The glans of the penis has a frenulum – a thin band of skin, like there is under the tongue. Similar it to the tongue it may be too short and thick. In the mouth it is called a tongue tie, with the penis it is called Frenulum Breve.
The penile frenulum functions to help the foreskin stay over the glans (head) of the penis. If it is too short it may prevent the foreskin from being retracted or on erection cause the glans of the penis to be restricted and pulled/curved downwards. This then can make the penis shorter, be painful during erection and sex and even repeated tear causing bleeding and pain. Pain in the penis may be misdiagnosed and a psychological problem so it is important to have a good examination to ensure the correct diagnosis.
Circumcision may remove the frenulum so circumcised men have problems less frequently. It is generally not necessary to have a circumcision to repair a short frenulum unless there is associated phimosis – narrowing of the opening of the foreskin such that it cannot be retracted easily over the glans penis.
Fortunately frenulum breve can be simply fixed in most men with just local anaesthetic in the office. We may use some numbing cream first (but most guys really don’t need it) then a small injection of local anaesthetic. The tight band is cut across ways (sometimes for very thick bands a portion may need to be excised). The glans is rotated upwards and any tightness released. Then the skin is closed using tiny dissolving stitched running lengthways along the frenulum to increase its length. Antibiotic ointment is applied, most guys don’t need a dressing.
The stitches dissolve in about 2 weeks. It is important to roll down the foreskin twice a day to prevent any sticking. It is unusual to have any significant issues. It will be slightly tender and it is best not to have sex for a month. Some guys may get a bit of swelling in the area. There is a small blood vessel in the area, therefore it is possible to get some bleeding afterwards (about one in twenty). In some guys, frenuloplasty is not curative and they may require a circumcision. Prolonged tenderness is rare (1/50) as is being unsatisfied with the cosmetic outcome.
It is surprising how many men have issues with a tight frenulum and don’t realise that there is a simple cure. If you have one currently, this procedure is available in Perth and soon Sydney and Melbourne.