CIRCUMCISION (ADULT):
Dear Sumner:
Al is a 62 year old man who has noticed that his foreskin has been progressively tighter over the past few months and in the last two weeks he has been unable to retract it at all. Isn’t it unusual that a previously retractable foreskin should become totally non-retractable? Any idea as to why this should occur at this time in his life? He (as well as I) would like your opinion about possible measures that can be taken to achieve a retractable structure, short of circumcision. If the foreskin does not loosen despite conservative measures, does this mean he should be circumcised? Al would like to keep his foreskin if at all possible. Are there procedures which can achieve this goal yet still spare the foreskin? Could you take a look at Al (and his foreskin) and let me know your thoughts and recommendations.
Dear Miriam:
In the world at large, circumcised men are in the minority (so obviously not every male needs a circumcision). When a previously retractable foreskin becomes non-retractable, one should always think about the possibility of underlying diabetes. And, indeed, Al did have sugar in his urine and he will be seeing you shortly for a diabetes evaluation. In the interim, I will see if oral and local anti-inflammatory preparations (e.g. steroid creams) may decrease the inflammatory process and permit foreskin retraction once again. Al will try to “stretch” the skin himself by trying to pull it back at least a few times per day. I mentioned to Al that he always bring the foreskin back over the head of the penis, since, with the tight foreskin there is a high possibility that the foreskin could not be brought forward, referred to as “paraphimosis” which might require emergency intervention to release it.
