Is phimosis the same as redundant prepuce? How do you differentiate between the two? Does redundant prepuce affect much? And can you have sex if you have phimosis? Does it affect sexual function? Let’s explore phimosis and redundant prepuce issues together!
1. Definitions of Phimosis and Redundant Prepuce
What is phimosis? Is redundant prepuce the same as phimosis? New parents often feel helpless when faced with a baby’s phimosis and don’t know what to do. Questions like whether a child with phimosis should undergo surgery or whether it’s too early for primary school children to have phimosis surgery are common concerns of parents during consultations. So, what is the definition of redundant prepuce, and where is the standard for redundant prepuce? I’ll answer these questions for you one by one!
(1) What is Phimosis? What is Redundant Prepuce?
Redundant prepuce refers to a condition in which the glans of the male penis is completely covered by the foreskin but can still be pushed down to the coronal sulcus to expose the glans. When the long foreskin completely covers the glans and cannot be pushed down to expose the glans, we call it “phimosis”.
Sometimes, people hear that their neighbor’s child had circumcision right after birth and come to the clinic worriedly asking me if their child also had circumcision early so that they won’t have problems when they grow up.
Phimosis is very common in newborn boys. At this stage, it’s normal for the foreskin not to be pulled behind the glans. However, as they enter puberty, about 95% of males can easily retract the foreskin to expose the glans. In adult males, poor hygiene can lead to inflammation of the foreskin and glans, causing the long foreskin to stick, resulting in phimosis.
So, generally, you can wait until your child enters elementary school or adolescence to assess whether surgery is needed. At this time, local anesthesia can be used for treatment, which is relatively stable compared to the instability of infants and the need for general anesthesia, which increases the risk!
For concerned parents, it’s normal to worry about your child, but be careful not to force the foreskin to retract forcefully to expose the glans, as this may cause injury to the foreskin and worsen the original narrow condition. If you notice redness and swelling of the urethral opening or difficulty urinating in your child, seek medical attention promptly!
(2) Have You Heard of Paraphimosis?
A male patient once came to the emergency room embarrassed. When he pulled down his pants, it was serious. His foreskin had swollen into a ring. After inquiring, I learned the truth. It turned out that the night before, he had had vigorous sexual intercourse with his girlfriend. Combined with his long foreskin, although he usually had no trouble, this time it swelled up suddenly, and he realized that it was serious, so he came to the emergency room for treatment. This is actually “paraphimosis”.
Next, let’s get to know what paraphimosis is!
Paraphimosis is an emergency condition. This type of phimosis means that after forcefully retracting the foreskin to expose the glans, it becomes stuck in the coronal sulcus of the penis due to the small or tight opening of the foreskin, causing redness, swelling, and pain in the glans. In severe cases, it may cause ulceration of the glans or even ischemic necrosis.
Paraphimosis tends to occur more frequently in adolescent males during masturbation or when parents accidentally push the foreskin too far back during cleaning, causing it to get stuck. In such cases, emergency physicians will use local anesthesia to manually reduce the foreskin, make a small incision, or perform a “circumcision” procedure.
★ Through the above two points, you can know that redundant prepuce cannot be directly judged as phimosis. However, if it meets one of the following two conditions, it can then be considered phimosis!
- Unable to pull the foreskin down to expose the glans
- After pulling the foreskin down, it gets stuck and cannot be pulled back up
(3) Are there false phimosis cases? Can’t tell true phimosis from false phimosis?
False phimosis is actually “redundant prepuce,” but when a male is erect, the glans will protrude from the foreskin by itself, or the foreskin can be pulled down manually to expose the glans. These situations are not considered “true” phimosis! On DCARD, there are often questions from young people about redundant prepuce: Does it always require surgery?
＞Redundant prepuce is not a disease, but it requires attention to hygiene to avoid infection problems. The following text will further explore the conditions that require surgical removal of the foreskin!
2. Can you have sex with phimosis? Will there be premature ejaculation issues?
It’s common to see questions online or in clinics from male patients like: What should I do if I can’t pull back the foreskin when masturbating, or sometimes it even hurts? Does the hardness differ when having sex with phimosis? Will circumcision make the penis smaller?
The glans is the most sensitive part of the male genitalia. As one grows older, the glans, which was originally covered during childhood, gradually becomes exposed. With the friction and stimulation from clothing, the sensitivity of the glans decreases. This is why some people experience premature ejaculation with phimosis, as the glans becomes relatively more sensitive during sex with phimosis or redundant prepuce, leading to quick ejaculation.
