before u potong....try this...
more shiok
Dr Peter Ball MB,B Chir
Last updated on 13th April 2008
The vast majority of tight foreskins can be suitably loosened
within a month or so by persistant stretching twice daily.
When possible start by warming the penis. Use baby oil, Vaseline
intensive care hand and body lotion, Nivea or any bland cream as a
lubricant. Pull the foreskin forward away from the body several
times then pull it back as far as it will go and hold it in this
stretched position for several minutes.Do this several times a day.
When the glans ( head of the penis} becomes visible, grip it
between thumb and fingers and roll the foreskin forward over the
glans until the tight ring is white with stretching. Hold it in
this position as long as you can at a time - say 5 minutes. Repeat
as often as you have the time and enthusiasm for. Later you will
find there is room for two or more fingers to insert into the tight
ring to stretch it further.
It may become apparent that further retraction of the foreskin is
held up by a short frenulum ( the tongue of skin in the mid-line
underneath the glans) This is called a Frenulum Breve and can be
cured by a small operation under a local anaesthetic called a
frenuloplasty.
Take care to avoid trapping the foreskin behind the glans
(Paraphimosis) when it becomes loose enough to happen but tight
enough to be difficult to bring forward again. Seek medical advice
early if you fail to return the foreskin to cover the glans.
If you are unable to see the glans or make any headway stretching ,
consider buying a glansie (www.glansie.com) to bring the foreskin
to the stage when the above methods can apply.
Attempt to retract your foreskin every time you pass water.
NORM-UK estimates that at least 9 out of 10 patients undergoing
circumcision in British hospitals do not need to be there 1 2. Conservative, non-surgical
treatments for common foreskin problems are much easier, cheaper
and far less likely to cause long-term harm to the patient
3. Unfortunately many doctors are
unaware of these. Others are uninterested in preserving the
patient's foreskin for religious, personal or even financial
reasons.
It is important that doctors keep up to date and ensure
that any decisions to undertake an invasive procedure are based on
the best available evidence. Therefore, to circumcise for
therapeutic reasons where medical research has shown other
techniques to be at least as effective and less invasive would be
unethical and inappropriate. [The
law & ethics of male circumcision - Guidance for
Doctors, BMA, March 2003]
The foreskin and the glans develop as one structure. Natural
separation of the two structures occurs gradually during childhood.
The age at which the foreskin becomes retractable differs for each
child. It may take until the age of 17 or beyond. This is normal.
Forcing the foreskin to retract may cause pain, bleeding, scarring,
infection, and adhesions. Therefore, the foreskin of a child should
be retracted only by the child himself when he is ready to do
so.
Steroid creams should be used next if no significant progress
has been made after a month. The cream you need is called
Betamethasone 0.05% sold in 30 G tubes. It is sold in the UK as
Diprosone. It is a prescription-only medicine which means you will
have to ask your doctor for a prescription. The cream should be
massaged into the tight part of the foreskin inside and outside 2-3
times a day for at least a month combined with further stretching.
As the foreskin widens it may become apparent that the frenulum is
restricting retraction. This can be remedied by a small operation
called a frenuloplasty performed under a local anaesthetic.
A preputioplasty should be able to cure any tight foreskin where
stretching and steroid cream application have failed. This is an
operation in which a cut is made through the tight ring that is
limiting foreskin retraction, in an up and down direction and then
sewn up in an across direction. Once this has healed (2-3 weeks)
the foreskin can usually be retracted fully and the only change in
appearance is a notch that becomes visible in the skin as it is
retracted. Make sure that you agree with your surgeon how far you
will allow him to cut through the foreskin.
<!--Begin NORM-UK Book-->
A short frenulum may be the cause of a foreskin not retracting
behind the glans, or pulling the glans downwards as soon as
retraction begins. If stretching the frenulum fails, as it usually
does, it can be freed by a minor operation called a Frenuloplasty.
This can usually be performed under a local anaesthetic.
Ballooning of the foreskin while urinating can be a normal phase
of development during childhood. It is not an
indication for circumcision. Ballooning is a temporary phenomenon
that arises when the foreskin begins to separate from the glans. It
speeds the process of separation and disappears when the process is
complete.
Phimosis is a name given to the condition where the foreskin is
unretractable. We must distinguish normal (physiological)
unretractability from abnormal (pathological) unretractability.
Physiological unretractability of the foreskin is found in nearly
all new-born infants, and becomes increasingly uncommon with
advancing age. It is not an indication for circumcision.
Pathological phimosis is scarring and obstruction of the opening of
the foreskin. This is rare and may be found in diabetes, and in a
localised skin condition called lichen sclerosus which is often
referred to as "balanitis xerotica
obliterans" (BXO) when it affects the penis. In this condition the
skin is thickened, white, and hard. Circumcision is a treatment
option for lichen sclerosus of the foreskin when it is refractory
(unresponsive) to conservative treatment. Circumcision will not
however cure or prevent outbreaks of lichen slerosus elsewhere on
the penis.
The medical literature contains many reports showing that most
cases of phimosis can be treated effectively by topical steroid
applications or by conservative surgery.
"True" phimosis --- better termed "preputial stenosis,"
because "phimosis" has so many different definitions it now is
devoid of any useful meaning --- occurs in less than 2% of intact
males.
Of these 2%, 85-95% will respond to topical steroids.
Of those who fail this, at least 75% will respond to stretching
under local anesthesia, either manually or with a balloon. The
arithmetic is simple: At the very most 7 boys in 10,000 may need
surgery for preputial stenosis. No wonder the Canadian Paediatric
Society calls circumcision an "obsolete" procedure! [What is 'phimosis'?, Van Howe R,
CIRP]
Further information on the conservative treatment of foreskin
problems can be found on CIRP.
1 - What is 'phimosis'?, Van Howe R, CIRP
(further references on CIRP page)
