The causes of adolescent phimosis

Investigation

The nerve supply of the foreskin and its role in sexual sensation are preserved.

Circumcision to remove the foreskin is a classic, though traumatic, treatment for phimosis.

The causes of adolescent phimosis

In the course of practicing preventive medicine over the past 15 years, I have carried out many routine examinations of students in the first year of higher education. Among males aged 18-22, I have discovered around 300 cases of phimosis.

The condition occurs in approximately 10% of the population and is recognized to be present when the diameter of the preputial orifice is smaller than the diameter of the erect glans.

The classic treatment for phimosis is surgical - either circumcision or a simple plastic surgical procedure that retains the foreskin but widens its excessively tight orifice.

In view of the fact that this treatment is essentially bloody and traumatic (and sometimes mutilating), it seemed appropriate to study the aetiology of the condition to find out why these males retain a an infantile foreskin and to determine whether some alternative simpler and less traumatic treatment could be devised.

Unusual masturbatory practices
The history obtained from these patients invariably showed that their practice of masturbation differed from the usual manipulation that mimics the dynamics of coitus and tends to force the preputial orifice back toward the base of the penis, thus exposing the glans.

Masturbatory methods used by boys with phimosis are of several types and I have classified them as follows.

• Some never masturbate.
• Some stroke the glans through the foreskin in the usual way, but attempt to pull the skin towards the tip of the penis instead of pulling it back toward the pubis. In these males the long, tubular foreskin of infancy persists.
• In some cases, they roll the penis between two palms or between one hand and another surface such as the abdomen, the thigh, a table, the edge of a chair or the toilet. It is usual in these cases for the raphe on the underside of the penis not to be in the midline, but more or less displaced to one side or even spiral. The preputial orifice is often displaced.
• Mechanical stimulation without the use of the hands is commonly found. This occurs, for example, when they lie prone on a pillow and thrust into it.
• Interfemoral stimulation is found.

Correcting phimosis
As a result of this discovery, it seemed logical to recommend that these patients practise conventional masturbation. Within a few weeks (three at the most) it was found that the preputial orifice became wider, thus correcting the phimosis.

The method is similar to the kinesitherapy of soft tissues and is remarkably simple. It is surprising that it has not been described before.

However, I have known some patients who have used their common sense and have themselves modified their practice of masturbation during adolescence. Furthermore, broaching the topic of masturbation helps to remove the guilt associated with a sexual practice that is widespread but often carried out shamefully because of the taboo attached to it, particularly in Western society.

Preserving sexual sensation
This medical treatment of adolescent phimosis seemed to be successful in all cases unless there was some pathological condition of the foreskin. As a result, the many problems caused by the amputation of the foreskin can be avoided.

The nerve supply of the foreskin and its role in sexual sensation are preserved and, more importantly, the mobility of the penile sheath that is necessary to prevent irritation of the partner's vaginal mucosa is preserved.

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