Skin Science: Resolving Phimosis with Stretching

You’re here because you want to fix your foreskin. If it doesn’t retract all the way by the time you hit puberty, join the crowd. You are part of 1% of men for which this happens. Most of them don’t mind, and some don’t even realize they are different. But a non-retractile foreskin can get in the way of experiencing the full joy of sex. For some it only needs to be a few millimetres larger, and for others (like me) it needs to expand from a tiny pinhole. Retraction may seem unobtainable.

Skin is a remarkably adaptable organ. Young_woman_with_stretched_ear_piercing pregnant-belly large-ear-stretchings-and-lip-plate-piercing All of the above feats were accomplished the same way: with gradual, persistent, gentle stretching.

What is skin?

Your foreskin is made of layers of different cells and connective tissue. Aside from skin cells, it’s packed with nerve endings, mucous membranes, and strong muscle tissue. You can’t control this muscle, but you can feel its effects. It contracts when it gets cold. Skinlayers Skin is layers of cells. The upper layers are the epidermis. The cells of the epidermis have hard, strong walls and fats between them to keep bad things out of your body. About a dozen layers below the epidermis lies the dermis — a mixture of different cells that help give skin structure. Fibroblasts, for example, exude collagen — a fibrous protein that helps pull everything together. Collagen gives skin its tightness. As people age, they produce less collagen, their skin stops snapping back when you pull it, and they get wrinkles. wrinkly skinHere’s a section of foreskin up close:

Section-of-the-epiderm-of-the-prepuce-showing-the-superimpos(source)

Near the bottom, some cells are dividing. They are undergoing mitosis. The epidermis is constantly replaced, as cells migrate up from the lower layers, every 48 hours or so. When you stretch skin, the cells flatten. But skin cells don’t like to be stretched out. During the time they are bent out of shape, they are more likely to begin mitosis (cellular division). This signalling method is called mechanotransduction.

To modify your skin, you will need to stretch it gently for as long as possible each day, without damaging it. This will stimulate new cell growth.

Corticosteroids and skin stretching

Many studies about fixing phimosis have found that you can get the best results with stretching in combination with a topical corticosteroid. If you use cream without stretching, probably nothing will happen. Stretch without cream, and you’ll need to do it for longer to see results.betamethasone creamHere’s where things get confusing. Corticosteriods have a devastating effect on skin. Seconds after they are applied, the epidermis will start to atrophy. Old cells shrink, and new cells will tend to divide more slowly. Since it is not being replaced, the epidermis — the hard upper layer, will grow thinner.

This seems counter-productive. When stretching, you want to promote growth, not inhibit it. However, corticosteroids have another important effect. The fibroblast cells in the dermis will also stop producing collagen. As the old collagen breaks down, the skin begins to resemble that of an elderly person. It becomes thinner, looser, and very pliable. Collagen production is suppressed for at least two weeks after application of a corticosteroid. If, during that time, you can stimulate some cell growth, you will have a long-term gain in skin surface area.

Gentle stretching and steroids

Gentle stretching and steroid creams are the first thing to try when resolving non-retracting foreskin. In many studies in children, 90% of the cases are resolved. With adults, it will take persistence, and a daily routine of stretching for several months.

How exactly? I’ll explain that in my next post.

Follow me on twitter @PhimosisJourney to get a stream of entertaining updates on my penis.

“Normally, we give this to two-year-olds, but…”

Went to the doctor’s office today. I told them on the phone: “I’m self treating for phimosis, and I’d like to discuss it with him.” So he was all ready to meet me:

funny-scary-quack-bad-doctor-surgeon-isolated-18402848

Just kidding. My Canadian doctor is like Dr. House; he sends his interns in first. I explained to the fresh-faced med student about how I was Googling for penises one day and noticed that “foreskin retraction” meant much more than I ever realized. I explained how I had delayed no ejaculation during intercourse, and — yes — although I have three children, we had to “work around” the problem to obtain them (I left that part up to his imagination).

I told him that I was about to embark on a regimen of stretching, and thought it prudent to check with a real doctor rather than some internet forum.

