Trimming the hyoid frenulum in a child

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.

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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.

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.

Phimosis - symptoms and treatment

Non-drug treatment

Physiological phimosis can be eliminated without surgical treatment . [4] The most acceptable method is gradual gentle stretching of the foreskin. Treatment of phimosis in children can be carried out starting from six months.
The elimination of phimosis using a bloodless method based on two principles.[7]

The first principle is a slow impact on the narrowed cavity of the foreskin. Treatment is carried out in stages and can last from 3-5 months to several years. During such events, the head of the penis ideally opens by the beginning of puberty, i.e. by 12-15 years. These dates are due to hormonal changes in the boy’s body.

The second principle is the most gentle stretching of the foreskin, in which even minimal injuries (tears, cracks) of the narrowed area are unacceptable. Each procedure is designed to dynamically open the foreskin cavity by 1-2 mm from the initial state. In order to improve the stretching of the flesh, before the procedure the patient should lie for 10-15 minutes in a bath with decoctions of chamomile, string, celandine or calendula. Thanks to this, the skin is steamed, stretches easier and is less injured. After the bath, stretching manipulations should be performed for at least 15 minutes. Then the foreskin should be treated with baby cream, levomekol, ELMA ointment 5% or solcoseryl - they help heal any microtears that arise. At the end of the procedure, the child should lie on his back for several minutes without diapers or underwear.

Initially, these procedures are performed by a doctor, who is obliged to show the technique of such manipulations to the parents. In the future, treatment comes down to the parents' daily compliance with the doctor's recommendations and medical monitoring of the dynamics of the process of displacement of the foreskin once every 3-6 months.

These principles are a very effective way to treat physiological phimosis. Thanks to them, the head of the penis opens halfway after 2-3 months in 91% of cases. In general, the success of treatment using this method depends on how regularly the procedures are carried out.

Also, in the treatment of phimosis, rings and bandages , which stretch the foreskin and fix its shape.[10]

Drug therapy

This treatment method involves regular and long-term use of corticosteroid ointments. They are applied to the foreskin and glans penis to increase the elasticity of the tissue and improve its stretchability.

Also, for phimosis, taking glucocorticoids is indicated. They are designed to reduce swelling and inflammation, accelerate the healing of microcracks, and suppress the activity of connective tissue formation.

The most effective ointments to combat phimosis are clobetasol 0.05%, betamethasone 0.05%, prednitop 0.25%, gel 2.5%.

Physiotherapy

Physiotherapeutic treatment methods include:[11]

• Phonophoresis is a painless injection of drugs into the deep layers of the skin using ultrasound. In case of phimosis, anandrogen-containing oil preparations are applied to the external opening of the foreskin. The exposure is carried out using a labile technique with a radiation frequency of 880 Hz, a working surface of 0.5 cm2, an intensity of 0.4 W/cm2 and a continuous mode of ultrasonic vibrations. The duration of the procedure is six minutes. They are carried out every other day for 1-2 weeks. This method provides effective treatment of the disease.
• Using a button probe to gradually gently stretch the foreskin. It is used in conjunction with 2.5% dihydrotestosterone gel and allows you to separate synechiae. This procedure is carried out twice a week after hygienic baths with decoctions of medicinal herbs.

Surgical treatment

Circular excision of the foreskin is indicated in cases of cicatricial phimosis. In this case, the foreskin can be removed partially (excision along the border of fibrous changes) or completely - partial or complete circumcision. In children it is performed under general anesthesia, and in adults under local anesthesia.[6] Complications after circumcision are rare. Sometimes bruising occurs on the penis, but this goes away over time.[12]

Other methods of foreskin plastic surgery:

• Prepucioplasty is performed for phimosis in adolescents with minor cicatricial changes in the skin fold. During the operation, a longitudinal incision is made along the upper part of the penis and adhesions are removed, then the wound is sutured.
• Surgical treatment with clamps is performed in children. Use Mogen clamps or disposable Plastibel clamps. Disposable clamps are placed on the head of the penis after a small incision, fixed and left for a week. No stitches are needed. The Mogen clamp is applied for 1-5 minutes and removed after cutting off the skin.

