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My foreskin is tight and getting tighter, gay man writes to Dr Ren

A man in his late 20s asks whether he should get circumcised

Before you agree to surgery, you may want to consider stretching the foreskin, Dr Pega Ren suggests to 27-year-old gay man who says his foreskin is too tight. Credit: thinkstock

Dear Dr Ren,

I’m a 27-year-old gay man who has always had problems with my foreskin being tight. It’s been getting worse, and I’ve been considering getting circumcised to deal with the problem once and for all. What’s involved?

I’m far from lean and work in an office at a computer. Will these things affect my healing? Mostly I’m concerned about how a circumcision will affect sex.

What do I need to know?

— Painfully Tight

Dear Painfully Tight,

About 20 percent of men worldwide (about 75 percent of them in the United States) are circumcised, though usually as newborns. Most doctors advise against adult circumcision unless necessary to correct a problem such as balanoposthitis (inflammation of the penis head and foreskin) or phimosis (difficulty retracting the foreskin), which you describe. These conditions are caused by chronic irritation and scarring.

Interestingly, both of these problems occur with greater frequency in men with diabetes. You describe yourself as overweight, sedentary and experiencing increasing trouble with phimosis. You would be wise to monitor your blood sugar in case you have an underlying disease process exacerbating the problem. Get this checked out.

There is a difference between tight and inflamed. If your dick head is sore, the first thing your doctor will do is try to clear up the infection by having you apply an anti-fungal or anti-inflammatory ointment under your cape, which provides an ideal moist and warm environment for yeast to grow. This may alleviate the issue. If the irritation recurs, circumcision becomes the treatment of choice.

Before you agree to surgery, you may want to consider stretching the foreskin. You can find stretching techniques online. Ask your doctor for a prescription for Betamethasone .1% cream, which will help the skin soften. This technique requires patience and time, which you may not have if your condition is already painful.

Adult circumcision can be performed under local or general anesthesia. There are two general types of incision: the slit and the sleeve techniques. Your physician will decide which is best for you. Regardless, good aftercare is the key to successful recovery.

Possible complications of adult circumcision include infection, bleeding, poor cosmetic results and a change in sensation during sex.

This last is not insignificant. Men cut as adults report longer times from arousal to ejaculation, which may not be a bad thing. But along with the delayed ejaculation comes decreased sensitivity, often marked. Researchers (Money and Davison) at Johns Hopkins reported that following adult circumcision, “changes included diminished penile sensitivity and less penile gratification.” One of those patients says it well: “The greatest disadvantage of circumcision is the awful loss of sensitivity when the foreskin is removed . . . On a scale of 10, the intact penis experiences pleasure that is at least 11 or 12; the circumcised penis is lucky to get to 3.” This loss of sensation is due to a process called keratinization, a sort of callous formation on the previously protected coronal ridge and glans of your penis, and the full effects of this permanent loss are not realized for five or more years.

That said, surgery may be your only reasonable respite. Keep in mind that many who choose circumcision for religious or aesthetic reasons report increased satisfaction with the look of their penis and say they are pleased with their decisions. Motivation affects not only your decision beforehand, but your attitude afterward.

Your first step is to find out why, at age 27, this problem is becoming worse. A thorough medical workup is indicated. Add good food and exercise, perhaps some medication and stretching, and maybe you can avoid surgery. If not, keep calm. When you’ve gathered all the necessary information, you’ll be able to make the correct decision.