If there is insufficient hardness during vaginal penetration due to pain from foreskin stretching or if there are already wounds from stretching, it is recommended to seek medical attention early for the doctor to determine if surgery is necessary.
＞Debunking the myth of “circumcision makes the penis shorter”!
There is no correlation between circumcision surgery and penis length. This misconception arises from some people mistakenly considering the foreskin as part of the penis. Some people also believe that circumcision at a younger age helps the penis grow larger, but there is no evidence for this!
3. What are the effects of redundant prepuce?
What should you do if the foreskin is too long? Does redundant prepuce always require surgery? What about phimosis? Is circumcision necessary for phimosis? Will there be problems if phimosis is left untreated? Let’s take a look at the conditions of long foreskin and circumcision for phimosis, and whether there are alternative methods to surgery. Read on to find out!
(1) 6 Conditions Requiring Circumcision:
- Adult phimosis: The glans cannot be exposed even when the penis is erect
- Difficulty in cleaning due to long foreskin
- Inflammation and infection caused by long foreskin
- Narrow opening of the foreskin, causing difficulty in urination and ballooning of the foreskin
- Pain during sexual intercourse, or even injury
- Paraphimosis (emergency condition)
(2) Circumcision Surgery Options:
- Traditional circumcision: Manual removal of excessive foreskin, takes about 30-40 minutes, with swelling and pain for up to 1 week after surgery.
- Laser circumcision: Laser is used instead of a surgical knife, shorter operation time, about 15 minutes, and less pain, but higher cost.
- Plastibell circumcision: The latest surgical method, with less pain and shorter operation time compared to the first two methods. After surgery, you can quickly return to work and daily life, but the cost is higher.
If the condition of the foreskin affects penile health and surgery is confirmed necessary by a doctor, health insurance coverage can be applied for. However, if there are other non-medical considerations for choosing circumcision surgery, the cost must be borne by the individual.
★ Post-Circumcision Care Instructions:
- Swelling and pain after surgery are normal and should be treated with medication as instructed by the doctor. Symptoms usually improve after 3 days, and complete recovery can be expected within 7-10 days.
- The wound should be kept clean and dry. If the gauze becomes soiled during urination, it should be replaced immediately.
- Most surgeries use absorbable sutures, so there is no need for suture removal. However, if the sutures have not completely fallen off after 2 weeks, seek medical assistance for removal.
- Do not clean the scab on the wound. Deliberate cleaning may cause bleeding. Let it fall off naturally.
- It is recommended to wait for 1 month after surgery before resuming sexual activity.
★ Cases Where Circumcision Is Not Recommended:
If a child has “hypospadias (the opening of the urethra is located on the underside of the penis instead of the tip),” circumcision is not recommended even if there is phimosis, because the foreskin can be used as “material” for reconstructing the urethra!
(3) Is Foreskin Cream Helpful?
When children are too young, considering the risk of general anesthesia and the possibility of local infection from the wound being covered by a diaper after surgery, parents may consider using topical corticosteroid cream for local application treatment. Currently, there are no significant adverse effects of drug treatment, and the necessity of surgery can be further considered after the complete development of the penis during puberty.
Treatment with foreskin cream: After cleaning, apply corticosteroid cream to the narrow part of the foreskin or where the foreskin adheres to the glans twice a day for 1-2 months. The inner foreskin will gradually separate from the glans, making it easier to clean.
(4) Understanding the Principles of Foreskin Hygiene
Many patients worry that long foreskin will affect fertility and often ask me in clinics: Will long foreskin affect fertility? The answer is: No!
Although long foreskin does not affect sexual function and fertility, poor hygiene may increase the risk of sexually transmitted diseases and penile cancer, and may even pose a risk of cervical cancer for sexual partners. This underscores the importance of proper foreskin hygiene! So, men, remember the following foreskin hygiene principles!
- When showering, pull back the foreskin to rinse. Also, pull back the foreskin during urination. Remember to pull it back.
- Use clean water or neutral shower gel to wash the foreskin and glans, but not excessively, as too much cleanser may cause irritation and pain.
- Keep dry. For men with long foreskin or those whose glans are not normally exposed, after showering, dry the glans and coronal groove before putting on pants to maintain dryness and prevent odor.
