Restoring the frenulum of the foreskin after a rupture

The foreskin is the part of the skin that covers the head of the penis. With some diseases or developmental abnormalities, the foreskin is so narrow that the head of the penis does not open or does not open completely. The disease is called phimosis. This has a number of serious health consequences.

An experienced urologist provides assistance in our medical center. To avoid the need for circumcision of the foreskin, one of the methods used is stretching. The doctor will give detailed advice on how to do this.

Make an appointment with a urologist by phone or by filling out the online form

Answers to frequently asked questions regarding foreskin:

• Which doctor deals with foreskin problems?
• What tests and examinations need to be done for foreskin problems?
• How does the foreskin affect sensitivity?
• How to stretch the foreskin?
• What is the foreskin for?
• Diagnosis of diseases of the foreskin?
• Why doesn't the foreskin open completely?
• What to do if the foreskin is swollen?
• Have plaque appeared under the foreskin?
• Do you perform foreskin plastic surgery at your clinic?
• Do you have cracks in your foreskin?
• What to do with a short frenulum of the foreskin?
• How to remove papillomas on the foreskin?
• Do you have a rash on your foreskin?
• Why do condylomas appear on the foreskin?
• Causes of itching on the foreskin?

Short frenulum of the penis - symptoms

Congenital short frenulum of the penis is accompanied by pain during sexual intercourse, and sometimes ends in rupture.

A rupture (tear) of the frenulum is manifested by severe pain and bleeding.

First aid for a ruptured frenulum is to treat the penis with antiseptics, apply a bandage and apply ice. You should contact a urologist (surgeon) as soon as possible to treat and suturing the wound and stop the bleeding.

A short frenulum of the foreskin is one of the causes of premature ejaculation (link to the page “premature ejaculation”).

The fact is that tension on the frenulum leads to hypersensitivity during friction, and as a consequence, to uncontrolled early ejaculation.

Sometimes a short frenulum of the penis is combined with a narrowing of the foreskin (phimosis), which makes sexual life even more difficult and causes even more inconvenience.

Congenital shortening or insufficient length of the frenulum is a common pathology, detected in 15-20% of men. The cause of this disease has not been established. The problem is sometimes detected in childhood (sometimes in combination with phimosis), but more often it becomes obvious only with the onset of puberty and the first experience of sexual activity.

Diagnosing a short frenulum is not difficult for a urologist. And the patient himself can often suspect this condition based on the characteristic signs mentioned above (pain on the lower side of the glans during sexual intercourse, downward deviation of the head of the penis during erection). If you wish, you can measure the length of the frenulum yourself from the lower surface of the glans to the shaft of the penis. A length of 1.5-2 cm or more is considered normal.

The essence of the problem

Photo: this is what a normal frenulum looks like in a child’s mouth

The tongue is attached to the base of the mouth by its root part. Between the tongue and the lower edge of the mouth there is a small fold of skin - the frenulum. Normally, it should be such a length that a person can easily move his tongue, stick it slightly beyond the lips, touch the front surface of the teeth, and pronounce sounds.

A shortened frenulum of the tongue greatly limits its mobility, speech capabilities and ability to eat normally.

, especially in children. The same problems arise if it is not attached correctly, when it is in close proximity to the tip of the tongue.

The consequences are:

• Photo: this is what an incorrectly positioned frenulum looks like

  During the period of breastfeeding, the baby is unable to suckle normally, as the tongue is limited in its movements. Because of this, children become very anxious, cry, and lose weight.

• Lack of nutrition can have a negative impact on any developing system of the body, causing stomach diseases.
• A child with a short frenulum develops an incorrect bite, which causes dental diseases and their displacement.
• After teething, when trying to stick out the tip of the tongue, the baby will injure it on the lower incisors.
• In older children, a short hyoid frenulum complicates the formation of sounds: it is difficult for them to pronounce words, and the process of learning speech is delayed.
• The breathing mechanism changes: the baby gets used to breathing through the mouth. Symptoms of the pathology

The frenulum in newborns normally has a length of about 8 mm

or more, and for five-year-old children it increases to 17. But mothers are not always able to take measurements at home, especially if the baby is very active. And only specialists can understand whether everything is located correctly in the oral cavity.

