Q I tore my frenulum two weeks ago, and it has not healed completely.
I'm nervous of having sex - is it likely to tear again?
DR THOMAS STUTTAFORD
A You should be pleased that you have such a vigorous sex life and that
the worst that has come of it is a small tear in a fold of mucous membrane.
For those whose knowledge of anatomy is sketchy, the frenulum is the thin fold
of skin on the underside of the head of the penis. It can be compared to a
feeble guy rope that helps to attach the foreskin to the penis. Only
uncircumcised men have a frenulum for the others lose theirs when they are
circumcised.
The penile frenulum is similar in appearance to the frenulum under the tongue,
but it is weaker. So feeble is the penile frenulum that any rough stuff
during sex is liable to damage it. But this is no great disaster and it is
fair to say that it is a minor injury that doesn't have any serious or
long-lasting consequences.
There are only two small problems from a torn frenulum, other than it may lead
to some days of abstinence. One occasional consequence is that patients are
unnecessarily worried and this may result in their sexual confidence being
compromised. The other is that when the small blood vessel in the fold of
mucus membrane is torn it can sometimes bleed. Even when the bleeding is
heavier than usual, there is no great gush of blood but, as in younger men
the genitalia have an exceptionally good blood supply, there may be enough
to look alarming. Even a teaspoonful of blood goes a long way on a spotless
white sheet.
On rare occasions, bleeding is either persistent or brisk enough for the
frenulum to need a single small stitch. As the foreskin is frequently
retracted the torn surface may be regularly irritated and take time to heal:
two weeks is not at all unusual. If an infection delays healing the simple
remedy is to apply an antibiotic or fungicidal cream or ointment.
The healed site of the tear may be vulnerable to minor trauma for a time, but
it is not likely that you will suffer anything more from it than a spot or
two of blood. Rest assured that even men with the tenderest of foreskins,
and the most violent and passionate of lovers, make a complete recovery and
all will be well.
It is easy to understand how men, who don't understand the lack of importance
of the frenulum, could be very disconcerted if it is torn. Even so, doctors
are always aware that some men's lives are spoilt by an excessive
preoccupation about the length, breadth, straightness and general appearance
of their penises, which to a detached, dispassionate observer would seem
perfectly normal.
However, doctors accept that in some patients there may be a relatively minor
trouble that causes big concern. This excessive anxiety about a mildly
aberrant feature or slight problem is sometimes described by doctors as
non-delusional dysmorphobia.
People with non-delusional dysmorphobia are overly concerned about a minor
blemish or defect. In men this often involves either a feature of their face
or penis. They will endlessly ruminate about some small fault in their
anatomy and are forever peering at it in the mirror as they fear it destroys
their allure. In these cases it has to be borne in mind that the anxiety
could be a symptom of a depressive condition.
Dr Thomas Stuttaford, The Times doctor, spent many years working in a
genitourinary clinic
SUZI GODSON
A Ouch. In medical books a torn frenulum is described as
“uncomfortable”. Personal accounts suggest that is something of an
understatement. It is the most sensitive part of the most sensitive organ on
a man's body and when it rips, the pain is absolutely excrutiating.
It happened to one of my husband's friends while he was having sex. (It was a
one-night stand in a hotel and when they left the room it looked as if
someone had been murdered on the bed. They didn't keep in touch.) When it
happened he said he thought that had broken his penis. “There was blood
spurting everywhere and I couldn't figure out where it was coming from. It
was terrifying.”
The frenulum is the little strip of skin that attaches the foreskin to the
shaft of the penis. It has a small artery running through it so even a small
tear can produce a disproportionate amount of blood, which can be very
alarming. Although it is a problem that affects between 5 and 10 per cent of
men, when I called a few male friends to ask them what they thought about
it, their responses veered between “that is disgusting” and “I can't allow
myself to have thoughts like that in my head”.
Whether it is avoidance or denial, men don't seem to want to know. Even the
internet is reticent on the subject. Type foreskin into Google and you get
5,250,000 results. Type in frenulum and you get 13,900. Trusty old NHS
Direct online offers minimal guidance. A short paragraph advises men to rest
their frenulum (little pillow, duvet, good book?) and says that it will heal
without treatment. It also suggests the use of lubricant to stop it
happening again.
Which answers your second question. If the tear forms a scar while it is
healing, it is likely to split again because scar tissue is thicker and more
brittle and it snaps easily. Also the scar tissue may leave the frenulum
shorter than it was before and this can be uncomfortable and put more
pressure on it when you have an erection. If this happens you need to see a
doctor, either your GP or at a genitourinary clinic.
If you feel mortified at the thought of getting your chap out in front of a
doctor, you could use a digital camera and take a close-up of your injury
and show the doctor on the camera. (Don't take it to Boots for printing!) In
a small minority of cases a really dodgy scar means circumcision, but in
most cases a small operation called a frenuloplasty does the trick. A local
anaesthetic is injected just below the head of the penis. This is probably
the most painful part of the process. The frenulum is cut vertically and the
two tiny flaps of skin that this creates are sewn into the foreskin with a
couple of stitches. The operation takes about ten minutes and there may be a
little bleeding for 12 to 48 hours afterwards. The stitches dissolve in a
fortnight, and support pants are worn to keep the dressing in place. It
takes six weeks to heal properly.
Frenuloplasty or not, you should keep your pecker moisturised with E45 cream
and wash your foreskin twice daily. E45 is available from any pharmacy and
the lanolin in it will stop scar tissue developing as it heals. If you are
concerned about it tearing, extend your period of abstinence for another
couple of weeks. Oh, and www.lovehoney.co.uk/sex/lubricants are having a
lube sale at the moment.
Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible
(Penguin, £16.99)