SNAP — on went those latex gloves and I dropped my drawers to demonstrate the difficulty.

doogie
“WOW,” he exclaimed, “that really is a small hole!”

After typing in all this information, including the phrase “tiny prepucial orifice” into his Windows XP computer, he left to check with his supervisor, no doubt to be instructed on the art of understatement.

Hours later, in walks Dr. House. Except in real life he talks just like Ned Flanders. I am not making this up.

“Well although it’s a little un-diddly-usual to have a non-retractable foreskin at your age,” he said, “I’m sure if we can fix it you’ll be A-OK in the old ejaculatory department!”

ned

He was already carrying a prescription for betamethasone cream.

“This is the same stuff I give to two year olds, ” he continued. “Try it for six weeks, and if it doesn’t work, I’ll give you a referral to a urologist.”

I went to the supermarket and filled out my prescription for $5. I had mixed emotions. There was no big fight. Nobody had even mentioned the C-word. Although he’d never heard of them, he was totally fine with me shoving flesh tunnels and other “dilation tools” up my foreskin.

But will this tiny bottle of cream really fix TEN YEARS OF DISAPPOINTING SEX?

creamApparently I need to pick up a few things from the hardware store to help.

“I’m unhappy with my penis,” I told my wife

With the crying baby, an inquisitive five year old, and a three year old story-telling chatterbox, my wife and I don’t get a lot of time to talk, despite spending at least six hours together each day.

But I had to bring her in on my plans somehow. The thought of it made me sick. With a single look, she could veto the whole thing. All I had was advice from a random chatroom on the Internet. I hadn’t even seen a doctor yet.

I was distracted the entire day, trying to find a way to bring it up. Time was growing short.

At nightfall, she was brushing her teeth as we worked through the daily administrivia.

So tell me about your day!
So tell me about your day, honey!

“..so because of my appointment WHIRRR SPLISH SPLASH,” she spat, “I need to you drive Katrina to ballet WHIRRRR SPLASH on Wednesday. WHIRR WHIRR SPIT”

“No problem, dear! Can we talk for a second?”

“Sure WHIRR WHIRR what’s on your mind? SPLASH SPIT”

“I’m unhappy with my penis.”

While she finished brushing, I demonstrated how my foreskin didn’t retract at all, and explained that in your Standard Model Penis, the pee-hole was actually much larger and should roll open, allowing the glans to protrude.

I told her about surgeries, Dorsal Slit, and preputioplasty, which could result in an ugly scar.

“Don’t worry about that, honey,” she soothed. “I think all penises are ugly.”

I explained how I wanted to try stretching it, because it worked for random people on the Internet, and not to worry if strange packages full of “Flesh Tunnels” started to arrive in the mail.

We sat on the floor in our pajamas and Googled for penises together.  We gawked at the images that popped up, and I found a video of a foreskin retraction.

The shraders watch TV
My wife and I react to videos of how a foreskin is supposed to work

“See,” she said, cheerfully jabbing a finger at the screen, “Ugly!”

I love how honest and supportive she is. She had no problem with my trying to stretch it out myself and offered to let me raid her collection of knitting supplies to find a suitable object.

“I want you to do what makes you happy,” she told me.

 That’s why I married her. I can’t begin to tell you the relief that comes with telling her my secret.

The only thing is: she made me promise to go to the doctor. You won’t believe what happened there!

Follow my journey on Twitter: @PhimosisJourney

Bic Pencaps, Chopsticks and Knitting Needles

Kids are in bed. Wife is knitting. I’m charging around the house, opening drawers and frenetically rifling their contents. I sweep aside old figurines, ancient packets of soy sauce, and hundreds of half-used erasers. There’s got to be something here I can use.

I’m looking for things to shove into my foreskin.

I’ve have phimosis my entire life. My foreskin doesn’t retract — it just stretches down. Unlike many men with the condition, mine is so extreme that no part of my glans has ever been exposed to air. Until last week, I didn’t even realize it was supposed to be.

According to the Internet, in as little as two months, I may be able to stretch the tiny pinhole large enough so that I’ll be able to see my glans. Eventually it will be able to slip through, and I’ll be the proud possessor of a completely normal, upstanding member of impropriety.

