WEBVTT - How phimosis affects men

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<v Speaker 1>Now,

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<v Speaker 2>Health Matters with Daniel Martin. Welcome into Health Matters right

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<v Speaker 2>here on CNN 938. I've got your health on my mind.

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<v Speaker 2>In today's edition, we need to understand thos. Ok. I

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<v Speaker 2>know it's a term that many of you maybe have

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<v Speaker 2>never heard of.

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<v Speaker 2>Um I think in layperson speak, you might have heard

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<v Speaker 2>the term tight foreskin. Yes, that's what we're talking about.

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<v Speaker 2>It is defined as the inability to retract the foreskin,

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<v Speaker 2>covering the head of the glands of the penis. And

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<v Speaker 2>in some cases, topical treatments or steroid creams could help,

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<v Speaker 2>but many men might hold back from seeking medical attention

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<v Speaker 2>out of stigma or, or

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<v Speaker 2>embarrassment or even just a lack of awareness as to

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<v Speaker 2>what could be suitable or helpful in this regard of

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<v Speaker 2>dealing with thy mosis or tight foreskin. But we're never

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<v Speaker 2>afraid of the important health topics here on health matters.

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<v Speaker 2>We need to talk about it. I'm so glad to

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<v Speaker 2>have Doctor Jay Lim joining me at a Pan Asia

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<v Speaker 2>surgery group. Joining me once again on health matters, Doctor Lim.

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<v Speaker 2>Welcome back. Hi.

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<v Speaker 1>Hi. Good to be back. Thanks for having me. Daniel.

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<v Speaker 1>Has this always

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<v Speaker 2>proven I mean, you all do forums and seminars and

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<v Speaker 2>things all the time. Is this really one of those

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<v Speaker 2>topics that people actually have a lot of questions about.

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<v Speaker 1>So these are the ones where nobody wants to raise

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<v Speaker 1>up their hand during the question and answer. They are

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<v Speaker 1>the one that swarms you at the corner after the

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<v Speaker 1>entire symposium and seminars is over and you can understand

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<v Speaker 1>why because it can actually happens And if it's an

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<v Speaker 1>embarrassing thing to actually talk about, but you know, a

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<v Speaker 1>lot of them actually do experience some form of this

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<v Speaker 1>and the numbers are actually quite robust. I mean, for

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<v Speaker 1>younger

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<v Speaker 1>populations up to 20% or 17.8% of young men actually

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<v Speaker 1>have five mosis that actually results in painful se cost.

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<v Speaker 1>So you can imagine. And with our total facility fertility

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<v Speaker 1>rate now in the news, it's not gonna help. And

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<v Speaker 1>that's some of the reason as to why a lot

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<v Speaker 1>of my patients actually come to see me a lot

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<v Speaker 1>of times apart from having painful

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<v Speaker 1>the cost with their partners, then they also have trouble

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<v Speaker 1>cleaning or hygiene becomes an issue or the older generations

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<v Speaker 1>will come in because they keep having recurrent infections or

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<v Speaker 1>having split skin, which is actually fairly painful because every

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<v Speaker 1>time you can imagine going to the toilet is gonna

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<v Speaker 1>hurt a fair bit. And

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<v Speaker 2>this is something that can occur both in childhood and adulthood.

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<v Speaker 2>As well as I understand is that correct?

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<v Speaker 1>Well, the difference is actually quite significant because in childhood,

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<v Speaker 1>generally not the inability to actually put back for skin

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<v Speaker 1>is actually quite normal when we were born, not everybody

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<v Speaker 1>can retract their for skin. And in many instances, mom,

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<v Speaker 1>mommy comes to me and basically wants to have a

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<v Speaker 1>circumcision done for their young ones. And primarily because they

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<v Speaker 1>say they can't actually, we try to force him that's

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<v Speaker 1>actually quite normal. And

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<v Speaker 1>many times I actually educate mothers and tell them, look,

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<v Speaker 1>things will happen in their own time in their own way.

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<v Speaker 1>There is really no rush in trying to retract, retraction

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<v Speaker 1>actually rather before initially gets fully developed by the time

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<v Speaker 1>we hit puberty. And if you have that problem after puberty,

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<v Speaker 1>anything wrong with hr 1314, then there actually might be

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<v Speaker 1>a problem and a tightening is usually the first sign

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<v Speaker 1>of them having issues. But as you correct,

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<v Speaker 1>pointed out just now before the show, you don't actually

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<v Speaker 1>have to have surgical treatment for this. You can in

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<v Speaker 1>this population, especially the young ones, you can actually try

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<v Speaker 1>topical steroids. And and the recommended regime is probably around

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<v Speaker 1>21 to 2 months worth of topical steroids twice a

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<v Speaker 1>day and try to gently pull back the for skin

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<v Speaker 1>every time you shower and it actually works around 80%

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<v Speaker 1>of the time. The only problem is you got to

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<v Speaker 1>keep on going and long term wise, typical

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<v Speaker 1>topical steroids are not good because it thins the skin.

