Speaker 1: Now,
Speaker 2: Health Matters with Daniel Martin. Welcome into Health Matters right
Speaker 2: here on CNN 938. I've got your health on my mind.
Speaker 2: In today's edition, we need to understand thos. Ok. I
Speaker 2: know it's a term that many of you maybe have
Speaker 2: never heard of.
Speaker 2: Um I think in layperson speak, you might have heard
Speaker 2: the term tight foreskin. Yes, that's what we're talking about.
Speaker 2: It is defined as the inability to retract the foreskin,
Speaker 2: covering the head of the glands of the penis. And
Speaker 2: in some cases, topical treatments or steroid creams could help,
Speaker 2: but many men might hold back from seeking medical attention
Speaker 2: out of stigma or, or
Speaker 2: embarrassment or even just a lack of awareness as to
Speaker 2: what could be suitable or helpful in this regard of
Speaker 2: dealing with thy mosis or tight foreskin. But we're never
Speaker 2: afraid of the important health topics here on health matters.
Speaker 2: We need to talk about it. I'm so glad to
Speaker 2: have Doctor Jay Lim joining me at a Pan Asia
Speaker 2: surgery group. Joining me once again on health matters, Doctor Lim.
Speaker 2: Welcome back. Hi.
Speaker 1: Hi. Good to be back. Thanks for having me. Daniel.
Speaker 1: Has this always
Speaker 2: proven I mean, you all do forums and seminars and
Speaker 2: things all the time. Is this really one of those
Speaker 2: topics that people actually have a lot of questions about.
Speaker 1: So these are the ones where nobody wants to raise
Speaker 1: up their hand during the question and answer. They are
Speaker 1: the one that swarms you at the corner after the
Speaker 1: entire symposium and seminars is over and you can understand
Speaker 1: why because it can actually happens And if it's an
Speaker 1: embarrassing thing to actually talk about, but you know, a
Speaker 1: lot of them actually do experience some form of this
Speaker 1: and the numbers are actually quite robust. I mean, for
Speaker 1: younger
Speaker 1: populations up to 20% or 17.8% of young men actually
Speaker 1: have five mosis that actually results in painful se cost.
Speaker 1: So you can imagine. And with our total facility fertility
Speaker 1: rate now in the news, it's not gonna help. And
Speaker 1: that's some of the reason as to why a lot
Speaker 1: of my patients actually come to see me a lot
Speaker 1: of times apart from having painful
Speaker 1: the cost with their partners, then they also have trouble
Speaker 1: cleaning or hygiene becomes an issue or the older generations
Speaker 1: will come in because they keep having recurrent infections or
Speaker 1: having split skin, which is actually fairly painful because every
Speaker 1: time you can imagine going to the toilet is gonna
Speaker 1: hurt a fair bit. And
Speaker 2: this is something that can occur both in childhood and adulthood.
Speaker 2: As well as I understand is that correct?
Speaker 1: Well, the difference is actually quite significant because in childhood,
Speaker 1: generally not the inability to actually put back for skin
Speaker 1: is actually quite normal when we were born, not everybody
Speaker 1: can retract their for skin. And in many instances, mom,
Speaker 1: mommy comes to me and basically wants to have a
Speaker 1: circumcision done for their young ones. And primarily because they
Speaker 1: say they can't actually, we try to force him that's
Speaker 1: actually quite normal. And
Speaker 1: many times I actually educate mothers and tell them, look,
Speaker 1: things will happen in their own time in their own way.
Speaker 1: There is really no rush in trying to retract, retraction
Speaker 1: actually rather before initially gets fully developed by the time
Speaker 1: we hit puberty. And if you have that problem after puberty,
Speaker 1: anything wrong with hr 1314, then there actually might be
Speaker 1: a problem and a tightening is usually the first sign
Speaker 1: of them having issues. But as you correct,
Speaker 1: pointed out just now before the show, you don't actually
Speaker 1: have to have surgical treatment for this. You can in
Speaker 1: this population, especially the young ones, you can actually try
Speaker 1: topical steroids. And and the recommended regime is probably around
Speaker 1: 21 to 2 months worth of topical steroids twice a
Speaker 1: day and try to gently pull back the for skin
Speaker 1: every time you shower and it actually works around 80%
Speaker 1: of the time. The only problem is you got to
Speaker 1: keep on going and long term wise, typical
Speaker 1: topical steroids are not good because it thins the skin.