They say giving birth is like trying to shove a soccer ball through your penis. I try not to think about this as I dump my bounty of pen caps, paintbrushes, chopsticks, and other small trinkets on the bathroom counter. Each has been recommended on the Internet forum that I’m following.

Men with partial retraction can get results with their bare hands by grasping the sides of the opening and slowly stretching several times daily. Companies like NovaGlan,  GlansPro, and Glansie will gladly send you a discretely packaged device to make it easier. But these tools are all too large for me, as they require at least a 6mm opening.

20141119_212210

This digital thermometer looks about right. I dip it in alcohol, let it dry, and then very very carefully press it against my urethra. It easily slips inside, and I gently move it to the side. I’m not sounding — just trying to stretch the tight circle of skin that seals everything shut. Slowly, I stir it around a little, exploring. Some parts are tight. Isn’t there something called a frenulum in there somewhere? I can’t remember if its on the top or the bottom, so I avoid both areas.

After a few minutes, I remove the thermometer. The opening looks a little larger. Maybe. The problem is the thermometer doesn’t get wider at all. I need something with more flare.

I move on to the plastic chopstick. It’s decorative, round, and very smooth. It slips in easily, but I know immediately that it’s too narrow.

Ouch! I hit something.

The right side hurts like hell. I take some Advil for the pain. Stretching will have to wait a couple days.

Everything's fine, dear! Just... ate too much pizza.
“Everything’s fine, dear! Just… ate too much pizza.”

One thing is clear: I’m going to have to tell my wife somehow.

Follow me on Twitter: @PhimosisJourney

Pinhole Phimosis FAQ

How do I know if it’s pinhole phimosis?

Pinhole phimosis means that the foreskin can’t be retracted. There’s just a tiny opening at the end. Nothing larger than a toothpick can fit through.

The biggest sign is in the bathroom. When you urinate, first the head of the penis fills up and balloons out slightly, and then the stream starts.

In some cases, the ring of tightness is on both the inner and outer side of the foreskin, so there is a bunching of skin at the tip that never gets unfolded.

However in my case, I can stretch the foreskin back tightly and aim the tiny hole with my fingers, allowing a very precise strong stream with no splatter. If I wanted to, I could move about six feet away from the toilet without problems.

It doesn’t take much longer than other men. I’m not sure why — the reason is literally rocket science.

When I’m done, a tiny amount always dribbles out in my pants for a few minutes afterwards. There is not enough to cause spotting or anything. I don’t yet know if this is normal.

Eeww, how do you keep it clean? Doesn’t it smell?

Because of the ballooning, the entire interior is flushed out naturally several times a day. Urine has no bacteria in it when it leaves the body, and it has antiseptic properties. There is no need for any special cleaning.

Aren’t women turned off by its appearance?

I’ve got news for you: many women aren’t aroused very much by viewing a penis, and they asked me to tell you to stop texting them photos. My wife says she finds all penises to be equally ugly.

Doesn’t sex hurt?

Pinhole phimosis has one advantage over other less extreme versions. When I have an erection everything just gets all stretched to the maximum right away. Since the foreskin doesn’t retract, there is no pain except for the roughest of sessions.

Does sex work?

This is my biggest problem. Sex is very nice but not stimulating enough to climax. It’s great if you can find a woman who wants to go for hours. But except for the intimacy part, I can have much more fun by myself.

Oral sex is much more of a turn-on for me, because one of us can use our hands to help.

Once achieved, ejaculation is not a problem. Those little guys can find their way out.

Did you masturbate strangely to cause this?

I do things differently. Instead of stroking the shaft, I use a few fingers to focus on where the glans should be. Since this area is small, the motions are quick and short as well.

I think the phimosis led to this technique, not the other way around. If I used the common method, the foreskin just stretches down and squeezes the glans tighter without moving very much. That’s what happens in sex as well. See above.

Follow me on Twitter: @PhimosisJourney

More resources:

Circumcision and Phimosis: A clear-cut decision?

My wife is nursing the baby and my kids are planted in front of the TV. I have a few minutes of peace. I sneak into the bathroom, lock the door, and prepare to try to turn my penis inside out.

