The frenulum (in Latin "little bowstring") is the small bridge of skin lying from the underside of the tip of the penis to the underside of the foreskin. It is a very sensitive area and many men find stimulation of the frenulum very arousing. While normally this piece of skin is reasonably long and elastic, in a substantial minority of men it is either too short from the beginning or else develops scarring which makes it prone to tearing and splitting particularly during intercourse.
This can be quite alarming since occasionally there is quite marked bleeding from the frenulum due to the small artery which runs inside it.
Although some surgeons will recommend a circumcision for men who have a frenular problem there is really no need for this in the vast majority of men since a small plastic surgical operation will lengthen the frenulum adequately in more than 90% of patients. As an alternative to any surgery, some men have reported success with frenular stretching at home: I have had no patients who have succeeded with this so far.
The Frenuloplasty Operation
A frenuloplasty is an operation which lengthens the frenulum.
This is a procedure which is simply done under local anaesthesia and can be carried out in the outpatients procedure room without necessitating admission to hospital.
Essentially a very small amount of anaesthetic is put into the area. A cut is made in the shape of a V which is then gradually loosened and sewn up in the shape of a Y usually increasing the length of the frenulum by around 1 to 1.5cm. Sometimes a modification of the plasty using "Z-plasties" may be more appropriate. Simple divisionof the frenulum is much less satisfactory for most men, so is not recommended. Small dissolving stitches are placed and these will usually fall out after a week to ten days. If they take a little longer there is no need to worry.
From the point of view of pain relief, most men do not require anything apart from the anaesthetic although it may be advisable to take something along the lines of a Paracetamol or Nurofen prior to going to bed at night for the first day or two.
It is important to apply a moisturising cream and to wash the foreskin twice daily since if the frenular area is not extended then it may scar down again ; I usually recommend simply washing with warm water, patting the penis dry and then placing a small amount of E45 cream (available from any chemist) on the area before replacing the foreskin. There may be a little bleeding for 12 - 48 hours after the operation but this is rarely enough to stop them going about their normal daily activities.
It takes about 6 weeks for the operation to fully heal but most men are able to resume a normal sex life after 3 weeks or so. Occasionally severely scarred skin may contract down again necessitating circumcision, but this is very unusual.
Photographs of a Frenuloplasty being performed
For professionals who are interested in the technique, and those who are not squeamish, a series of images showing the steps of a frenuloplasty can be seen at this link. Please note this contains graphic genital and surgical images.
Advice Service for Men with Frenular Problems
Men, particularly if they have not had frenuloplasty discussed as an option, are often unsure as to whether they may be able to avoid a circumcision. It is often possible to give an provisional idea on this if a good quality digital photograph of the end of the penis and frenulum is sent. While we are happy to offer this as a free advisory service please note that it is impossible to give a formal opinion by email and any advice given in the absence of a consultation cannot be regarded as a basis for any modification of treatment or advice offered by other doctors. It is not possible to offer any advice by email unless patient images are available.
Preputial plasty
Although some surgeons will recommend a circumcision for men who have a tight foreskin (phimosis), there is really no need for this in the vast majority of men unless there is significant scarring, since either stretching or a small plastic surgical operation will do the job in mostf patients. For those men who are unable to strecth the foreskin themselves, or where not enough stretching is obtained, a small plastic surgical operation is often helpful.
The Preputial Plasty Operation
A preputial plasty is an operation which widens the foreskin (prepuce).
This is a procedure which is simply done under local anaesthesia and can be carried out in the outpatients procedure room without necessitating admission to hospital.
Essentially a very small amount of anaesthetic is put into the area. A "small figure of 8" incision is made in the upper surface of the foreskin and sewn up in such a way that the foreskin is widened. Any small blood vessels are sealed. The extra width is checked by moving the foreskin back and forwards, and demonstrated to the patient!
Small dissolving stitches are placed and these will usually fall out after a week to ten days. If they take a little longer there is no need to worry.
From the point of view of pain relief, most men do not require anything apart from the anaesthetic although it may be advisable to take something along the lines of a Paracetamol or Nurofen prior to going to bed at night for the first day or two.
It may help to apply a moisturising cream and to wash the foreskin twice daily since if the area is not extended then it may scar down again ; I usually recommend simply washing with warm water, patting the penis dry and then placing a small amount of E45 cream (available from any chemist) on the area before replacing the foreskin. There may be a little bleeding for 12 - 48 hours after the operation but this is rarely enough to stop them going about their normal daily activities.
It takes about 12 weeks for the operation to fully heal but most men are able to resume a normal sex life after 4 weeks or so. The skin may contract down again necessitating circumcision, affecting about one man in 8-10.
Advice Service for Men with Foreskin Problems
Men, particularly if they have not had preputial plasty discussed as an option, are often unsure as to whether they may be able to avoid a circumcision. It is often possible to give an provisional idea on this if a good quality digital photograph of the end of the penis and frenulum is sent. While we are happy to offer this as a free advisory service please note that it is impossible to give a formal opinion by email and any advice given in the absence of a consultation cannot be regarded as a basis for any modification of treatment or advice offered by other doctors. It is not possible to offer any advice by email unless patient images are available.
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