Changes

'''Stretching''' of the tight [[foreskin ]] is a well-known and the recommended treatment of [[phimosis]] and [[paraphimosis]]. Dunn (1989) reported successful treating of phimosis by manual stretching.<ref name="dunn1989">{{REFjournal |last=Dunn |first= |init=HP |author-link= |etal=no |title=Non-surgical management of phimosis. |trans-title= |language= |journal=Aust N Z J Surg |location= |date=1989-12 |season= |volume=59 |issue=12 |article= |page=963 |pages= |url=http://www.cirp.org/library/treatment/phimosis/dunn1/ |archived= |quote= |pubmedID=2597103 |pubmedCID= |DOI=10.1111/j.1445-2197.1989.tb07640.x |accessdate=2022-09-20}}</ref> Foreskin stretchers should take care to avoid [[paraphimosis]]. === A word to intact teens === Boys are born with a [[foreskin]] that is non-retractable for reasons of [[Immunological_and_protective_function_of_the_foreskin#The_protective_and_hygienic_function_of_the_foreskin| protection]]. The inner surface is fused with the [[glans penis]] by a [[synechia]] (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider, so the foreskin gradually becomes [[Retraction of the foreskin| retractable]]. A survey carried out in [[Denmark]] found that the mean age of first foreskin retraction is 10.4 years.<ref name="Thorvaldsen">{{REFjournal |last=Thorvaldsen |init=MA |last2=Meyhoff |init2=H |title=Patologisk eller fysiologisk fimose? |trans-title=Pathological or physiological phimosis? |language=Danish |journal=Ugeskr Læger |volume=167 |issue=17 |pages=1858-1862 |url=http://www.cirp.org/library/normal/thorvaldsen1/ |quote= |pubmedID= |pubmedCID= |DOI= |date=2005 |accessdate=2023-12-09}}</ref> This means that 1/2 of boys become retractable earlier and 1/2 of boys become retractable later. a few [[intact]] boys go through puberty but find that their [[foreskin]] is still too narrow to permit retraction.  Beaugé (1997) reported that boys, who [[masturbation| masturbate]] by pulling their [[foreskin]] away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of [[masturbation]] to the more conventional method of pulling the foreskin toward the body so that the narrow orifice gets stretched.<ref name="beauge1997">{{REFjournal |last=Beaugé |init=Michel |author-link= |last2= |init2= |author2-link= |url=http://www.cirp.org/library/treatment/phimosis/beauge2/ |title=The causes of adolescent phimosis |journal=Br J Sex Med |date=1997 |volume= |issue=September/October |pages=26 |accessdate=2021-04-21}}</ref>  The traditional way of addressing this issue was to consult a [[Issues_with_American_urologists_and_the_practice_of_male_circumcision#Issues_with_care_of_adult_intact_males| urologist]] and get a [[Adolescent and adult circumcision| circumcision]], however we now understand that in the vast majority of cases, manual [[stretching]] over a few months will widen the narrow [[foreskin]] by [[tissue expansion]], make the foreskin retractable and eliminate the need for a destructive and harmful [[Adolescent and adult circumcision| circumcision]]. One should continue to stretch until one gets satisfactory [[gliding action]].

Human [[skin ]] can be stretched and normally returns to its normal size and position. But when stretching is done over a longer period of time, chances are that this stretching causes new [[skin ]] cells to grow([[mitosis]]) and [[tissue expansion]] to occur. We all know this from the [[skin ]] which covers e.g. the human stomach or the breast area.=== Topical steroid cream for stretching ===Basically, all curative or constructive stretching of human [[skin ]] should be accompanied by applicating applying a steroid cream or lotion to the [[skin]]. The steroid thins the skin and makes stretching easier. Topical steroid treatment is also useful to hasten foreskin retraction in boys with nonretractile foreskins. A number of steroid preparations have been used, including [https://www.webmd.com/drugs/2/drug-4897-722/betamethasone-valerate-topical/betamethasone-valerate-topical/details Betamethasone Valerate] 0.05% to 0.1%, triamcinolone 0.1% and mometasone furoate 0.1%.<ref name="cps2015">{{REFjournal |last=Sorokin |first=S. Todd |init=ST |author-link= |last2=Finlay |first2=JC |author2-link= |last3=Jeffries |first3=AL |author3-link= |etal=yes |title=Newborn male circumcision |journal=Paediatr Child Health |location= |date=2015-08 |volume=20 |issue=6 |pages=311-20 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578472/ |quote= |pubmedID=26435672 |pubmedCID=4578472 |DOI=10.1093/pch/20.6.311 |accessdate=2023-06-15}}</ref> It does not work without stretching. Betamethasonevalerate<ref>{{REFweb

}}</ref> is the most commonly recommended active ingredient. A cream with 0.05% betamethasone appears effective in treating [[phimosis ]] in boys,<ref>{{REFjournal

}}</ref> and often averts the need for [[Adolescent and adult circumcision| circumcision]].<ref>{{REFjournal

|author-link=Robert S. Van Howe

}}</ref> It has replaced [[circumcision ]] as the preferred treatment method for some physicians in the British National Health Service.<ref>{{REFjournal

Where the phimosis It is very mild it may be possible to stretch the [[foreskin]] by pulling it back tightly against the head [[glans]] of the erect [[penis]]. One should pull the [[foreskin ]] back until one feels non-painful tension in the tight part of the foreskin and hold that for perhaps five minutes. Do that twice two or more times a day. <u>'''Do not force retraction and do not cause yourself pain'''</u>. One should gradually see the narrow tip widen and become more retractable.

Or the fingers can be inserted into the opening and used to stretch the foreskin. If the foreskin is only slightly tight, a minor case of phimosis, then the stretching can be accomplished using fingers inserted into the opening in the foreskin and applying outward pressure.<refname="glansie">{{REFweb

* [[Retraction of the foreskinParaphimosis]]* [[Preputial sac]]* [[Preputioplasty]]