Speaker 1: And if you stop it, the pharmac has come back,
Speaker 1: which is why a lot of them actually progress to
Speaker 1: coming me to get the definitive treatment, which would be
Speaker 1: to do a circumcision.
Speaker 2: Interesting. Ok. So you mentioned before we start talking about
Speaker 2: the option like circumcision. I'm curious, you mentioned painful intercourse,
Speaker 2: hygiene issues as well. What other signs and symptoms could
Speaker 2: be occurring that's affecting somebody who has type for skin
Speaker 2: or form?
Speaker 1: Well, these are some of the more common ones and
Speaker 1: some other common in the common presenting complaints are when
Speaker 1: they have cracks on the skin.
Speaker 1: These generally happen in the older population, especially for those
Speaker 1: that may have undiagnosed, say diabetes. These patients are generally
Speaker 1: more prone to having infections. And when you get little cracks,
Speaker 1: for example, when they were showering and they actually pull
Speaker 1: back a bit more than they should,
Speaker 1: they don't heal that well. And once you have a
Speaker 1: full skin tear, what happens is when you recover the
Speaker 1: scar of the scarring actually makes the ring somewhat tighter.
Speaker 1: And with each issue in infection or beit, it gets
Speaker 1: tighter and tighter and tighter and tighter and so much
Speaker 1: so that they cannot retract at all their foreskin.
Speaker 1: And when that happens, you have accumulation of, you know,
Speaker 1: smack mamma, basically debris of the epithelial cell that comes
Speaker 1: between the penis and you shut off like any anywhere
Speaker 1: else in the body, you collect them and then basically
Speaker 1: they become a hygiene problem because you actually end up
Speaker 1: having a bit of a foul smell that comes out.
Speaker 1: And they are usually
Speaker 1: in the older population, we're talking about 40 fifties and
Speaker 1: even up to 60. And these are the kind of
Speaker 1: presentation that would usually come to me and naturally can
Speaker 1: be a bit embarrassing, but they do realize that something
Speaker 1: needs to be done about it because they're not getting
Speaker 1: any easier when it comes to cleaning themselves and keeping
Speaker 1: themselves hygienic. So what
Speaker 2: circumcision solve the problem
Speaker 1: while circumcision is probably one of the oldest way of
Speaker 1: solving the problem. This has been described in the literature
Speaker 1: as far as as the previous millennium. And essentially, it's, it's,
Speaker 1: it's commonly done as we all know, 70% of the
Speaker 1: world's circumcision is done for religious reasons. For Judaism of
Speaker 1: Islamic followers. They have to have it done as usually
Speaker 1: as a baby.
Speaker 1: But 30% of the circumcision are done for non-religious reasons.
Speaker 1: So they are quite commonly done in all parts of
Speaker 1: the world. And there are many, many, many ways of
Speaker 1: doing circumcision and how I said, literally skinning the cat.
Speaker 1: They are different techniques and dorsal slid and circum devices
Speaker 1: all come up now in the last recent days. And
Speaker 1: the whole goal is to remove that tight ring of
Speaker 1: war skin while leaving you enough normal skin to actually
Speaker 1: function normally. And that's actually one of the most important
Speaker 1: thing is doing the circumcision itself is actually easy but
Speaker 1: doing the operation, how much to leave behind is always tricky.
Speaker 2: So interesting. So if done correctly,
Speaker 2: pain during sex no longer an issue, hygiene becomes a
Speaker 2: lot easier, but it's about getting it done the right way.
Speaker 2: So I'm curious what's new in the world of circumcision?
Speaker 2: Are there new techniques, new approaches, new management?
Speaker 1: So what's new in the techniques? Why is apart from
Speaker 1: your old school using the scissors and basically doing a trip,
Speaker 1: there are many new devices that come on the market.
Speaker 1: For example, they are the Clan devices and they are
Speaker 1: like the ring
Speaker 1: devices. And in fact, unfortunately, I just saw patients who
Speaker 1: had a bit of a problem after having circumcision with
Speaker 1: some of the Clan devices and these clam devices are wonderful.
