It was 2:30 am on a November morning when Steve woke up to the snuffles of his three-month-old son. The 35-year-old from Ontario slung on a bathrobe and went to change his baby’s diaper. As he tossed the used diaper in the trash, he caught a glimpse of his son’s penis, and something that had evaded him since birth suddenly became crystal clear. “After seeing how his foreskin worked, that's when it clicked for me,” Steve says. “Honestly, I had always thought mine was different from others because I was not circumcised.”
Steve experiences a medical condition in which he is unable to pull his foreskin back past his glans (the round part forming the end of the penis). This condition—known as ‘phimosis’—is congenital in most male babies, whose penises are still developing and therefore have adhesions preventing full flexibility of the foreskin. Around 96 percent of baby boys have a non-retractable foreskin, but biological changes and the onset of erections mean that the foreskin becomes looser as they grow older. By the time men reach 18 years old, the figure drops to around two percent and is referred to as ‘pathological phimosis.’
The most common cause is infection to the penis due to poor hygiene. “Enthusiastic attempts to correct congenital phimosis by hand increase the risk of developing pathological phimosis,” says Sonia Ahmed, a UK-based general practitioner at Push Doctor, an online primary healthcare consultation service. In other words, premature forcible foreskin retraction during infancy and childhood is a significant cause of phimosis in adult life.
According to a 1993 study, there is a five-grade classification of phimosis severity, ranging from full foreskin retraction with tightness behind the glans (Grade 1), to no retraction at all (Grade 5, also called ‘pinhole phimosis’). Steve—who runs a blog documenting his phimosis journey alongside photos of his penis (he doesn’t use his last name in general and prefers not to for this piece)—had Grade 5 phimosis when he first made his discovery back in 2014. Ironically, because his case was so extreme, Steve experienced almost no physical issues, meaning that he didn’t realize he had phimosis for over three decades. “Somehow there was never any hygiene problem, because the whole area is always flushed out during urination,” he explains. “But I always did have problems climaxing from sex.”
On the other end of the spectrum is Daniel Austin, a 20-year-old from California, who became aware of his phimosis when he was 16. “I would watch porn and noticed that when the male wasn’t circumcised, his foreskin clearly rolled back and forth over the head,” he tells me. A quick look online revealed to him that what he was experiencing—the inability to pull his foreskin more than halfway down—was most certainly phimosis. Nonetheless, Austin didn’t really experience any physical issues. Genital stimulation and sex can be painful for people with phimosis, but he knew how to masturbate without using his full foreskin. When he had his first sexual experience, Austin’s partner was very understanding. “I was straight up with her and let her know that I couldn’t have sex for a few weeks or months [while waiting to treat his phimosis],” he says. “She was super cool with it and just gave me head because that wouldn’t hurt too bad.”
Austin believes that his condition primarily had a psychological impact on him and may have made him more reserved at high school. “Don’t get me wrong, I had plenty of friends and was pretty outgoing,” he says, “but I never made any attempts to talk to girls or go to dances because I figured I didn’t wanna get my hopes up.” Although Fred Drayton, a 20-year-old who lives in Australia, is sexually inexperienced, he has similar fears to Austin. His glans is incredibly sensitive as a result of his phimosis, to the extent that if something touches it, he experiences a searing sensation. “I always worried that if I ever got with a girl, it wouldn’t be pleasant for both of us,” he explains. “I also read stories about people with phimosis having their foreskin rip and tear during sex.” In some cases, phimosis can lead to foreskin tears during intercourse, and Ahmed recommends using a condom (ironically) to make the penis more comfortable. Unfortunately, Drayton thinks that these fears may have unconsciously prevented him from initiating flirtation and sex.
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Luckily for Steve, Austin, and Drayton, phimosis can be treated. The first step is to be comfortable enough to seeking professional medical advice from a doctor. Through this route, both Steve and Austin were prescribed topical steroid cream. According to Ahmed, this softens the foreskin and has reported success rates of 33 to 95 percent, owing to the varied severity with which phimosis can be experienced.
Indeed, with such extreme phimosis, Steve found the steroid cream to be largely ineffective (my experts explain that it’s often a matter of trial and error alongside the other techniques). Instead, he looked towards the stretching exercises documented on phimosis internet support pages and in academic papers. George Denniston—a former professor of family medicine at the University of Washington, Seattle, and founder of the non-profit Doctors Opposing Circumcision—recommends a variety of techniques, such as “pulling the foreskin back regularly to challenge it to open up, without causing trauma” and “stretching exercises coupled with a device like ‘Glansie,’ a tiny speculum that, used regularly, encourages the tissue to be more elastic.”
Steve used his collated knowledge to develop his own penis-specific technique. “At first, nothing larger than a toothpick would fit in the opening, so I improvised by wrapping increasing layers of Teflon tape around the sawed-off ends of Q-tips,” he recalls. Although this left him sore and red, he was encouraged when he noticed that he could pee faster. “Over a few months, I progressed until I could fit in two Q-tips and hold it open to stretch, and then finally use my fingers. I would do this for five to ten minutes at a time, three to five times a day.” Note: The cotton swab method is not endorsed by either Ahmed or Denniston—they both suggest consulting a doctor before finger stretching. Personal hygiene is maintained around and under the foreskin (if retractable), as Ahmed mentions, or the condition could be worsened.
After 18 months, Steve had mostly treated his phimosis, and the difference in the bedroom is palpable. “The sensation from the head is like the bass beat of a song, and the nerves of the foreskin provide the melody, vocals, and all the other instruments,” he says. “With the head covered, I was always missing the bass beat.”
As Steve’s case illustrates, stretching can be a long and somewhat painful journey. This means that others, including Austin, opt for a surgical solution. “Urologists in your area may be unfamiliar with the conservative [non-surgical] treatments, or are dead-set to perform an adult circumcision, which they often reach for as more lucrative for them, but which we absolutely advise against as unnecessarily intrusive and destructive,” Denniston says, adding that preputioplasty, a minimally-invasive surgical procedure that widens the foreskin opening, could be a better option.
Austin went ahead with a full circumcision. The surgery was painful and he struggled through a five-week recovery. Two years down the line, everything down there is working great and Austin has managed to allay most of his psychological issues. “I find that I have a lot more confidence because before, I felt subpar. I felt like something was wrong with me, that other guys had fully functioning members and they hadn’t ever had to worry about rubbing a cream down there or taking a knife to it,” he explains. “I’m sure had I tried to have sex with phimosis it could have maybe worked, but I was just too afraid to even try.”
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