Days ago, I discovered that my penis wasn’t normal. My foreskin stretches down, rather than retracting. What appeared to be my glans was still all covered up, terminating in a 1mm sized opening at the top. (This man has pics of what I could easily mistake for my own penis)

It explains everything. Sex has always been enjoyable, but always ends the same way: I get tired or she gets bored. Thank goodness I don’t need condoms any more. I have 100% sympathy for men who refuse them. For me, they deaden all feeling except for warmth. (“Am I in you?” “Um, that’s my leg.”). We’ve found other methods of birth control. Not that we need it — I can last forever.

I can either go on with my life or fix this now.

The C word

Many people feel strongly about circumcision. Rightly so — there are vanishingly few reasons to have this procedure done on a child. But as an adult, with a medical reason, I thought the decision would be a no-brainer. If there’s a medical reason, it’s free in Canada, and doctors don’t push unnecessary procedures. (We send all the greedy ones south, and tell them it’s “brain drain”)

I trust facts and data. I trust peer reviewed studies. But what they are telling me doesn’t make the decision easy.

It’s a controversial issue, which means unbiased information is scarce. By some accounts that I have read from people with phimosis, it completely changes their life and they highly recommend it. Other quotes are from people that “lost sensation” or “ruined their life”. The trouble is, all of these quotes are from one-sided internet sites, and not representative of the typical experience.

This testimonial seems encouraging: 

I always felt sexual intercourse was a bit of a let down when I lost my virginity, because it felt no different to when I masturbated. I suppose what I am saying is that the foreskin just seemed to slide back and forth over the glans during intercourse, and that was the same experience that I had when I masturbated.

I always remember thinking when I first had intercourse that it just wasn’t any great revelation. But OOHHH! how different things are without a foreskin to get in the way. I cant believe how good it is now. Last weekend I just couldn’t believe intercourse could be so enjoyable. The feeling of the glans in direct stimulation against the vagina and not a foreskin is wonderful.

You have probably heard it all before, but intercourse certainly is better circumcised. Take it from one who knows. This will make you laugh but I rub vitamin E cream into the wound to help it heal. And then we very gently “… well … let me just say sex is great … fantastic.. nothing to get in the way.

I have no regrets. I have ABSOLUTELY no regrets. There is nothing I miss about my post-operative state. Which is strange because I really went into this being totally realistic and thinking I may have some regrets. But sex is far more enjoyable. And with summer on the way cleanliness is going to be so much easier, even now for that matter. 2 Well it’s late and I am going home. I hope to hear from you soon and thanks for your help and advice.”

On the other hand, @BSR163 from twitter has counselled real people who have been cut after they had reached sexual maturity and had experienced sex prior to circumcision:

All were profoundly affected by the change and loss that they experienced.

Two reported the initial joy of the liberation of the glans, but found it was short-lived. Both subsequently experienced major difficulties reaching orgasm without (in 1 case, using a rough towel) or in the other, using a ‘death grip’. Neither techniques are compatible with normal sexual interiors. The vagina cannot replicate the ‘death grip’. With their increasing difficulties, their confidence was knocked and they experienced ED… even though they were on their 20s.

Once circumcised, you will experience two effects. The ‘liberation’ of your glans will probably be fantastic initially, though at the same time, hypersensitive in an uncomfortable way, not a sexual way. The second effect will be the apparent and immediate loss of the main source of your (up until circumcision) sexual stimulation. It will be absent.

However, once the glans has been exposed for a number of years, the epithelium on the glans will noticeably thicken and keratinize. The net effect of this will be a further dulling of the sensation derived from the glans as the receptors are buried deeper under the thickening skin. In order to reach orgasm, you will likely need to use significant force and friction, resulting in rougher sex or masturbation. Jack-hammer sex is how it is often described.