You can determine whether a child has a short frenulum by some external signs:

• In infants, due to their low ability to suck milk, loud smacking and clicking sounds appear.
• The baby attaches incorrectly to the breast, does not cover the areola with his mouth, so he often bites the nipple, which then becomes inflamed.
• The baby is nervous, arches, twists his arms and legs when feeding, often throws and applies to the breast again. Does not gain weight or even lose it.
• The tip of the tongue may be bifurcated due to shortening of the septum. What a child’s forked tongue looks like with a short frenulum, look at the photo on the right.
• Older children have noticeable speech defects, their voice is nasal and quiet.
• Saliva production increases.
• Apnea attacks are possible.
• Due to insufficient food processing, digestive problems occur.

If parents suspect a problem, they should contact their pediatrician or dentist. But in many cases, the defect is determined by a neonatologist in the maternity hospital.

Treatment of short frenulum of the penis

The only treatment for short frenulum is surgery. Surgery for a short frenulum (frenuloplasty or frenuloplasty) involves lengthening or excision of this skin fold. There are several options for frenuloplasty.

Classic frenuloplasty

It involves transverse intersection of the frenulum followed by suturing in the longitudinal direction. The advantage of this technique is its simplicity (the operation takes a few minutes).

Among the disadvantages of such plastic surgery, we can note the unevenness along the edges of the incision, formed from the remains of the dissected frenulum. Although the latter can be easily excised and leveled.

Z-plasty

Professor N.D. Akhvlediani proposed Z-shaped plastic surgery with the appropriate incision shape for the correction of premature ejaculation. This method is advantageous in the formation of a more mobile, elastic scar.

Complete excision of the frenulum

In some cases, especially when combined with circumcision, it is better to perform a complete excision of the frenulum, which permanently eliminates this hypersensitive area.

Laser and radio surgery

In recent years, new technologies such as laser or radiosurgery have begun to be used in frenuloplasty. More and more patients are seeking laser frenuloplasty. Indeed, a laser or radiosurgical knife allows frenuloplasty to be performed almost bloodlessly and very aesthetically.

Regardless of the option chosen, frenuloplasty is performed on an outpatient basis under local anesthesia. At the request of the patient, it is possible to perform this operation under anesthesia (during sleep).

For suturing, I use thin self-absorbable threads, which provides excellent cosmetic results and eliminates the need to remove sutures.

After surgery, a circular pressure bandage is usually applied, which protects the wound and reduces the risk of postoperative bleeding.

Wound healing after frenuloplasty takes about 10 days. Dressings are usually performed by the patient independently.

Restrictions after surgery relate only to sexual abstinence during the period of wound healing. There is no need to take sick leave or give up sports.

Causes of the defect

A short frenulum of the tongue in a newborn is a congenital anomaly

, which is formed in the first months of fetal development, when all organs are formed. There are several reasons for its appearance:

• The presence of a hereditary predisposition: if the parents had such a feature, it can be inherited.
• The older the expectant mother, the more likely her child is to develop a short frenulum due to the increased risk of developing anomalies.
• The defect can develop if a woman has an infection during pregnancy or suffers from chronic diseases.
• Severe early toxicosis can lead to a lack of nutrients, which is why the fetal organs do not form correctly.
• Exposure to any teratogenic factors: radiation, toxic substances, drugs that are harmful to the body, alcohol, tobacco and drugs.
• Accidents involving injuries to pregnant women.

Some of these reasons do not depend on the actions of future parents, especially genetic predisposition. Other risk factors should be avoided: a pregnant woman should not work in hazardous work, drink, smoke, self-medicate, or expose herself to the risk of falls when playing sports.

Complications after frenuloplasty

Like any other operation, frenuloplasty can be complicated by wound inflammation, bleeding and the formation of a rough scar.

Infectious and inflammatory complications can develop both as a result of violation of the rules of asepsis during surgery, and due to improper treatment of the wound in the postoperative period and during dressings. Prevention of this type of complications is strict adherence to hygienic requirements during and after surgery.

Bleeding may occur in the first day or two after surgery and is sometimes quite profuse. The cause may be insufficiently reliable suturing of the vessels during surgery or a violation of the blood coagulation system. To prevent bleeding, it is necessary to perform thorough hemostasis with control of all vessels, as well as a mandatory preoperative study of the coagulation system (coagulogram).

The formation of a rough scar after frenuloplasty is an unpleasant problem from both a cosmetic and functional point of view. A rough scar in the frenulum area can be a source of hypersensitivity and premature uncontrolled ejaculation.

