An abnormally short or sensitive frenulum of the penis can make some types of sexual activity uncomfortable or even painful. This may be a complication of circumcision or a naturally occurring event. When it is a naturally occurring event, a short frenulum can restrict normal retraction of the foreskin during erection, (a condition known as frenulum breve). The goal of treatment is to allow normal retraction of the foreskin. Circumcision may relieve this condition but is not indicated solely for treating frenulum breve. Frenuloplasty is an alternative to circumcision for frenular issues. Avoidance of circumcision and the preservation of the foreskin and its numerous protective, immunological, sensory, and sexual physiological functions is a major advantage of frenuloplasty.
The procedure usually involves the removal of the frenulum or the creation of an incision in the frenulum that is then stretched to lengthen it and stitched closed. The incision can be z-shaped, y-shaped or a single horizontal cut. Once healed, the procedure effectively elongates the frenulum, allowing normal retraction of the foreskin. Under normal circumstances the incision heals completely in around six to eight weeks, after which time normal sexual activity can resume. Other methods of treatment include horizontal stitches in the frenulum which over the course of a week cut through the tight skin, elongating it. This is generally more painful than the standard procedure, but heals faster.
Another reason for the treatment is to correct a rare complication of a frenulum breve which presents as scars on the frenulum, these scars cause pain and make normal sex very difficult and are caused by the rubbing of the frenulum whilst engaging in sexual activity. These scars only effect those with frenulum breve. The frenuloplasty can be conducted under either general or local anesthesia.
Rajan et al. (2006) surveyed patients who had received a frenuloplasty. The authors reported a high rate of satisfaction with the outcome of the procedure among the patients. Eleven percent of patients received a later circumcision. Dockray et al. (2011) reported a series of 106 patients who received a frenuloplasty. They reported that frenuloplasty is a safe alternative to circumcision for issues caused by frenulum breve. A small number of patients required a later adult circumcision.
- Dockray J, Findlayson A, Muir GH. Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring. BJU Int. May 2011; 109(10): 1546-50. PMID. Retrieved 30 December 2020.
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Frenuloplasty, The British Association of Urological Surgeons. Retrieved 24 January 2023.
- Rajan P, McNeill SA, Turner KJ. Is frenuloplasty worthwhile? A 12-year experience. Ann R Coll Surg Engl. October 2006; 88(6): 583-4. PMID. PMC. DOI. Retrieved 11 February 2023.
It is possible that frenuloplasty may avoid the need for circumcision even when a clinician felt circumcision to be indicated at presentation.