Speaker 1: They basically takes up the foreskin, that's a bit more fire.
Speaker 1: And after you twist the device, rows of metal staplers
Speaker 1: that actually comes out. And essentially what happens is that
Speaker 1: the staple itself actually seals up after resecting the excess
Speaker 1: force skin of the tight for skin,
Speaker 1: basically clamps the remaining skin together. And therefore, that's it,
Speaker 1: it can be done as recent as quickly as 30
Speaker 1: minutes and it can be done under local anesthetics. You
Speaker 1: don't have to have an operation for that. Then they
Speaker 1: are the ring devices like the sh device, the Sh
Speaker 1: Wing on the purse factory they may, they are a
Speaker 1: bit fancy. There are lots of videos that you can
Speaker 1: look up on the internet and search about it, but
Speaker 1: generally they can be a bit uncomfortable because they're quite big.
Speaker 1: And you might have to wear
Speaker 1: this little plastic ring devices on for a bit before
Speaker 1: it starts. You can start consider removing them and of
Speaker 1: course not forgetting traditional device, traditional ways of doing it
Speaker 1: is still using the blade and the scissors. And that's
Speaker 1: generally what I prefer to do because I find that
Speaker 1: I get to tailor to the needs of the patient
Speaker 1: a lot better that way. And
Speaker 2: really recovery from adult circumcision for men can be something
Speaker 2: like 8 to 10 days. That's all right.
Speaker 1: Actually, the most disturbing thing of doing a circumcision and
Speaker 1: the real need to having that 8 to 10 days
Speaker 1: is actually not the pain.
Speaker 1: The most disturbing things that I see and this is,
Speaker 1: this has been quite consistent. I've got hearing it from
Speaker 1: 11 year old boys all the way up to 50
Speaker 1: year old man
Speaker 1: is not so much the wound itself, the wound actually
Speaker 1: doesn't cause much pain. What really disturbs them is the desiccation.
Speaker 1: What do I mean is basically when you have the
Speaker 1: force when they have the corona, which is the head
Speaker 1: of the penis being exposed to air. All right. And
Speaker 1: for that, for some of them, they've never seen the
Speaker 1: sunlight for a long, long time and when they exposed
Speaker 1: to the environment, they dry up. And that's the essentially
Speaker 1: desir location
Speaker 1: that discomfort usually lasts around the 3 to 4 day period.
Speaker 1: And in the first two days of the surgery, I
Speaker 1: always tell my patient don't worry about the pain. Pain
Speaker 1: is not going to be a biggest problem. The discomfort
Speaker 1: from the desiccation is going to be. And that is
Speaker 1: why I always advise them in the recovery period. You've
Speaker 1: got to really handle a bit of a TLC with
Speaker 1: this group of patients that you advise them not to wear,
Speaker 1: they hang around at home and walk around in a
Speaker 1: loin cloth or sarong and basically keep it nice and
Speaker 1: airy so that you don't actually need to wear underwear
Speaker 1: and because the sensitivity
Speaker 1: is going to be quite irritating. So that accounts for
Speaker 1: a large part of discomfort. And usually by the fifth
Speaker 1: or sixth day they get used to it and they
Speaker 1: basically starts walking a bit normal. That's you can tell
Speaker 1: that because patients who walk into my room have a
Speaker 1: certain gate, especially early part. And if everything goes well,
Speaker 1: the gate becomes normal.
Speaker 2: Physical assessment is part of how a doctor is analyzing
Speaker 2: you in a clinic. By the way, they see how
Speaker 2: you open the door, how you walk in as well.
Speaker 2: It's important,
Speaker 1: all
Speaker 2: the visual cues are important, Dr Lim, it's been a pleasure.
Speaker 2: Thanks for opening up the discussion on this. I hope
Speaker 2: more men seek medical attention for this and not live
Speaker 2: in silence. Thanks for your time. Thank you, PSIS is
Speaker 2: what we've been discussing on today's addition type for skin.
Speaker 2: Doctor Jay Lim has been here out of Pan Asia surgery.
Speaker 2: This has been health matters
Speaker 2: before making any decisions based on the information in our program.
Speaker 2: Please consult a medical professional.