In a personal message, I confronted the author of A Circumcision Diary with this information. Two years after his experience, he writes:

If that is true then keratinisation is a non-factor for sensation. My glans also doesn’t look or feel any different than it did a month out. The sensation hasn’t changed since the six month mark, either. Knowing what I do about skin physiology, keratinisation shouldn’t affect sensation that much anyway, because it doesn’t change the way the nerves are stimulated. I think that sensation is “lost” because the glans is untrained to touch after being occluded for so long, so there’s a period of increased sensation immediately after surgery, followed by a slow decrease to a new normal. It is simply acclimatisation to new stimuli.

I’m sure we could go on forever. Let us leave the intactivists and the circumcisionists to duke it out on Twitter. In any case, anecdotes are no way to make a life-changing medical decision.

Let’s use science

In 2002 some researchers followed up on men who were circumcised as adults and asked them how they felt. Of the responders, 47% reported that sex was more pleasurable and satisfying after the circumcision. 38% reported a problem or perceived difficulty afterwards. Overall, 62% of men were satisfied with having been circumcised. Read the study

So it’s not a slam-dunk decision. The odds are that I would be happy and raving about it. But there is a four in ten chance I’d have “some difficulties”,  and only a 50/50 shot at better sex.

Dr. John Aquino, medical director of Ontario Men’s Health, echoes this in a Toronto Star interview:

“It’s like rolling the dice. You don’t know what’s going to happen,” he says, adding it can either increase or decrease sensitivity. “Most of the time it’ll probably make (the penis) less sensitive because there’s a lot of nerve endings in the foreskin.”

The other primary method of getting rid of phimosis is to beg your doctor for some steroid cream, and slather it on, and “stretch” daily for 2 months to a year. Reading over the internet forums, it’s clear why American doctors aren’t jumping at the chance to recommend it. Can you imagine your doctor telling you to do something for 20 minutes a day, for months? Patient compliance would be astoundingly low. While you’re at it, why don’t you work out three times a week and and eat ten daily servings of vegetables?

In 2005, some researchers intercepted children who were scheduled for circumcision and gave their parents specific instructions:

  1. Apply steroid cream to the foreskin every day.
  2. Four times a day for a month, retract the foreskin gently as much as possible without causing pain or strictures for one minute.

At the end of one month, 71% of the most severe cases were fully cured. The ones who weren’t  were allowed to go for another month, and a third if necessary. By the end of three months, only 2 / 50 of the most severe cases went on to surgery — a 96% success rate. (Read the study)

That’s rather clear.

At 35 years, I’m much older than the kids in the study, but I have little to loose.

  • I’ll try stretching and cream for a month.
  • If my opening gets any bigger at all, I’ll try it some more.

Odds are good that it’ll resolve my condition. If all else fails, I’ll get snipped and I’m 62% likely to be happy with it.

That’s why I’m locked in the bathroom, stretching my foreskin. I’m frustrated now because I can’t grasp near enough to the opening.

“Can you try get your finger in it?” a forum poster asks. Sure, if I were a gerbil.

I can only pinch the skin around it and raise it higher. The hole remains tight. Not even a soda straw would fit through it.

My wife is calling now. One of the kids has spilled orange juice on the couch. Stretching will have to wait today.

My story continues here.

Follow me on Twitter: @PhimosisJourney

A stranger has my penis

I was just on the internet googling for penises.

I’m not gay. In fact, my problem is that I haven’t seen enough penises. After years of marriage, both my wife and I thought I had a typical, God-given schlong that could stand proudly alongside the best johnsons of the country.

We couldn’t have been more mistaken.

I was researching my condition and I came upon this page:

http://phimosiscases.blogspot.ca/2014/01/a-very-severe-case.html?m=0

I know every vein and fold of my penis. And that man has it.

Isn’t that weird? I swear I am not him.

The shocked reactions on reddit do not make me feel very good.

Update

I contacted my penis-twin and asked him how phimosis affects him. Does he have the lack of sensitivity that I do? He wrote back:

It only bothers me because I don’t know if not having it would be better than it is.

I’ve tried a little bit of stretching but nothing consistent so I’ve not seen any progress.

It doesn’t really affect my life too much. I have a problem with excess urine after peeing, but thats about it. I’m a married man with a perfectly normal sex life, I guess it is a little tight sometimes but nothing has ever split. I don’t last forever at all though. lol.