It’s only Wednesday, but already this week I have seen three men in clinic for tight penile frenulum. This condition is also known as frenulum breve (short frenulum). Lots of men have it. Most men don’t have a problem, but these three men were having problems. One of them said it felt like a slingshot on tension.

The frenulum is the band of skin that attaches the skin from the penile shaft to the under surface of the glans (penile head). It is usually cut during routine circumcision in boys, so most men with frenulum breve are uncircumcised. The problem usually develops over time, and some men have had problems their entire lives.

The frenulum is like a banjo string, and it can get tight, causing pain or pulling during an erection or during sexual stimulation. Commonly, it can tear, causing more pain, infection or scarring. As it scars, the frenulum becomes shorter, tighter and more painful. It is a vicious cycle of pain, injury, scarring…. rinse and repeat.

What do I recommend to men?

• pull the foreskin back during urination to decrease irritation which can worsen the pain, inflammation and scarring
• was under the foreskin daily with soap and water
• rinse the foreskin with warm water after intercourse
• wearing a condom with lubrication under the condom works for some men

When this doesn’t work, I usually recommend a steroid ointment for 4-6 weeks. This causes the skin to weaken and can result in stretching of the frenulum.

When all else fails, I perform a frenuloplasty, also known as a frenulotomy. The procedure takes about 10 minutes and is performed in the office with local anesthesia. It involves making a small cut in the middle of the frenulum to release the tight band. This allows me to lengthen the frenulum and the reconstruct it by sewing it closed.

The procedure is not painful. The recovery is easy and men do not require pain medications. I recommend using ibuprofen or similar if there is pain. I tell men that it will get worse and look worse before it gets better. Cleaning the surgical area is critical during recovery to prevent infection. Some men will have tightening of the foreskin for a couple of weeks and not be able to pull it back during that time. Sexual activity must wait for 4 weeks.

Long-term, most men are very happy with the result. In the short-term, men will have some sensitivity, even burning, in the frenulum during sexual activity. This usually resolves. The sensation of the penis, ability to get an erection, achieve orgasm and urinate are remain the same. It is rare to require a reoperation or circumcision if the frenuloplasty fails.

Summary

• most men do not have a problem and need no treatment
• hygiene can help mild cases
• steroids work in moderate cases
• severe cases are treated with frenuloplasty
• overall frenuloplasty provides men with excellent function with minimal pain or recovery.