Phimosis, Circumcision, and Frenuloplasty in Adults

What is Phimosis in Adults?

Phimosis consists of the inability or difficulty to fully retract the foreskin—the skin covering the end of the penis—in order to fully expose the glans (the head of the penis). Although it is a very common condition in childhood, in adult men, phimosis is considered pathological.

In adults, phimosis often arises as an acquired condition secondary to recurrent fungal or bacterial infections (balanoposthitis) or due to a chronic dermatological pathology called Lichen Sclerosus, which creates a ring of whitish, rigid, and inelastic scar tissue on the foreskin, preventing its retraction.

Symptoms and Clinical Consequences

The presence of phimosis in adults entails several problems that justify a consultation with a urologist:

  • Pain During Sexual Intercourse: An erection increases the volume of the penis, causing the narrow ring of skin to stretch painfully, which can lead to fissures (small cuts) or tears that bleed.
  • Difficulty with Personal Hygiene: The inability to expose the glans prevents proper washing, leading to the accumulation of smegma (natural secretions), which promotes the appearance of chronic infections and bad odor.
  • Risk of Paraphimosis (Emergency): This occurs when the narrow skin is forced behind the glans and becomes stuck, acting like a tourniquet that prevents blood from returning. This causes significant swelling and extreme pain in the glans, requiring urgent urological treatment to avoid tissue necrosis.
Short Penile Frenulum (Frenuloplasty)

Often confused with phimosis, a short penile frenulum (or short frenulum of the foreskin) affects the small fold of elastic skin that connects the underside of the glans to the foreskin. When the frenulum is excessively short, during an erection or sexual intercourse, the skin is severely stretched, pulling the head of the penis downward uncomfortably. This excessive tension often causes the **rupture or tearing of the frenulum** during intercourse, causing profuse and bright bleeding that generates great anxiety in the patient.

Effective Surgical Treatments

When initial medical treatments based on topical corticosteroid ointments fail to restore skin elasticity, urological surgical solutions are definitive and safe. They are performed on an outpatient basis under local anesthesia (with or without sedation), and the patient returns home on the same day.

1. Circumcision (Posthectomy)

This is the indicated surgery for the definitive treatment of phimosis. It consists of the surgical removal of the narrow skin ring and the excess pathological foreskin, leaving the glans totally or partially uncovered permanently. The tissues are joined with ultra-fine, absorbable surgical sutures. The procedure takes about 20 to 30 minutes.

2. Frenuloplasty (Frenulum Surgery)

Strictly indicated for a short frenulum. It consists of a small transverse cut made in the frenulum under local anesthesia, followed by a longitudinal suture. This simple technique “lengthens” the frenulum, eliminating tension and the risk of future hemorrhagic ruptures during sexual intercourse, without the need to remove the foreskin (keeping the natural anatomy practically intact).

Postoperative Care and Recovery

Complete healing occurs in about 3 to 4 weeks. Essential care includes:

  • Careful daily hygiene with water and neutral soap and the application of a healing or antiseptic ointment prescribed by the urologist.
  • Slight swelling or small bruises are normal in the first few days after surgery. The stitches fall out spontaneously between the 10th and 20th day.
  • Sexual Abstinence: The patient must strictly avoid any sexual activity or masturbation for **4 weeks** to prevent the stitches from opening and to ensure a perfect aesthetic scar.
Do you suffer from pain during sexual intercourse or have a history of local infections on the prostate skin?

Appointment booking

Book your urology appointment with Dr Frederico Furriel, a urologist with consultations in Leiria, Caldas da Rainha and Porto de Mós. Select your preferred location and submit your appointment request.