Now,
Health Matters with Daniel Martin. Welcome into Health Matters right here on CNN 938. I've got your health on my mind. In today's edition, we need to understand thos. Ok. I know it's a term that many of you maybe have never heard of. Um I think in layperson speak, you might have heard the term tight foreskin. Yes, that's what we're talking about. It is defined as the inability to retract the foreskin,
covering the head of the glands of the penis. And in some cases, topical treatments or steroid creams could help, but many men might hold back from seeking medical attention out of stigma or, or embarrassment or even just a lack of awareness as to what could be suitable or helpful in this regard of dealing with thy mosis or tight foreskin. But we're never afraid of the important health topics here on health matters.
We need to talk about it. I'm so glad to have Doctor Jay Lim joining me at a Pan Asia surgery group. Joining me once again on health matters, Doctor Lim. Welcome back. Hi.
Hi. Good to be back. Thanks for having me. Daniel. Has this always
proven I mean, you all do forums and seminars and things all the time. Is this really one of those topics that people actually have a lot of questions about.
So these are the ones where nobody wants to raise up their hand during the question and answer. They are the one that swarms you at the corner after the entire symposium and seminars is over and you can understand why because it can actually happens And if it's an embarrassing thing to actually talk about, but you know, a lot of them actually do experience some form of this
and the numbers are actually quite robust. I mean, for younger populations up to 20% or 17.8% of young men actually have five mosis that actually results in painful se cost. So you can imagine. And with our total facility fertility
rate now in the news, it's not gonna help. And that's some of the reason as to why a lot of my patients actually come to see me a lot of times apart from having painful the cost with their partners, then they also have trouble cleaning or hygiene becomes an issue or the older generations will come in because they keep having recurrent infections or having split skin, which is actually fairly painful because every time you can imagine going to the toilet is gonna hurt a fair bit. And
this is something that can occur both in childhood and adulthood. As well as I understand is that correct?
Well, the difference is actually quite significant because in childhood, generally not the inability to actually put back for skin is actually quite normal when we were born, not everybody can retract their for skin. And in many instances, mom, mommy comes to me and basically wants to have a circumcision done for their young ones. And primarily because they say they can't actually, we try to force him that's
actually quite normal. And many times I actually educate mothers and tell them, look, things will happen in their own time in their own way. There is really no rush in trying to retract, retraction actually rather before initially gets fully developed by the time we hit puberty. And if you have that problem after puberty, anything wrong with hr 1314, then there actually might be a problem and a tightening is usually the first sign
of them having issues. But as you correct, pointed out just now before the show, you don't actually have to have surgical treatment for this. You can in this population, especially the young ones, you can actually try topical steroids. And and the recommended regime is probably around 21 to 2 months worth of topical steroids twice a day and try to gently pull back the for skin every time you shower and it actually works around 80%
of the time. The only problem is you got to keep on going and long term wise, typical topical steroids are not good because it thins the skin. And if you stop it, the pharmac has come back, which is why a lot of them actually progress to coming me to get the definitive treatment, which would be to do a circumcision.
Interesting. Ok. So you mentioned before we start talking about the option like circumcision. I'm curious, you mentioned painful intercourse, hygiene issues as well. What other signs and symptoms could be occurring that's affecting somebody who has type for skin or form?
Well, these are some of the more common ones and some other common in the common presenting complaints are when they have cracks on the skin. These generally happen in the older population, especially for those that may have undiagnosed, say diabetes. These patients are generally more prone to having infections. And when you get little cracks, for example, when they were showering and they actually pull back a bit more than they should,
they don't heal that well. And once you have a full skin tear, what happens is when you recover the scar of the scarring actually makes the ring somewhat tighter. And with each issue in infection or beit, it gets tighter and tighter and tighter and tighter and so much so that they cannot retract at all their foreskin.