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<v Speaker 1>And if you stop it, the pharmac has come back,

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<v Speaker 1>which is why a lot of them actually progress to

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<v Speaker 1>coming me to get the definitive treatment, which would be

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<v Speaker 1>to do a circumcision.

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<v Speaker 2>Interesting. Ok. So you mentioned before we start talking about

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<v Speaker 2>the option like circumcision. I'm curious, you mentioned painful intercourse,

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<v Speaker 2>hygiene issues as well. What other signs and symptoms could

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<v Speaker 2>be occurring that's affecting somebody who has type for skin

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<v Speaker 2>or form?

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<v Speaker 1>Well, these are some of the more common ones and

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<v Speaker 1>some other common in the common presenting complaints are when

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<v Speaker 1>they have cracks on the skin.

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<v Speaker 1>These generally happen in the older population, especially for those

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<v Speaker 1>that may have undiagnosed, say diabetes. These patients are generally

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<v Speaker 1>more prone to having infections. And when you get little cracks,

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<v Speaker 1>for example, when they were showering and they actually pull

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<v Speaker 1>back a bit more than they should,

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<v Speaker 1>they don't heal that well. And once you have a

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<v Speaker 1>full skin tear, what happens is when you recover the

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<v Speaker 1>scar of the scarring actually makes the ring somewhat tighter.

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<v Speaker 1>And with each issue in infection or beit, it gets

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<v Speaker 1>tighter and tighter and tighter and tighter and so much

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<v Speaker 1>so that they cannot retract at all their foreskin.

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<v Speaker 1>And when that happens, you have accumulation of, you know,

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<v Speaker 1>smack mamma, basically debris of the epithelial cell that comes

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<v Speaker 1>between the penis and you shut off like any anywhere

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<v Speaker 1>else in the body, you collect them and then basically

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<v Speaker 1>they become a hygiene problem because you actually end up

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<v Speaker 1>having a bit of a foul smell that comes out.

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<v Speaker 1>And they are usually

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<v Speaker 1>in the older population, we're talking about 40 fifties and

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<v Speaker 1>even up to 60. And these are the kind of

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<v Speaker 1>presentation that would usually come to me and naturally can

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<v Speaker 1>be a bit embarrassing, but they do realize that something

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<v Speaker 1>needs to be done about it because they're not getting

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<v Speaker 1>any easier when it comes to cleaning themselves and keeping

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<v Speaker 1>themselves hygienic. So what

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<v Speaker 2>circumcision solve the problem

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<v Speaker 1>while circumcision is probably one of the oldest way of

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<v Speaker 1>solving the problem. This has been described in the literature

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<v Speaker 1>as far as as the previous millennium. And essentially, it's, it's,

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<v Speaker 1>it's commonly done as we all know, 70% of the

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<v Speaker 1>world's circumcision is done for religious reasons. For Judaism of

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<v Speaker 1>Islamic followers. They have to have it done as usually

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<v Speaker 1>as a baby.

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<v Speaker 1>But 30% of the circumcision are done for non-religious reasons.

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<v Speaker 1>So they are quite commonly done in all parts of

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<v Speaker 1>the world. And there are many, many, many ways of

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<v Speaker 1>doing circumcision and how I said, literally skinning the cat.

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<v Speaker 1>They are different techniques and dorsal slid and circum devices

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<v Speaker 1>all come up now in the last recent days. And

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<v Speaker 1>the whole goal is to remove that tight ring of

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<v Speaker 1>war skin while leaving you enough normal skin to actually

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<v Speaker 1>function normally. And that's actually one of the most important

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<v Speaker 1>thing is doing the circumcision itself is actually easy but

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<v Speaker 1>doing the operation, how much to leave behind is always tricky.

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<v Speaker 2>So interesting. So if done correctly,

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<v Speaker 2>pain during sex no longer an issue, hygiene becomes a

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<v Speaker 2>lot easier, but it's about getting it done the right way.

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<v Speaker 2>So I'm curious what's new in the world of circumcision?

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<v Speaker 2>Are there new techniques, new approaches, new management?

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<v Speaker 1>So what's new in the techniques? Why is apart from

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<v Speaker 1>your old school using the scissors and basically doing a trip,

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<v Speaker 1>there are many new devices that come on the market.

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<v Speaker 1>For example, they are the Clan devices and they are

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<v Speaker 1>like the ring

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<v Speaker 1>devices. And in fact, unfortunately, I just saw patients who

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<v Speaker 1>had a bit of a problem after having circumcision with

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<v Speaker 1>some of the Clan devices and these clam devices are wonderful.

