Short frenulum of the penis

frenulum of the foreskin of the penis SIGNS - SYMPTOMS - TREATMENT Frenulotomy - plastic correction of a short frenulum A common feature of the structure of the male reproductive system is a short frenulum of the penis. Normally, this is a small formation, located at the site of attachment of the foreskin to the head of the penis, and is invisible. But in some cases, a short frenulum can cause many problems. Among them are pain during sexual intercourse, downward curvature of the penis, premature ejaculation, but the most dangerous manifestation is, undoubtedly, rupture of the frenulum of the penis.

Don't waste your precious time - call!

Our specialists will be happy to answer all your questions

Most often, a short frenulum of the penis is congenital or forms in adolescence due to a discrepancy in the growth rate of the cavernous bodies of the penis and the skin. In such cases, a teenager who is just beginning his acquaintance with sex life faces a problem. At this age, a short frenulum of the penis can lead to the formation of complexes associated with unsuccessful attempts at sexual intercourse or dissatisfaction with the appearance of one’s penis.

Matar Asaad Akhmadovich

Head of the center, professor, pediatric surgeon, urologist-andrologist

The main principle of our center is high professionalism, dedication to their profession, human participation and mutual understanding between specialists, young patients and their parents!

Go to doctor's page

There are often cases when a short frenulum of the penis is formed as a result of injury to a normal frenulum and scar formation. Rupture of the frenulum of the penis occurs most often during rapid sexual intercourse, defloration or insufficient hydration of the partner’s vagina. Since blood vessels and nerves pass through the frenulum, the rupture is always accompanied by severe pain and severe bleeding, which cannot always be stopped without the help of a doctor. Even if the bleeding was stopped and the rupture healed on its own, a scar forms in its place, shortening the frenulum. In this case, the same problems arise as with congenital shortening, but the scar is inelastic and very often the frenulum ruptures again. The situation repeats itself and the shortening of the frenulum worsens. That is why it is preferable to perform the operation without waiting for a rupture, and if this happens, then to prevent the formation of a rough scar.

Recommendations in the post-operative period

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.

Features of the anatomical structure of the foreskin

The foreskin is represented by folds of skin, which are one of the elements of the protective cover covering the male penis.
One of the folds is located along the body of the latter and connects the foreskin and the head of the penis to each other. It's called a bridle. The features of this anatomical formation are such that it can stretch when the flesh moves, or during sexual intercourse, when friction is performed. In the latter case, if the frenulum is of sufficient length, the head receives additional stimulation due to slight bending. If it is too short or the skin folds do not have the desired elasticity, complete exposure of the head of the penis during erection becomes impossible, so this defect can only be identified during the boy’s puberty. Treatment of a short frenulum of the foreskin is simply necessary, since this defect is characterized by a number of extremely unpleasant manifestations for any man. The penis becomes cosmetically defective, appearing curved during erection. During sexual intercourse, a man feels pain, and the frenulum, due to excessive tension, can tear and even rupture. Due to scarring of wounds, the defect intensifies, causing disruption of erectile function, emotional distress, and even fear of sexual relations.

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.

Why does a short frenulum of the foreskin develop?

In the vast majority of cases, this defect is congenital, often combined with a pathological condition such as phimosis. The latter is characterized by the narrowness of the foreskin, which does not allow the head of the penis to be exposed.

It is found in 96% of newborn boys, but as their body develops, the foreskin gains the necessary mobility, and the problem goes away on its own. At the age of three, it is found in only 10% of young patients.

The causes of a short frenulum are as follows:

different rates of development of skin structures and cavernous bodies of the penis;
inflammatory processes of the structures of the penis, occurring in a chronic form;
constant injury to the foreskin when playing sports, wearing incorrectly selected underwear and too tight trousers;
diabetes mellitus, which provokes failures in tissue regeneration.

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.

4.Treatment

A condition such as phimosis, with its minor degree, can sometimes be eliminated by prolonged, patient, systematic and targeted stretching of the skin of the foreskin. In relation to a short frenulum, such a practice can hardly be considered a reasonable solution, since the time spent, forced restrictions and, most importantly, the final result cannot be compared with the effectiveness of radical elimination. Surgical correction of a short frenulum can be performed in various methodological options (freniculotomy, freniculoplasty); the choice of a specific surgical technique (for example, the so-called Z-plasty) depends on the characteristics of a particular case. The main task is to prevent scarring, now post-operative, but modern urosurgery almost always copes with this task without much difficulty.

In general, correction of a shortened frenulum in most cases is an outpatient procedure and does not require either general anesthesia or long-term rehabilitation, while at the same time allowing for the complete restoration of normal anatomy and function of the penis.

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

How is a short frenulum of the foreskin diagnosed?

As already mentioned, this defect can only be identified during puberty. That is why adolescents going through this stage need to visit a consultation with a professional urologist.

Diagnosis of the disease involves analyzing the patient’s complaints and conducting an examination of the penis, during which a specialist identifies the existing problem. Timely diagnosis and adequate treatment play a vital role in this case. They eliminate the risk of complications and also prevent psychological trauma to the patient, which can be very difficult to treat.

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...

2. Reasons

A disproportionately short frenulum of the foreskin in the vast majority of cases is an anomaly of intrauterine development, the causes of which are currently unclear. Some sources emphasize a certain influence of hereditary predisposition, but the statistical significance of this factor and the genetic mechanism of inheritance are also not well understood.

Much less often, shortening of the frenulum is a consequence of injury and post-traumatic scarring.