And when that happens, you have accumulation of, you know, smack mamma, basically debris of the epithelial cell that comes between the penis and you shut off like any anywhere else in the body, you collect them and then basically they become a hygiene problem because you actually end up having a bit of a foul smell that comes out. And they are usually in the older population, we're talking about 40 fifties and
even up to 60. And these are the kind of presentation that would usually come to me and naturally can be a bit embarrassing, but they do realize that something needs to be done about it because they're not getting any easier when it comes to cleaning themselves and keeping themselves hygienic. So what
circumcision solve the problem
while circumcision is probably one of the oldest way of solving the problem. This has been described in the literature as far as as the previous millennium. And essentially, it's, it's, it's commonly done as we all know, 70% of the world's circumcision is done for religious reasons. For Judaism of Islamic followers. They have to have it done as usually as a baby. But 30% of the circumcision are done for non-religious reasons. So they are quite commonly done in all parts of
the world. And there are many, many, many ways of doing circumcision and how I said, literally skinning the cat. They are different techniques and dorsal slid and circum devices all come up now in the last recent days. And the whole goal is to remove that tight ring of war skin while leaving you enough normal skin to actually
function normally. And that's actually one of the most important thing is doing the circumcision itself is actually easy but doing the operation, how much to leave behind is always tricky.
So interesting. So if done correctly, pain during sex no longer an issue, hygiene becomes a lot easier, but it's about getting it done the right way. So I'm curious what's new in the world of circumcision? Are there new techniques, new approaches, new management?
So what's new in the techniques? Why is apart from your old school using the scissors and basically doing a trip, there are many new devices that come on the market. For example, they are the Clan devices and they are like the ring devices. And in fact, unfortunately, I just saw patients who had a bit of a problem after having circumcision with some of the Clan devices and these clam devices are wonderful. They basically takes up the foreskin, that's a bit more fire.
And after you twist the device, rows of metal staplers that actually comes out. And essentially what happens is that the staple itself actually seals up after resecting the excess force skin of the tight for skin, basically clamps the remaining skin together. And therefore, that's it, it can be done as recent as quickly as 30 minutes and it can be done under local anesthetics. You
don't have to have an operation for that. Then they are the ring devices like the sh device, the Sh Wing on the purse factory they may, they are a bit fancy. There are lots of videos that you can look up on the internet and search about it, but generally they can be a bit uncomfortable because they're quite big. And you might have to wear this little plastic ring devices on for a bit before
it starts. You can start consider removing them and of course not forgetting traditional device, traditional ways of doing it is still using the blade and the scissors. And that's generally what I prefer to do because I find that I get to tailor to the needs of the patient a lot better that way. And
really recovery from adult circumcision for men can be something like 8 to 10 days. That's all right.
Actually, the most disturbing thing of doing a circumcision and the real need to having that 8 to 10 days is actually not the pain. The most disturbing things that I see and this is, this has been quite consistent. I've got hearing it from 11 year old boys all the way up to 50 year old man is not so much the wound itself, the wound actually doesn't cause much pain. What really disturbs them is the desiccation.
What do I mean is basically when you have the force when they have the corona, which is the head of the penis being exposed to air. All right. And for that, for some of them, they've never seen the sunlight for a long, long time and when they exposed to the environment, they dry up. And that's the essentially desir location that discomfort usually lasts around the 3 to 4 day period. And in the first two days of the surgery, I always tell my patient don't worry about the pain. Pain
is not going to be a biggest problem. The discomfort from the desiccation is going to be. And that is why I always advise them in the recovery period. You've got to really handle a bit of a TLC with this group of patients that you advise them not to wear, they hang around at home and walk around in a loin cloth or sarong and basically keep it nice and airy so that you don't actually need to wear underwear and because the sensitivity is going to be quite irritating. So that accounts for
a large part of discomfort. And usually by the fifth or sixth day they get used to it and they basically starts walking a bit normal. That's you can tell that because patients who walk into my room have a certain gate, especially early part. And if everything goes well, the gate becomes normal.
Physical assessment is part of how a doctor is analyzing you in a clinic. By the way, they see how you open the door, how you walk in as well. It's important,
all
the visual cues are important, Dr Lim, it's been a pleasure. Thanks for opening up the discussion on this. I hope more men seek medical attention for this and not live in silence. Thanks for your time. Thank you, PSIS is what we've been discussing on today's addition type for skin. Doctor Jay Lim has been here out of Pan Asia surgery. This has been health matters before making any decisions based on the information in our program. Please consult a medical professional.