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QUESTION: Hi,

Firstly I appreciate this may be an unusual question but I would be very grateful of any advice you might be able to offer.

I was circumcised about 4 years ago and have suffered various problems since.  I believe these problems may have been caused by a lack of circulation after the operation due to an extreme tightness around the circumcision scar along with a lot of swelling in the rest of the penis which lasted for nearly a month.

The penis - particularly the glans - has approximately doubled in volume since the circumcision but is now virtually numb internally (on pressing it I do not feel much) apart from the skin of the glans, which is extremely sensitive (to the point of being quite painful) in response to friction.  This makes walking around quite an ordeal due to rubbing on underwear.

The doctors I have seen have not been able to treat me effectively so far.  I have tried Betnovate cream on the glans for 1 month which did not do anything.  I have also been prescribed Amitriptyline which unfortunately doesn't help much either and so I have to continue what I have been doing for the past 4 years, which is daily bandaging of the glans during to obtain some degree of comfort during my waking hours.

I believe this is beyond the normal sensitivity that circumcised guys feel after a circumcision; this has lasted a long time and has not improved over the years.  It also feels particularly uncomfortable and is not how I recall the glans feeling before the circumcision.

Practically speaking I am looking for any kind of treatment I could have.  Urologists have offered me a split skin graft of the glans, replacing the skin with a graft harvested from the thigh.  I am seriously thinking about going for this option but am wondering if there are any other options to try first.

I have read about Capcaisin cream but I understand this would only be a temporary fix and might not be suitable for use on mucosal areas such as the glans.

Anyway, thank you for reading this and for any ideas you might have about my problem.

ANSWER: Jeff:

You are correct that what you've described is quite unusual.  I can't see that replacement of the glans skin would help as it would seriously and permanently affect sensation.  Capsaisin cream is reasonable, but would only be temporary.  Application of an ointment such as vaseline would provide protection without the need for a heavy bandage.

The bottom line is that this is probably a neuropathy and might benefit from a neurological exam.  You can also try vitamin B-6 which sometimes helps.

---------- FOLLOW-UP ----------

QUESTION: Cheers for your reply mr leslie.

I shall take a course of b6 to see if it helps.

I will also try capcaisin although I anticipate some burning on initial use.

however I do look for a more lasting solution and split skin graft seems to be a serious option given my symptoms. The sexual function of my glans seemed to be centrered internally in the glans and this has been all but destroyed already, so I am not so concerned about this aspect. The skin of the glans is not sexually significant, only painful.

please could you let me know what you mean by the sensation being permanently affected? If you mean that the skin would be much less sensitive then this would be a real blessing. What is your experience with patient feedback following this surgery?

Many thanks again.

Answer
Jeff:

Since I have never done the surgery described I cannot give you any personal feedback from patients.

Sensation being permanently affected means just that; that any damage or change in sensation from a surgery could be permanent and may not be treatable.

The skin of the glans plays relatively little role in sexual arousal.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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