The use of modern technologies, such as laser and radiosurgical knife, as well as careful treatment of tissues and the use of modern suture material, allow us to avoid this problem.

From my own experience, I can say that over the past ten years I have not had a single complication after frenuloplasty.

Ways to solve the problem

At the moment, there are several correction methods:

• Trimming the frenulum in children with a scalpel.
• Laser cutting of the frenulum under the tongue.
• Stretching through exercise.
• Removing the defect using massage.

Surgical interventions can be performed in different ways, the main methods are:

• Frenuloplasty is the removal of a flap from the tissue of a defective bridge, which is sutured to the resulting wound to increase the mobility of the tongue. Local anesthesia is required, but the damaged mucous membrane heals very quickly. Used for preschool children.
• Frenulotomy: the length of the frenulum is conventionally divided into three parts, an incision is made between the lower and middle lobes, and the edges of the mucous membrane are sutured. This method is suitable for infants.
• Frenulectomy is the same manipulation, but the frenulum is clamped with instruments. The method is suitable for five-year-old children.

In more modern clinics, trimming is performed using a laser. The dissection is carried out after treatment with an anesthetic: gel, spray. For patients, such cutting is less traumatic, damage to blood vessels is minimal - the laser simultaneously cuts the mucous membrane and causes adhesions of the affected capillaries

.

Tissue regeneration after laser trimming takes place within a few days, and you can return to your normal lifestyle an hour after the procedure. But how long you need to stay in the clinic is decided by the doctor. Complications are less common than after eliminating the defect with a scalpel.

In what cases should you contact a urologist for consultation?

So, in what cases should you contact a urologist for consultation on plastic surgery of the frenulum of the penis?

• with a short frenulum
• with previous tears and microcracks of the frenulum
• when the head of the penis is deviated downwards
• with premature ejaculation

Why is it important not to delay surgery for a short frenulum of the penis?

• A timely operation prevents complications such as rupture or tearing of the frenulum, accompanied by quite severe bleeding
• Frenumplasty relieves pain and discomfort during erection and sexual intercourse
• Eliminating this problem in some cases restores the normal duration of sexual intercourse

You can familiarize yourself with contraindications for frenuloplasty, as well as the list of necessary examinations, on the “Preparation for planned operations” page.

I will be glad to help you solve this delicate problem and offer any of the frenuloplasty options, performed by experts at a competitive price.

Pay attention to the promotion - frenuloplasty as a gift (Learn more...) when denervation of the head is performed in combination with circumcision. An ideal option to actually increase the duration of sexual intercourse!

Author: candidate of medical sciences, doctor of the highest category, Rotov Anton Evgenievich

Correction using gymnastics for the tongue

Only a doctor can determine whether it is worth performing surgery on a child’s short frenulum of the tongue or whether it is better to remove the defect with the help of exercises. Therefore, even if parents are not inclined to undergo surgery, they still need to go to a pediatrician or dentist for consultation and surgery or correct individual selection of exercises.

The opportunity to conduct gymnastic classes appears when the baby can already repeat some given actions. But there are simple exercises even for newborns: they are given a silver spoon to lick, milk is dripped onto their upper lip, which makes them try to lick it, and at a slightly older age they are smeared with jam.

When the baby is able to understand the mother’s requests to repeat certain actions, you can do more complex gymnastics:

• Close your mouth and feel the side walls of your tongue, palate and lower part of your mouth.
• Open your mouth and reach as far as possible to the outer surface of your lips.
• Click your tongue.
• Place the tongue on your lower lip and hold it in this position for 10 seconds.
• Stick your tongue out as far as possible and hold for 10 seconds. You can also ask the baby in a playful way to show how long his tongue is.

Questions about the article

Peter 20 years old

July 28, 2022 at 00:00

Doctor, hello. We performed a frenuloplasty operation, the operation was bloodless, the doctor did not use a scalpel. On the third day, sex occurred at night. In the morning I noticed very small specks of dried blood on the wound. Please tell me, is this dangerous? Could it be fraught with the formation of a rough scar or any other complications?

drrotov

July 29, 2022 at 15:30

No, I don't think it's dangerous. This area is healing well.

Ivan 21 years old

April 15, 2022 at 00:00

Hello. I had a quadruple operation at once: straightening the inverter (there was a downward tilt), lengthening the frenulum, complete circumcision and ligamentotomy.

drrotov

April 16, 2022 at 12:00

Great! You forgot to ask a question...