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I am uncircumcised, and the opening at the end of my foreskin is not large enough for the head of my penis to pass through. This means my foreskin doesn't pull back when I get an erection. The internet says this is a condition called "phimosis," and a lot of medical websites recommend circumcision. I'm not super-excited by that idea. I don't have any pain or difficulty with sex or urination, and I've never had any health problems related to being uncircumcised. The foreskin isn't stuck or fused to the glans—the hole is just small. Is there a safe, nonsurgical way to enlarge the opening in the foreskin?

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Dick Hole Panic

"Tell Dick Hole Panic not to panic," said Stephen H. King, MD, a urologist in Washington State and my new go-to guy for all questions dick. "Phimosis occurs in an uncircumcised penis when a circular ring of the foreskin becomes scarred, often from prior infection, inflammation, or trauma. This scar prevents the normally elastic tissue of the foreskin from fully retracting to expose the head of the penis."

Roughly one in a hundred men have phimosis, said Dr. King, "and depending on the degree of narrowing, complications of phimosis can vary widely. These can include difficulty with cleaning/hygiene, infection, pain with erection, bleeding from skin cracking, and paraphimosis." Paraphimosis sounds like something you want to avoid: "It occurs when a narrow foreskin is pulled back to expose the head of the penis but then can't be pulled back over the head, which then constricts blood flow to the glans," said Dr. King. Paraphimosis can cut off blood flow to the head of the penis, which can cause the head of your cock to become gangrenous and die, which is why anyone suffering from it should head to an emergency room immediately. Here's something else to worry about: "Although extremely rare, penile cancer can arise, usually in older patients with recurrent infections/inflammation."

You're probably panicking now, DHP—hell, hearing about paraphimosis has me panicking, and I'm circumcised. But the doctor said your case doesn't sound serious: You aren't experiencing any pain, your dick seems to work fine, you haven't suffered from a series of infections. You don't need to do anything about your phimosis for now, said Dr. King, but if you're worried about complications arising in the future, or if you want your sex partners to see the head of your dick someday, there are nonsurgical remedies.

"'Preputial gymnastics' is one way to resolve phimosis," said Dr. King. "It sounds like an Olympic event, but it involves gently pulling the foreskin back to expose the tip of the glans to the point where the ring of scar is exposed." In other words, pull your foreskin back until you can't pull it back anymore, and you'll be looking at the scar tissue. "Hold this position for one minute and repeat three to four times a day," Dr. King continued. "In combination with topical application of a steroid cream twice daily, typically betamethasone 0.05 percent (by prescription), more than 90 percent of cases will dramatically improve or resolve within four to six weeks."

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And if you're one of the 10 percent of phimosis sufferers whose case doesn't improve through preputial gymnastics?

"Then he should break out the Manischewitz for his impending bris," said Dr. King.

Originally published on April 17, 2013.



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