Laser treatment of phimosis

This method of treating phimosis is called the photodestructive method. Using a laser, the doctor excises and removes the abnormal tissue. The beam aimed at the flesh has a temperature of up to 300 ℃. Once on the fabric, it evaporates, or vaporizes.

The operation lasts approximately 20 minutes, including the procedure itself, preparation of documents and discharge. The laser beam quickly seals the vessels, without damaging the tissues and preventing blood loss.

Treatment of phimosis with traditional methods

The effectiveness and safety of traditional methods has not been scientifically proven. Phimosis often goes away on its own with age, which reinforces misconceptions about the effectiveness of alternative medicine.

Rehabilitation

After the operation you will need:

• Maintaining cleanliness - proper care will help avoid inflammation and suppuration. The treatment site can be treated with antiseptics: chlorhexidine and miramistin. Baths with potassium salt of permanganic acid are also useful.
• Monitoring by the attending physician - if inflammation, suppuration and pain occur, you should consult a doctor.
• Rest - during the first 2-3 days, it is advisable to lie down more often, as this increases the outflow of blood from the penis and reduces the development of tissue edema.
• Strict adherence to the dressing schedule established by the attending physician. After circumcision, bandages are applied to the penis, which are worn all the time until the penis heals, and are changed periodically. To wash the penis with warm and soapy water, the first change of bandages is carried out after 48 hours.
• Local treatment with antibacterial ointments. To avoid suppuration, your doctor may recommend using antibacterial ointments, such as Levomekol and Levomethyl.
• It is important to ensure that the child does not touch the wounds with his hands. Instead of water procedures, it is better for the boy to be rubbed down until complete healing.
• It is not recommended to wash the penis for 7 days until the stitches are removed. To avoid getting the wound wet while showering, you should wear a condom on the penis. It is also important to ensure that urine does not come into contact with the wound, otherwise inflammation may develop and the wound will heal more slowly.
• Comfortable underwear. If the foreskin is removed on a small child, then the best option would be thick panties so that he does not touch his penis during play. An adult man should wear loose underwear that does not restrict movement.
• Until complete healing, abstinence from sexual activity will be required.

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.

Optimal age for surgery

Is it worthwhile to manipulate the frenulum under the tongue and at what age is it better to trim it? Such decisions depend on when the anomaly was discovered and what the individual characteristics are. If in the maternity hospital the neonatologist determines that the baby has a defective hyoid frenulum, it is better to trim it immediately.

The baby is not yet so mobile as to interfere with the procedure, and the membrane itself is small, thin and does not contain blood vessels. Thanks to these factors, local anesthesia will be sufficient for the manipulations, and you can calm the baby by applying it to the chest after the operation.

Trimming the frenulum of the tongue in children over 6 months of age is associated with some difficulties. The baby becomes mobile, and parents cannot discipline him with persuasion. Due to careless movements, surgery may not occur correctly, which is why surgery is postponed until the age of five

.

During this period, children talk, the doctor can determine whether there are speech defects, whether the frenulum under the tongue is bothering the child, whether it needs to be trimmed or whether it can be stretched with gymnastics.

If the infant’s tongue frenulum was not cut, and many years later he developed speech defects, breathing and digestive problems, then it needs to be circumcised in adulthood. But the older a person is, the denser his membrane becomes, it becomes overgrown with capillaries and nerve endings - which is why cutting it is much more painful than in the case of a baby. Anesthesia is required to make the incision.

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

Postoperative period

The mucous membrane in the mouth is restored quickly. But cutting the frenulum can cause complications:

• Formation of a hard scar at the site where the incision was made.
• The development of the inflammatory process due to infection.
• Temperature increase. It appears as a sign of the development of an infectious process or a peculiar reaction to an operation.

The baby may react to complications with constant anxiety and refusal to eat. Children three years old and older can tell themselves what worries them. If you experience any discomfort, you should consult a doctor; only a specialist will correctly assess the baby’s condition and prescribe the best treatment.

To avoid complications, you need to keep your mouth clean. Five-year-old children already brush their teeth and can rinse their mouths with water. For several days after the defect is removed, you should not chew solid food or talk much.

You should ask your doctor exactly how long the restrictions should be observed. After a follow-up examination, the attending doctor will recommend special exercises to develop the elasticity of the frenulum.

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...