For Patients Urology

What should you do if you have a tight or torn penile frenulum?

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The skin ridge at the back of the head (glans) of the penis is called frenulum (banjo string) which joins the foreskin to the glans of the penis. If you have a short frenulum, you can have a tear or pain during erection. A bleeding or recurring scarring of the frenulum can happen after recurrent tearing.

What is Frenulum Breve?

Frenulum breve is due to the tight penile frenulum. This condition will cause pain, tears, bleeding, scarring and penile bending during sexual activities. The short frenulum can have repeated torn during sexual activity. Scarring can be due to a skin condition called Balanitis Xerotica Obliterans (BXO). The only penile frenuloplasty may not be appropriate if the frenulum is accompanying with scarred foreskin due to BXO. 

There are four stages of penile frenulum issues:

  • Tight/short frenulum without any tear or scar
  • Torn frenulum with healing without a visible scar 
  • Visible frenulum scaring with or without BXO
  • Complete scarring of BXO beyond the frenulum 

There are 4 options with regard to treating a tight or torn frenulum:

  1. Observation: No specific treatment in mild cases. You can use a lubricant during sexual activity to avoid the problem from happening again
  2. Steroids cream: Steroid cream can resolve the problem in the early stages of scarring
  3. Penile Frenuloplasty is simply a foreskin releasing operation. An incision is made transversely on frenulum and re-stitching vertically lengthwise, thus allowing the full release of the frenulum. This will allow you to keep your foreskin, but at the same time to avoid further trauma to the frenulum.
  4. Circumcision means that the foreskin is removed especially in the association of the tight foreskin with or without BXO. The benefit of circumcision is that once the foreskin is removed then you will not have any issue related to it. However, the head of the penis is exposed permanently after the circumcision which is an irreversible procedure.

What does Frenuloplasty involve?

Surgical treatment of a short penile frenulum to increase in a lengthwise fashion. Methods of V‐Y plasty, Z‐plasty or a combination of the two were also performed on the tight penile frenulum.

What are the benefits of having a frenuloplasty?

The benefit of frenuloplasty is that you retain the foreskin. Frenuloplasty helps to get rid of the tight or torn frenulum. Circumcision used to be a commonly performed operation with excellent results in the past in all cases.

Details of a penile frenuloplasty

  1. Penile frenuloplasty is usually done under a local anaesthetic, but occasionally under general anaesthesia. 
  2. Local anaesthetic injections relieve the postoperative pain as well.
  3. Division and re-stitching of the frenulum ends in lengthening the frenulum.
  4. Dissolvable stitches are used which usually dissolve within 3-4 weeks.
  5. Apply to the wound glue which sloughs off within 7-10 days.
  6. Covering the penis in a loose bandage which you can remove it after 1-2 days.

What are the risks and consequences of having a penile frenuloplasty?

Bruising and swelling of the penis which may last for 2-3 weeks. Most operations are successful, however, there is some chance of complications such as bleeding from the wound site but is usually minimal and settles after putting pressure. Infection can occur and treated with antibiotics in mild cases but can be potentially serious (less than 1% of patients) which may require hospital admission. The infection may require antibiotics and medicated honey dressing/gel.  The sensation over the glans penis may alter with this procedure. Tenderness of the scar at the site of the frenulum and the dissatisfaction with the cosmetic result may be the issue. Failure to improve your issue which may end up circumcision or redo frenuloplasty. After penile frenuloplasty, 5-10% of the foreskin may become tight again due to scarring. The other alternative for tight foreskin is usually full circumcision.

What can I expect when I get home?

  • Some swelling and bruising of the penis may commonly for the last several days
  • All your stitches will dissolve, usually within 3-4 weeks. 
  • Painkillers such as paracetamol or Ibuprofen are helpful if you have any pain
  • Remove dressing after 24 hours
  • Keep the area dry for 3 days. Take shower after 3 days but avoid soaking in a bath for 10 days 
  • Avoid swimming, gym or any exercise for two weeks
  • Make sure your wound clean and dry after passing urine
  • Apply a Vaseline to the tip of your penis
  • Wear tight underwear for 2-3 days
  • Withdraw your foreskin on a daily basis to maintain the benefits of the surgery after 4 days
  • You will be given a letter which should be handed over to your GP
  • Get an antibiotic cream from any pharmacy and apply to the wound for 10 days
  • Abstain from sexual activity (intercourse and masturbation) for four to six weeks

After 3 days of penile frenuloplasty, it is VERY IMPORTANT that you withdraw the foreskin each day to avoid the foreskin becoming tight again. If you are concerned about any of these risks or have any further queries, please speak to the urologist or your GP.

Smoking and Surgery: Ideally, we would prefer you to stop smoking before any operation. Smoking can worsen some urological conditions and makes complications more likely after the operation.

In summary, if the penile frenulum is tight or torn, it can cause pain during erection or sexual activities, and it can cause bleeding and discomfort after tearing. Simple division of the penile frenulum under local anaesthesia can cure the problem. Decrease sensation on the head of the penis may happen after the frenuloplasty. Circumcision may be the solution if only penile frenuloplasty failed to solve the problems.

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