Visit our Urology page

How to recognize pathology in a child

A neonatologist, pediatrician, or the mother herself can recognize a pathological frenulum of the tongue in a newborn. If during the first and subsequent breastfeedings the baby experiences difficulties and cannot grasp the nipple correctly, then there is a reason to consult a doctor.

The second common sign of a pathological frenulum of the tongue in children is the occurrence of a speech defect when they begin to speak in phrases, namely at 3-4 years. Most often, with this anomaly, children do not pronounce several letters: “zh”, “sh”, “sch”, “ch”, “z”, “l” and “r”. Moreover, the sound “l” is easily pronounced if it is followed by a soft vowel, for example, “i”, “yu”, “e”, “e”, “ya”, in other cases it is simply “swallowed”. If there is incorrect pronunciation of sounds, then an examination by a speech therapist is necessary.

The most common symptoms of a tongue tie in a child are the following:

the child is not able to reach the front teeth of the upper jaw or palate with the tip of his tongue;
the child may have difficulty moving the tip of the tongue from one side to the other;
the front teeth of the lower jaw may have a gap between each other;
when the tongue is pulled forward, its tip remains flat, square or heart-shaped (that is, the front edge of the tongue seems to bifurcate);
feeding problems in newborns.

It is important to understand that if the problem of the tongue frenulum exists, then sooner or later it will have to be solved. The sooner measures are taken, the easier and more painlessly the baby will endure them.

Preparation for plastic surgery

A medical examination is carried out, during which the degree of shortening of the frenulum of the penis and existing scar changes are revealed. The genitals are examined for the presence of rashes and skin changes, which are a contraindication to plastic surgery.

During the preoperative consultation, you should inform the urologist about the medications you are taking. Some medications have a negative effect on blood clotting and may be incompatible with anesthesia drugs. In this case, the medications are canceled or replaced with others.

The patient undergoes tests:

General – blood and urine.
Analysis for sexually transmitted infections, which are a contraindication to plastic surgery.
Blood test for coagulogram - clotting time and bleeding duration. If there is increased bleeding, surgery is contraindicated. Sometimes it can be done after preliminary normalization of blood counts.
Blood for the group and Rh factor is donated in case of unexpected blood loss, which is eliminated by the introduction of donor blood. If a man has documentary evidence of his group and rhesus, the study is not carried out.

Patients who are planning to undergo surgery under general anesthesia are prescribed an ECG and a consultation with an anesthesiologist - a doctor who will deal with pain management.

If necessary, other research methods and additional consultations with doctors may be prescribed.

One day before surgery, you should refrain from sexual activity, physical activity, and drinking drinks containing caffeine. You should not drink alcohol, as they are incompatible with pain medications and can cause bleeding. During the period of preparation for surgery, you should not take medications not recommended by your doctor.

Before plastic surgery of the frenulum of the foreskin of the penis, performed under general anesthesia, you should not eat for 8 hours. You can drink still water and unsweetened tea.

Pubic and groin hair is removed. Carrying out basic hygiene procedures is mandatory. Before the operation, you need to remove removable dentures, contact lenses, hearing aids, and empty your bladder.

Exercises for correcting the frenulum of the tongue and in the postoperative period

Postoperative frenulum stretching and correction exercises are aimed at developing new muscle movements of the tip of the tongue inside and outside the mouth. Regular practice will increase the range of movement of the tongue.

Articulation exercises by themselves will not improve speech and will not be able to correct the defect, so it is very important to carry them out in conjunction with individual speech therapy sessions.

The most common and universal exercises for stretching and correcting the frenulum of the tongue are given here in the article. Following them, you can study at home with your child on your own:

Stretch your tongue forward, then stretch the tip up to your nose, then down to your chin. Relax, repeat the exercise several times (at first, up to five repetitions are enough, gradually the number of repetitions must be increased, bringing them to twenty).
The exercise is performed by analogy with the previous one, moving the tongue left and right. The number of repetitions is also gradually increased to twenty.
Open your mouth wide. Use the tip of your tongue to touch the upper incisors and try to press on the teeth with all your might, not allowing your mouth to close. During each execution, mentally count to ten. The number of repetitions is the same as the previous ones.
The exercise is performed in front of a mirror. The mouth is wide open. When performing the exercise, it is important to monitor the movements of the tongue. Pronounce the syllables “dar-dar-dar”, “nar-nar-nar”, “tar-tar-tar”, etc.
Sticking your tongue forward as much as possible, alternately “lick” your upper and lower lips.
Closing your mouth, move your tongue from right to left and back, forcefully pressing the inside of your cheeks with the tip of your tongue.

To achieve good results, exercises should be performed daily, in several approaches, for 15-20 minutes . The articulation of specific sounds can be gradually corrected.

Important! You can begin to perform exercises for the frenulum of the tongue only after the wound has completely healed.

Speech therapy classes should include exercises to improve the functioning of the speech apparatus and oral kinesthesia, without which it is difficult to claim significant improvements in the development of a child’s speech. Many young patients, after cutting the frenulum, begin to speak more quietly and more quickly, trying to “drown out” speech problems.

Reasons for the development of tongue frenulum pathology in a child

The formation of an anomaly associated with a short hyoid membrane begins before the birth of the child. This is preceded by negative factors, which include:

genetic predisposition;
infection of the fetus during pregnancy;
viral and infectious diseases suffered by the mother during pregnancy;
mechanical injuries to the expectant mother’s abdomen;
the age of the expectant mother is over 35 years;
unfavorable environmental conditions;
the influence of other factors of unknown etiology.