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<v Speaker 1>They basically takes up the foreskin, that's a bit more fire.

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<v Speaker 1>And after you twist the device, rows of metal staplers

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<v Speaker 1>that actually comes out. And essentially what happens is that

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<v Speaker 1>the staple itself actually seals up after resecting the excess

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<v Speaker 1>force skin of the tight for skin,

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<v Speaker 1>basically clamps the remaining skin together. And therefore, that's it,

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<v Speaker 1>it can be done as recent as quickly as 30

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<v Speaker 1>minutes and it can be done under local anesthetics. You

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<v Speaker 1>don't have to have an operation for that. Then they

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<v Speaker 1>are the ring devices like the sh device, the Sh

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<v Speaker 1>Wing on the purse factory they may, they are a

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<v Speaker 1>bit fancy. There are lots of videos that you can

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<v Speaker 1>look up on the internet and search about it, but

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<v Speaker 1>generally they can be a bit uncomfortable because they're quite big.

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<v Speaker 1>And you might have to wear

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<v Speaker 1>this little plastic ring devices on for a bit before

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<v Speaker 1>it starts. You can start consider removing them and of

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<v Speaker 1>course not forgetting traditional device, traditional ways of doing it

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<v Speaker 1>is still using the blade and the scissors. And that's

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<v Speaker 1>generally what I prefer to do because I find that

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<v Speaker 1>I get to tailor to the needs of the patient

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<v Speaker 1>a lot better that way. And

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<v Speaker 2>really recovery from adult circumcision for men can be something

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<v Speaker 2>like 8 to 10 days. That's all right.

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<v Speaker 1>Actually, the most disturbing thing of doing a circumcision and

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<v Speaker 1>the real need to having that 8 to 10 days

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<v Speaker 1>is actually not the pain.

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<v Speaker 1>The most disturbing things that I see and this is,

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<v Speaker 1>this has been quite consistent. I've got hearing it from

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<v Speaker 1>11 year old boys all the way up to 50

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<v Speaker 1>year old man

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<v Speaker 1>is not so much the wound itself, the wound actually

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<v Speaker 1>doesn't cause much pain. What really disturbs them is the desiccation.

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<v Speaker 1>What do I mean is basically when you have the

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<v Speaker 1>force when they have the corona, which is the head

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<v Speaker 1>of the penis being exposed to air. All right. And

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<v Speaker 1>for that, for some of them, they've never seen the

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<v Speaker 1>sunlight for a long, long time and when they exposed

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<v Speaker 1>to the environment, they dry up. And that's the essentially

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<v Speaker 1>desir location

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<v Speaker 1>that discomfort usually lasts around the 3 to 4 day period.

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<v Speaker 1>And in the first two days of the surgery, I

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<v Speaker 1>always tell my patient don't worry about the pain. Pain

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<v Speaker 1>is not going to be a biggest problem. The discomfort

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<v Speaker 1>from the desiccation is going to be. And that is

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<v Speaker 1>why I always advise them in the recovery period. You've

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<v Speaker 1>got to really handle a bit of a TLC with

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<v Speaker 1>this group of patients that you advise them not to wear,

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<v Speaker 1>they hang around at home and walk around in a

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<v Speaker 1>loin cloth or sarong and basically keep it nice and

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<v Speaker 1>airy so that you don't actually need to wear underwear

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<v Speaker 1>and because the sensitivity

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<v Speaker 1>is going to be quite irritating. So that accounts for

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<v Speaker 1>a large part of discomfort. And usually by the fifth

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<v Speaker 1>or sixth day they get used to it and they

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<v Speaker 1>basically starts walking a bit normal. That's you can tell

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<v Speaker 1>that because patients who walk into my room have a

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<v Speaker 1>certain gate, especially early part. And if everything goes well,

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<v Speaker 1>the gate becomes normal.

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<v Speaker 2>Physical assessment is part of how a doctor is analyzing

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<v Speaker 2>you in a clinic. By the way, they see how

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<v Speaker 2>you open the door, how you walk in as well.

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<v Speaker 2>It's important,

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<v Speaker 1>all

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<v Speaker 2>the visual cues are important, Dr Lim, it's been a pleasure.

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<v Speaker 2>Thanks for opening up the discussion on this. I hope

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<v Speaker 2>more men seek medical attention for this and not live

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<v Speaker 2>in silence. Thanks for your time. Thank you, PSIS is

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<v Speaker 2>what we've been discussing on today's addition type for skin.

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<v Speaker 2>Doctor Jay Lim has been here out of Pan Asia surgery.

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<v Speaker 2>This has been health matters

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<v Speaker 2>before making any decisions based on the information in our program.

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<v Speaker 2>Please consult a medical professional.