link, and have always been amazed every doctor I've ever spoken to, has not known why that link... as I've always thought that should be part of "general" scientific knowledge... so it's a pleasure to "bump into" someone who clearly does, and much more besides.
Have you been involved in research Paul, to have this knowledge, and if so, in what area ?
Ooops this is very off topic isn't it
I shall of course keep you posted, onthe issue that first brought me here
I need in the next week at some point to try making a very small "continual stretching mahcine" too of course....
Tonight I swallowed my first fluconazole 150mg tablet btw...
More to come !
Current Topic - Very tight phimosis stretching methods
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